Leg Fractures Research Articles

Temporary external fixation for lower leg fractures for minimally invasive local damage control using Taylor spatial frame and wires

Temporary external fixation for lower leg fractures for minimally invasive local damage control using Taylor spatial frame and wires

Pseudo Tumor of the Bladder Simulating Cancer: Pseudotumoral Glandular Cystitis

Intestinal metaplasia of the bladder is a rare pathology, estimated at less than 1% of bladder pathologies. Some forms, including pseudo tumor glandular cystitis, can mimic cancer. We report a rare case of this pathology, little studied in our context, treated in Senegal and we underline the epidemiologicalclinical and anatomopathological particularities. Observation: Mr. MN, 26 years old, non-smoking, known epileptic, with psychomotor delay since birth (under Tegretil and Gardenal), presented with a hip’s trauma, not operated on in 2012, then a left leg fracture following a traffic accident in August 2019. He consulted for recurrent terminal hematuria without urination burn, dysuria and pelvic pain. The clinical examination revealed a motor deficit, a normal prostate on rectal examination. Cystoscopy showed a solid, vegetative, ulcerated tumor lesion of the bladder, of trigonal location and of the right lateral wall without invasion sign, with ureteral meatus and permeable ureters. The rest of the devices and biological assessments examination are unremarkable. Abdomino-pelvic ultrasound revealed a semi-replete bladder with a non-significant post-void residue and 39.78 cc prostatic hypertrophy without repercussions on the upper urinary system. The patient underwent a complete and deep bladder’s transurethral resection which, after histological examination, showed a pseudotumoral glandular cystitis of the bladder. Conclusion: The bladder should be taken into account in adult patients, often males, with irritative and obstructive urinary signs. It can occur without previous bladder infection. This pathology can simulate bladder cancer from which the interest of the pathological examination which makes it possible to make the formal diagnosis.

Long Scarf Related Injuries in Female Bike Riders Reported at Different Tertiary Care Hospitals Karachi

Objective: To determine the frequency of long scarf related injuries in female bike riders.
 Study Design: This is an observational study.
 Setting: This study was conducted in the emergency department of a tertiary care hospital in Karachi and aims to calculate the type of injury due to long scarf in female bike riders. It was conducted during the period of Dec, 2020 to Nov, 2021.
 Materials & Methods: Participants visiting the emergency department due to motor bike accidents and female patients were screened for long scarf related injuries. Statistical analysis was done by SPSS version 21 and descriptive statistics were used.
 Results: For one year time, we received 174 patients due to motor bike accidents and 20.6% injuries were due to long scarf in females. As 36 patients matched our inclusion criteria due to long scarf while riding a motor bike. The mean age of females was found to be 34 years (range 16-55 years). Majority of the patients had more than one site of injury and left leg fracture was the most common injury found in 44.6% of females. Out of 32 patients, 14 patients required admission urgently. 
 Conclusion: A considerable number of injuries and deaths can be prevented by simple interventions and carefulness while riding on motorcycle. We have identified this problem only in a small group of population but this issue needs to be highlighted at a higher place.

Sebészeti beavatkozások nyomai a XVIII. századi váci múmiákon

The primary purpose was to find cases where traces of contemporary surgical interventions can be observed during the examination of the remains of mummified individuals excavated from the crypt of the Dominican Church of the Whites in Vác (1) to get closer to the surgical techniques of the 18th century, (2) to gain information about the way and quality of contemporary health care. Initially, the research focused mainly on the most exceptional, spectacular cases. We looked for traces of autopsy or amputation. Meanwhile, we also found less notable but similarly valuable cases, ones we did not even think about at first.
 When studying the preserved body surface of mummies, we found traces of cuts and presumably found remnants of contemporary bandages. These may be traces of surgical interventions that have been used to treat the various wounds. Traces of long-term bed restraint were also discovered on the back body surface of some mummies. In these cases, no trace of the cubitus's possible healing was found; only an attempt was made to cover and spare the damaged skin with a bandage. In many cases, we observed bandage residues on various body regions and presumably even found residues of the sticky top layers used to secure the bandage.
 Contemporary surgeons were able to cure and repair sprains, it appears that the dislocated fractures could not be appropriately treated. Two leg fractures healed with axial dislocation and limb shortening were found.
 The two dissected cases are entirely different from each other. It is suggested that in the 18th century, there was no generally accepted method to perform an autopsy, and according to our investigations, there was no mandatory protocol for it.
 The case of Terézia Borsodi is the second documented post-mortem caesarean section in Hungary known so far. The case of Terézia Borsodi can be considered a medical historical curiosity by providing an opportunity for a detailed analysis of the contemporary caesarean section technique. The case of Vác is also unique in the world. To the best of our knowledge, nowhere else in the world the corpse of a mother, who died during a caesarean section, has survived.
 As a result of the research, we also found traces of clearly post-mortem cuts that do not suggest an autopsy to determine deaths. These were smaller, short cuts that were only large enough to remove an internal organ. In two cases, an incision was found around the heart.

The Association between Clinical Features and Measurements of Intra-Compartmental Pressure in Diagnosis of Acute Compartment Syndrome of Closed Leg Fractures

Objective: To find the clinical features of compartment syndrome and measurement of intra-compartmental pressure (ICP) in early diagnosis of the compartment syndrome of different types of closed leg bone fractures and their association with the severity of the fracture. Methodology: This prospective study included 20 patients with unilaterally closed fractures of the tibia and/or fibular fracture that presented to Shar Hospital, Sulaimaniyah City, Northern Iraq, from October 1st, 2018, to July 1st, 2020. Sociodemographic information with date and mechanism of injury, severity, side, and site of a fractured leg, and fracture's type according to Oestern and Tscherne classification of the close fracture were obtained. ICP was measured in the broken leg and normal leg at the time of admission to the emergency ward for patients using the needle-infusion technique (Whiteside's technique).Results: All patients were followed clinically by looking at features of the compartment for three days before the definitive treatment was established. We found that 8 out of 20 patients were complaining of severe, unusual pain (paresthesia) during follow-up. Acute compartment syndrome (ACS) was diagnosed in 1 (55-year-old man) out of 8 patients whose clinical features of compartment syndrome built up and with the differential pressure (∆p) of <30 mmHg. The cause of his fracture was a road traffic accident (RTA), and he underwent a fasciotomy. At the same time, the rest of the patients had no features of the compartment.Conclusions: We revealed a significant clinical correlation between the measurement of ICP and early detection and diagnosis of the post-traumatic ACS of the leg, and the measurement of ICP was valuable in the diagnosis of ACS and as a criterion for decompression. Also, this study shows a positive correlation between the type of fracture according to the Oestern and Tscherne classification and the increase in the measurement of the ICP.

Using blood glucose and lactate levels for early detection of venous congestion following a free flap procedure for lower extremity open fractures.

Gustilo-Anderson type IIIB and IIIC open fractures of the lower extremities require reconstruction of extensively injured soft tissues using a free flap; however, impaired blood flow through the flap is an early postoperative complication. To detect flap congestion due to venous thrombosis, blood glucose and lactate level measurements within the flap are taken to determine variations in these levels. We aimed to detect early-stage venous congestion and to perform salvage operations. We included 22 limbs with lower leg and foot open fractures, with fracture sites covered using a free flap. A pinprick test was used to measure blood glucose and lactate levels. Of 7 and 15 congested and non-congested limbs, respectively, the 7 congested limbs had a mean flap blood glucose level immediately before salvage surgery of 3.8 ± 2.0 (7.4-1.8) mmol/L. The ratio to blood glucose levels in healthy fingertips was 0.6 ± 0.2 (0.8-0.3). Lactate levels increased to 13.3 ± 5.1 (9.4-22.8) mmol/L. The ratio of blood glucose levels in congested flaps and in healthy fingertips was significantly lower than that in non-congested flaps and in healthy fingertips (p = 0.0016). Lactate levels were significantly higher in patients with congestion (p = 0.0013). Salvage surgery was performed, thrombi were removed, and six limb flaps were viable. Flap blood glucose and lactate levels provide a quantitative method of evaluating blood flow and detecting flow abnormalities postoperatively, and are useful in detecting early congestion due to venous thrombosis.

An abbreviated Caprini model for VTE risk assessment in trauma.

The Caprini risk assessment model (RAM) is widely used to assess risk of venous thromboembolism (VTE). However, it is cumbersome with 31 variables and poses challenges with inter-rater reliability. This study aimed to determine if an abbreviated model could perform similarly in VTE risk assessment. We performed a retrospective review of trauma patients ≥ 18years old and admitted for over 24h at a Level I trauma center from January 1, 2018, to December 31, 2018. Demographic and clinical data were analyzed to generate Caprini scores. Using a p-value cutoff of < 0.05, the individual components of the original Caprini RAM most highly associated with VTE were identified and used to calculate an abbreviated Caprini score. Logistic regression assessed odds of inpatient VTE with the original or abbreviated Caprini RAMs. Receiver operating characteristic curves and c-statistics were generated to assess discriminatory ability. The study sample included 1279 patients. Ten risk factors were included in the abbreviated model (recent major surgery, length of surgery > 2h, transfusion, restricted mobility > 72h, central venous catheter, current major surgery, age, history of VTE, hip or leg fracture, and serious trauma). Compared to the original, the abbreviated model had a similar odds ratio (1.17 vs 1.07, both p-values < 0.001), c-statistic (0.747 vs 0.753), sensitivity (0.73 vs 0.76) and specificity (0.62 vs 0.61). An abbreviated Caprini RAM performs similarly to the original, may streamline workflow and allow for automation in electronic health records, potentially enhancing its use in resource limited settings.

The Correlation between Lower Extremity Fracture and Subsequent Arterial Embolism and Thrombosis-A National Population Cohort Study.

The hazard of subsequent arterial embolism and thrombosis (SAET) in patients with lower leg fractures is not yet well demonstrated. The purpose of this study is to determine the correlation between lower leg fracture and SAET in Taiwan. A total of 134,844 patients with lower leg fractures (ICD-9-CM: 823) and chronological diagnosis as SAET (ICD-9-CM: 444.22) was matched (1:1) to the non-fracture cohort according to their propensity score (data coming from the National Health Insurance database between January 2000 to December 2012). Patients were matched by age, gender, and comorbidities. The incidence of SAET and correlation between SAET development and lower leg fracture was statistically analyzed, and subgroup analysis categorized by characteristics and comorbidities was conducted as well. The cumulative incidence of SAET was calculated by Kaplan–Meier analysis. Kaplan–Meier analysis plot showed that, by the end of the ten-year follow-up period, the cumulative incidence of SAET was significantly higher for the lower leg fracture cohort than for the non-fracture cohort (log-rank test: p < 0.001). The lower leg fracture, male, elder age (45–64-year-old; ≥65-year-old), hypertension, diabetes mellitus, and gout were significantly associated with lower extremity SAET risk compared with the matched group. There was an inseparable correlation between the lower leg fracture group and the risks of SAET; subgroup analysis by gender (male, female), age (age < 40 years, age 40–64 years, and age > 65 years) and comorbidities (hypertension, diabetes mellitus, and gout) show compatible results as well. Patients with lower leg fracture have a significantly increased risk of SAET since then two years after the fracture. The hazard of SAET was significantly higher in patients with lower leg fracture than in the non-fracture cohort, and the high incidence was found since then two years after fracture. Further studies are warranted.

Burden of Road Traffic Injuries in Tanzania: One-Year Prospective Study of Consecutive Patients in 13 Multilevel Health Facilities.

Background Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and specifically in Tanzania, where the mortality due to RTIs is nearly double the global rate. There is a paucity of RTI data in Tanzania to inform evidence-based interventions to reduce the incidence and improve care outcomes. A trauma registry was implemented at 13 health facilities of diverse administrative levels in Tanzania. In this study, we characterize the burden of RTIs seen at these health facilities. Methods This was a one-year prospective descriptive study utilizing trauma registry data from 13 multilevel health facilities in Tanzania from 1 October 2019 to 30 September 2020. We provide descriptive statistics on patient demographics; location; share of injury; nature, type, and circumstances of RTI; injury severity; disposition; and outcomes. Results Among 18,553 trauma patients seen in 13 health facilities, 7,416 (40%) had RTIs. The overall median age was 28 years (IQR 22–38 years), and 79.3% were male. Most road traffic crashes (RTC) occurred in urban settings (68.7%), involving motorcycles (68.3%). Motorcyclists (32.9%) were the most affected road users; only 37% of motorcyclists wore helmets at the time of the crash. The majority (88.2%) of patients arrived directly from the site, and 49.0% used motorized (two- or three-) wheelers to travel to the health facility. Patients were more likely to be admitted to the ward, taken to operating theatre, died at emergency unit (EU), or referred versus being discharged if they had intracranial injuries (27.8% vs. 3.7%; p < 0.0001), fracture of the lower leg (18.9% vs. 6.4%; p < 0.0001), or femur fracture (12.9% vs. 0.4%; p < 0.0001). Overall, 36.1% of patients were admitted, 10.6% transferred to other facilities, and mortality was 2%. Conclusions RTCs are the main cause of trauma in this setting, affecting mostly working-age males. These RTCs result in severe injuries requiring hospital admission or referral for almost half of the victims. Motorcyclists are the most affected group, in alignment with prior studies. These findings demonstrate the burden of RTCs as a public health concern in Tanzania and the need for targeted interventions with a focus on motorcyclists.

Возможности средств для малоконтактного многоплоскостного остеосинтеза переломов голени и методик для ее реализации

Актуальность. Переломы костей голени (ПКГ) являются одним из наиболее распространенных повреждений опорно-двигательного аппарата. Время нетрудоспособности при них в среднем достигает 5–9 месяцев, в 22–45 % случаев наблюдаются неудовлетворительные результаты. Большое значение в лечении ПКГ имеет остеосинтез биомеханически обоснованными фиксаторами. Цель работы: оптимизировать средства малоконтактного многоплоскостного остеосинтеза (ММО) для лечения ПКГ, исследовать фиксирующие возможности этих фиксаторов, разработать методики их применения. Материалы и методы. Нами усовершенствовано устройство для фиксации костных отломков (УФКО) (патент Украины № 17502) соответственно анатомическим особенностям голени. Для определения микроподвижности отломков (МПО), стабилизированных полноконтактной накостной пластиной (ПНП) и УФКО, проведены теоретические расчеты с использованием метода конечных элементов. Исследовалась величина МПО большеберцовой кости (ББК) при поперечном, косом, оскольчатом переломах. Фиксация фрагмента имитировалась проведением 3–4 винтов. При косой линии излома, оскольчатом переломе фрагменты дополнительно стабилизировались 1–2 репозиционными винтами. Для исследования напряженного деформирования трехмерного тела созданы объемные модели, отображающие наиболее существенные особенности геометрии ББК, УФКО, ПНП. Результаты. Тактика лечения ПКГ строго индивидуальная. Она разрабатывалась с учетом полученных результатов исследований МПО, напряжения элементов конструкции фиксаторов и кости. Это отразилось на формировании конструкции УФКО, послеоперационном ведении больных. При поперечной и косой линии перелома преимущественно использовалась конструкция устройства с пластиной на 8 отверстий. У большинства пациентов послеоперационная иммобилизация не производилась. Время и величина дозированной нагрузки прооперированного сегмента определялись индивидуально. При массе тела пациента до 80 килограммов дозированная нагрузка разрешалась через 1,5 месяца после операции, полная — соответственно через 2,5–3 месяца. Критерием для ее начала было наличие достаточно развитой костной мозоли. На сегодняшний день с положительным результатом прооперировано более 460 пациентов с ПКГ. Выводы. Результаты исследования величины МПО, напряжения конструкций фиксаторов, ББК подтверждают значительные функциональные возможности предложенных средств для ММО ПКГ, позволяют разработать эффективные методики их использования. Они обеспечивают хороший клинический результат при диафизарных ПКГ, улучшают качество жизни пациентов, позволяют исключить многие осложнения, характерные для традиционного остеосинтеза.

Tibial Sliding Elastic Nailing Technique in Moderate-to-Severe Osteogenesis Imperfecta: Long-term Outcomes.

Osteosynthesis of leg fractures and deformities in children with osteogenesis imperfecta should align the skeleton and overcome its fragility during growth with a telescopic effect. A high rate of mechanical complications is associated with various surgical techniques described in the literature. The objective of this work was to assess the long-term clinical and radiologic outcomes of tibial sliding elastic nailing technique. A total of 22 children with an average age of 4.7 years were operated using the technique between 2004 and 2018 unilaterally (6) or bilaterally (16), that is, 38 operations. They were listed according to the Sillence classification into type I (3), III (17), or V (2). The nails were introduced percutaneously at the distal tibial epiphysis through the medial malleolus, and in the prespinal area for the proximal tibial epiphysis. The stainless-steel rods diameter was 1.5 to 2.5 mm, adapted to the size and weight of the patient. Realignment osteotomies were performed if necessary. Radiographic data including the correction of the deformation in the frontal and sagittal planes, as well as the width at mid-shaft of the tibia in the frontal and sagittal planes, were reviewed. Gillette Functional Score, assessment of pain, mechanical and infectious complications were collected. The average follow-up was 8.6 years. In the frontal plane, preoperative average varus was 8 degrees (maximum, 40 degrees), 5 degrees (maximum, 13 degrees) postoperatively, and 6 degrees (maximum, 12 degrees) at last follow-up. Preoperative valgus was 11 degrees (maximum, 22 degrees), 9 degrees (maximum, 15 degrees) postoperatively, and 9 degrees (maximum, 14 degrees) at the last follow-up. In the sagittal plane, the mean sagittal bowling of the tibia was 32 degrees (4 to 75 degrees) preoperatively, 9 degree (1 to 26 degrees) postoperatively, and 9 degrees (1 to 24 degrees) at last follow-up. The width at mid-shaft of the tibia in the frontal plane was 1.1 cm (0.6 to 1.8 cm) preoperatively and 1.3 cm at the last follow-up (0.7 to 2.0 cm). In the sagittal plane, it was 1.25 cm (0.7 to 2.7 cm) preoperatively and 1.27 cm (0.8 to 2.8 cm) at the last follow-up. Ten patients did not require revision surgery during their follow-up. Sixteen mechanical complications occurred in 12 patients (12 fractures or deformities following a lack of overlap of the 2 rods at an average time of 4.9 years after the initial surgery, 3 prominence of the nail, 1 pseudarthrosis). No infectious complication was reported. Gillette Functional Score was 20.54/65. Fifteen patients were able to walk at last follow-up, and 18 had no painful discomfort. The tibial sliding elastic nailing technique provides satisfactory clinical and radiologic results over time. Performed in case of fracture or as a preventive treatment, it allows a good correction of angular deformations. It is particularly suitable for young patients with a narrow medullary shaft. Level IV-therapeutic study.

Post Traumatic Fat Embolism Syndrome Initially Suspected as COVID-19 Infection

Acute respiratory distress is a clinico-biological syndrome in which acute hypoxemia is the main symptom. Various etiologies may be responsible. The SARS-COV-2 infection represents the first cause to be suspected because of the current pandemic context. However, several differential diagnoses may remain undetected. We present the case of a young patient admitted for a leg fracture complicated by a fat embolism syndrome after surgery with clinical and radiological manifestations mimicking a covid 19 infection.

ICD-10 codes do not accurately reflect ankle fracture injury patterns

ObjectiveTo determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for ankle fracture injury patterns. DesignRetrospective cohort study Patients97 adult patients with fractures about the ankle (rotational ankle fracture or distal tibia fracture) from 2016 to 2020, selected by stratified random sampling. InterventionAssignment of an ICD-10 code representative of a rotational ankle fracture, pilon fracture, or unspecified fracture of the lower leg. Outcome measurementsInjury radiographs were reviewed by three authors to determine the correct code. Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes. Results59 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Aggregate agreement between all codes was fair (K = 0.26). Lateral malleolus fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72–0.99), while the lowest PPV was found for “other fractures of the lower leg” (0.05, 95% CI 0.0–0.24) and “other fracture of the fibula” (0.0, 95% CI 0.0–0.15). Generalized “other fracture” codes comprised 45% of EMR codes compared to only 6% of assigned codes (p < 0.001). EMR codes were specific but not sensitive. ConclusionThere is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for ankle fractures. Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.

Orthopedic fracture hospitalizations are revving up from E-Scooter related injuries

IntroductionDue to market expansion of electric-scooter companies, a significant rise of personal e-scooter use in dense, urban communities has been observed. No literature has specifically focused on e-scooter fracture epidemiology and risk factors associated with direct hospital admission. The aims of this study were to evaluate the 1) patterns of e-scooter related orthopaedic fractures 2) risk factors associated with direct hospital admission. Materials and methodsA retrospective review of National Electronic Injury Surveillance System (NEISS) from the United States between 2015 and 2019 was utilized to identify e-scooter fracture epidemiology. Uni/multivariable analyses were conducted to identify independent variables associated with direct hospital admission. Results5,016 patients were identified. The most common fracture location was the upper extremity (25.4%). Multiple distinct fractures diagnoses (p < 0.001), fracture of the upper arm (p = 0.01), metacarpal (p = 0.03), skull(p < 0.001), and associated internal organ injury (p = 0.02) all had a statistical increase over time. Fracture of the upper leg (OR 58.31), lower trunk (OR: 47.04), and associated internal organ damage (OR: 37.82) had the greatest association with direct hospital admission. DiscussionThis study highlights that e-scooter fracture related injuries continue to progress, and without appropriate educational and public health efforts, these injuries will continue to rise.

Individualized Determination of the Mechanical Fracture Environment After Tibial Exchange Nailing-A Simulation-Based Feasibility Study.

Non-union rate after tibial fractures remains high. Apart from largely uncontrollable biologic, injury, and patient-specific factors, the mechanical fracture environment is a key determinant of healing. Our aim was to establish a patient-specific simulation workflow to determine the mechanical fracture environment and allow for an estimation of its healing potential. In a referred patient with failed nail-osteosynthesis after tibial-shaft fracture exchange nailing was performed. Post-operative CT-scans were used to construct a three-dimensional model of the treatment situation in an image processing and computer-aided design system. Resulting forces, computed in a simulation-driven workflow based on patient monitoring and motion capturing were used to simulate the mechanical fracture environment before and after exchange nailing. Implant stresses for the initial and revision situation, as well as interfragmentary movement, resulting hydrostatic, and octahedral shear strain were calculated and compared to the clinical course. The simulation model was able to adequately predict hardware stresses in the initial situation where mechanical implant failure occurred. Furthermore, hydrostatic and octahedral shear strain of the revision situation were calculated to be within published healing boundaries—accordingly the fracture healed uneventfully. Our workflow is able to determine the mechanical environment of a fracture fixation, calculate implant stresses, interfragmentary movement, and the resulting strain. Critical mechanical boundary conditions for fracture healing can be determined in relation to individual loading parameters. Based on this individualized treatment recommendations during the early post-operative phase in lower leg fractures are possible in order to prevent implant failure and non-union development.

Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study

AimsCompare quantitative ultrasound (QUS) of calcaneus and dual energy X-ray absorptiometry (DXA) as measurements of bone density, calculate 20-year fracture incidence in patients with T1DM and T2DM and multiple complications, and compare the methods’ predictive ability. MethodsSixty-two hospital foot clinic patients with T1DM or T2DM and complications were followed (1995–2015; 610 person-years). Clinical assessments and QUS of calcaneus were performed on all at inclusion and DXA of the spine and femoral neck on a subgroup (n = 34). Fracture incidence was assessed at follow-up and compared to incidence in the general population. We evaluated the correlation between QUS of calcaneus and DXA (Pearson’s correlation test) and the association between bone density and fracture incidence at follow-up (logistic regression). ResultsBone density (QUS of calcaneus) correlated with hip bone density (DXA). Incidence of all fractures (30/62 patients; 48%) and hip fractures (6/62 patients; 10%) was higher in patients than the general population. Twelve (19%) experienced foot fracture. QUS of calcaneus predicted hip, lower leg, and foot fractures; DXA did not. ConclusionsBecause QUS of calcaneus predicted fractures in patients with diabetes and multiple complications, it seems appropriate to test QUS of calcaneus as a fracture risk predictor in primary care.

Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes.

Background:The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance.Purpose:To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance.Study Design:Cohort study; Level of evidence, 3.Methods:Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position.Results:A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes (P < .05), scored 0.09 more assists per game (P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury (P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games (P < .05), 603 fewer total minutes (P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury (P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls.Conclusion:Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.

Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

SummaryBackgroundBone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019.MethodsUsing the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs).FindingsGlobally, in 2019, there were 178 million (95% UI 162–196) new fractures (an increase of 33·4% [30·1–37·0] since 1990), 455 million (428–484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70·1% [67·5–72·5] since 1990), and 25·8 million (17·8–35·8) YLDs (an increase of 65·3% [62·4–68·0] since 1990). The age-standardised rates of fractures in 2019 were 2296·2 incident cases (2091·1–2529·5) per 100 000 population (a decrease of 9·6% [8·1–11·1] since 1990), 5614·3 prevalent cases (5286·1–5977·5) per 100 000 population (a decrease of 6·7% [5·7–7·6] since 1990), and 319·0 YLDs (220·1–442·5) per 100 000 population (a decrease of 8·4% [7·2–9·5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419·9 cases (345·8–512·0) per 100 000 population and an age-standardised rate of YLDs of 190·4 (125·0–276·9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381·5 incident cases (11 245·3–20 651·9) per 100 000 population in those aged 95 years and older.InterpretationThe global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden.FundingBill & Melinda Gates Foundation.

Lower Extremities Fractures in Alnajaf/Iraq

Purpose: To take an idea about the size of an important socioeconomically public health problem and toput solutions.Material and Methods: All the patients who sustained lower extremities fractures in one year (between 1stJan. till 31st Dec. 2018)included in this study. Data collected from the documents of Alsader medical city inAlnajaf, it included the types of fractures, ages , gender, side of fracture ,and causes. Analysis of these datawas done and the results were demonstrated in tables.Results : The total number of the patients was (2466),males (1655) and females( 811).The types of thefractures include: hip fracture 350, fracture femure 738, patellar fracture 49, leg fracture 831, ankle fracture220 and foot fracture 278. People in the 1st decade were the most 697 followed by the 3rd decade 446, 2nddecade 440 , 4th decade 287 , 7th decade 193, 5th decade 155, 6th decade 142 , and above 70 (106) patient.The most common cause of the fractures was RTA in 800 patient followed by fall 727, fall from height 594,and fall of heavy object 123 patients.Conclusion: Children and adolescent are mostly affected. People below thirty represent more than 50%of the cases. Planes from all the government administrations showed be more effective to decrease theoccurrence of such injuries by learning programs to avoid fractures in all ages , in order to decrease thesocioeconomically burden on the community.

A hospital based one year randomised controlled trial to determine optimum height of leg elevation in closed fractures of leg by invasive intra compartmental pressure monitoring

Introduction: Closed fractures of leg are common following RTA, which requires immobilization and leg elevation above heart level to reduce oedema formation and increase of compartment pressure leg elevation is routine in pre operative and post operative period to reduce intra compartment pressure whereas optimum height of elevation has not been standardized till now. Inadvertent elevation of leg decreases venous oedema whereas chances of muscle ischemia increases with prolonged and inappropriate elevation of leg. So determination of appropriate level of leg elevation above heart level by invasive method by white side’s method will help reduce muscle ischemia and discomfort to the patient. Purpose: To determine optimum height of leg elevation above heart level to reduce intra compartmental pressure.Methods: Patients at KLES Dr. Prabhakar Kore Hospital with closed fractures of leg. Anterior compartment pressure measured with Whiteside’s invasive method .Patients were randomly divided into two groups Group A: 15 cm of leg elevation and Group B:30 cm of leg elevationResults: In this study 60 patients with closed fractures of tibia were selected for intra compartmental pressure monitoring and randomised for different weights of leg elevation i.e., Group A 15 cm above heart level and Group B 30 cm above heart level. The mean age of leg fractures in our study was 40.1 years. Male subjects were 85% (mean = 53) and female were 17% (mean = 7) of total of 60 patients.The measurement of compartment pressure of normal leg was 9.4 ± 2.5 mm Hg. Pressure were measured within 5 cm of fracture site at 0 hr, 12 hr, 24 hr and 48 hr interval using Whiteside’s method. The mean values at 0 hr were 29.17 ± 5.95 mm Hg, at 12 hr interval it was 29.97 ± 5.46 mm Hg, at 24 hr interval it was 23.36 ± 3.8 mm Hg and at 48 hr interval it was in Group A. The mean values at 0 hr were 32 ± 7.8 mm Hg, at 12 hr interval it was 32.33 ±57.65 mm Hg, at 24 hr interval it was 26.48 ± 3.5 mm Hg and at 48 hr interval it was in 25.19 ± 2.56 mm Hg in Group B. In our study 5 patients out of 60 underwent fasciotomy. All patients had differential or delta pressure below 30 mm Hg before fasciotomy.Conclusion: Tibia fractures are commonest cause of compartment syndrome of leg. Whiteside’s method is a reliable and safe method of measuring intra compartment pressure when sophisticated methods are not available. Inappropriate levels of leg elevation causes muscle ischemia. Elevation of leg to 15 cm leads same clinical results as 30 cm with the advantage of avoiding muscle ischaemia. There is further need for evaluation of different heights of leg elevation and review about our practice of leg elevation.