Majority Of Fractures Research Articles

Craniomaxillofacial trauma in the elderly

Purpose : Limited data are currently available regarding the nature of craniomaxillofacial fractures in the geriatric population. This retrospective study reviews 109 hospital records dating from 1981 to mid-1993. The goal of this study was to provide details relevant to these types of injuries. Results : Most patients were injured in motor vehicle accidents (MVA) or fall-related episodes. Females sustained 43.9% of the fractures while males sustained 56.1%. In females, falls were the most common cause of fractures, while in males MVAs caused the majority of fractures ( P < .01). Most fractures were found in the upper midface region (60.3%) and the mandible (27.5%). MVAs and falls were responsible for 82.7% of all mandibular fractures. The majority of fractures were treated nonsurgically (49.5%); however, 37.6% were treated with open reduction and internal fixation. The in-hospital mortality rate was 11.1%, and there were three postoperative complications. Conclusion : The geriatric Craniomaxillofacial trauma patient is readily treatable with both aggressive surgical measures and more conservative approaches. Elderly patients often have an underlying medical condition that may subsequently alter the patient's treatment. The findings of this study also suggest that more preventive measures and methods of minimizing mortality and morbidity need to be implemented.

Femur Fractures in Alpine Skiing: Classification and Mechanisms of Injury in 85 Cases

A retrospective review of 85 femur fractures sustained while alpine skiing in the north Lake Tahoe area was performed to determine incidence, severity, and mechanisms of injury. The incidence of femur fractures averaged 0.8 per 100,000 days of skiing and accounted for 0.4% of reported accidents in this series. Skiers sustaining femur fractures had a mean age of 30.2 years, significantly older than the skier mean age overall. Comminuted femoral shaft and trochanteric fractures that were the result of high-energy impact most often occurred in advanced skiers in firm or icy conditions. Firm ski conditions provided the most striking correlation to this type of fracture in the older age groups. In skeletally immature individuals (< 18 years of age), the femur fractures were mainly of the low-energy impact and minimally comminuted variety and were produced by an indirect, torsional, or bending mechanism. This injury typically occurred while skiing fast and resulted from catching the tip of a ski in wet or heavy snow. The majority of fractures (55%) occurred in the young adult population (18-45 years of age). Being predominantly advanced skiers, most of their fractures were the result of a high-energy, direct-impact fall or collision that led to severely comminuted femoral shaft and trochanteric fractures. Nineteen percent of those injured were > 45 years of age. More than two thirds of these individuals sustained fractures about the hip, typically a simple fracture in low-impact falls on hard or icy surfaces.

入院中に発生した骨折患者の治療経験

From 1988 to 1991, we treated 127 cases of extremity fracutres in our general hospital. Eleven of these cases occurred in our hospital and the others were transferred from other hospitals, old peoples homes or elsewhere. The average age of patients was 75.6 years. Mental disease or cerebral palsy was noted in 92 cases. The majority of fractures were caused by minor trauma such as a fall. There were 116 cases (85%) with fractures of the femoral neck.For prevention of fractures during hospitalization, more cautious medical management, and nursing control should be carried out.

Pathological analysis of bone fractures in race horses.

Pathomorphological analysis was performed on fractured bones of 470 race horses. The most common fracture site was the limb (98% of cases), and the majority of fractures were intra-articular. Focal osteochondral lesions consisting of osteochondrosis, osteonecrosis and osteosclerosis were observed frequently in fractured and non-fractured bones. In the fractured bones, the lesions frequently appeared in the vicinity of the fractured site. Under the influence of antecedent osteochondrosis from the young stage, osteosclerotic and osteonecrotic lesions may have been induced by immoderate exercise and localized ischemia. These morbid conditions may be important as local predisposing factors for bone fracture because the osteosclerotic and osteonecrotic lesions may contribute to diminished resistance to torsion and shearing forces.

不安定型骨盤骨折の治療経験

We will report on our experiences in the treatment of 35 cases of unstable pelvic ringfracture. The majority of fractures was caused by either trafficaccidents or at work. The treatments were traction in 24 cases and external fixation in 9 cases. The results were excellent and good in 90%, and poor in 3 cases, which had severe anterior pelvic fractures with sacro-iliac subluxations.

Avianca Flight No. 052 Accident: A Plastic Surgical Perspective

The crash of Avianca Airlines flight no. 052 en route to JFK Airport on January 25, 1990, in Cove Neck, New York, resulted in the death of 72 passengers. Eighty-nine victims were admitted to 13 regional hospitals. Despite difficult access to the wooded crash site, early warning and prompt response by 37 volunteer fire and rescue units resulted in organized EMS triage and rapid hospital transport. This report reviews the specific injuries incurred, highlights the team management approach to a major aviation accident in a suburban area, and studies the likelihood of accidents of this magnitude. Thirty-eight patients triaged to two level I trauma centers, North Shore University Hospital-Cornell University Medical Center and Nassau County Medical Center, form the basis of this report. Seventeen patients were male; 21 were female. The average patient age was 33 years. Eight patients were children. The average length of stay was 30.9 days (range 2 to greater than 90 days). Twenty-six patients (including nonsurvivors) (68 percent) sustained significant multiple orthopedic injuries. The majority of fractures were open grade II to III tibia-fibula fractures. Bilaterality was commonly seen. Soft-tissue coverage of open long bone fractures was required in 10 patients (11 extremities) and included 3 microvascular muscle transfers, 7 muscle transposition flaps, and 3 skin grafts. Seven patients required open reduction and fixation of complex facial fractures (two of Le Fort II to III type, four of complex naso-orbital-ethmoid type). Plastic surgical repair of complex lacerations was common. Peripheral nerve exploration was required in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid Flow in Healed Tectonic Fractures

Summary Core samples recovered during the course of the Multi-well Experiment (MWX)contained numerous mineralized vertical tectonic fractures a few millimeterswide. Permeabilities of these calcite-filled fractures were higher but of thesame order as the surrounding matrix. Increases in permeability of up toseveral-thousand-fold were obtained by treatment with permeability of up toseveral-thousand-fold were obtained by treatment with acetic acid. Acidfracturing provides a possible approach to formation stimulation. Introduction Core recovered during the course of the MWX in the Mesaverde formationexhibited numerous tectonic fractures. The majority of fractures in thepenetrated sandstones are vertical. Their abundance in the formation, particularly in the fluvial zone, is indicated by their presence in 4-in.-diameter cores. The fractures are readily identifiable because ofmineralization, which, in most cases, appears to fill the fracture space. Thepermeability of the rock matrix, however, is generally only a few microdarcies, and it is not obvious whether the mineralized fractures serve as a conduit oras a barrier to gas flow. The flow properties of mineralized fractures weretherefore included as part of a broader investigation of the petro-physicalproperties of low-permeability petro-physical properties of low-permeabilitysandstones from the MWX. Gas production from the Mesaverde formation measuredduring the course of the MWX was often one to three orders of magnitude greaterthan predicted from measurements of matrix permeabilities. It was concludedthat natural fractures contribute significantly to observed production. A modelof fracture distribution, based on MWX results and other observations, wasproposed for horizontal fluvial reservoirs. proposed for horizontal fluvialreservoirs. It was postulated that damage to natural fracture systems duringthe course of hydraulic fracturing could explain the reduction of productivityto below prefracture values. productivity to below prefracture values. Finleyand Lorenz recently reported on a detailed study of fracture distribution andtype in MWX cores. A compilation of these results shows the relative abundanceof vertical calcite-healed fractures. In some of the mineralized fractures, crystal growth from the fracture walls is only partial. Thus, in the reservoir, some fracture areas may have very high conductivity and as-yet-unknowncontinuity, which may dominate production behavior. The presence of numerousvertical mineralized fractures (VMF's), however, poses a number of questionswith respect to their contribution to reservoir behavior and response tostimulation. In this paper, we summarize an investigation of (1) flowproperties of core plugs containing VMF's relative to the neighboring matrix, (2) relative permeability behavior of VMF cores, and (3) permeabilityenhancement through refracturing and acidization of mineralized fractures. Experimental Methods Porosities, Surface Areas, and Porosities, Surface Areas, andPermeabilities. Porosities were determined Permeabilities. Porosities weredetermined gravimetrically by liquid saturation. Reported surface areas weremeasured by the single-point BET method with nitrogen as adsorbent and heliumas a carrier. Numerous variables and uncertainties arise in attempts to measurethe flow properties of low-permeability gas sands. properties oflow-permeability gas sands. Determination of in-situ stresses and satisfactorymethods of representing formation conditions in the laboratory arelong-standing problems. Permanent changes in core properties problems. Permanent changes in core properties can arise from drilling, strain-relaxationeffects, cutting of test plugs, contact with drilling filtrate, drying, andother aspects of core storage. Other considerations that enter into laboratorytest procedures are core orientation, choice of test fluid, pore pressures, transient effects, variation in pressures, transient effects, variation in meanconfining pressure in measurements for Klinkenberg plots, procedures forchanging water saturations in relative permeability measurements, and possibleleakage of fluid between the core surface and sleeve material. These factorscan contribute to obtaining results of limited significance. Thus, testing oflow-permeability gas sands involves compromises. Permeability, desorptionisotherms, and relative permeability measurements confirm that it is obviouslypreferable to use preserved cores (cores that have not been dried preservedcores (cores that have not been dried since recovery from the field) ratherthan dried cores, so that irreversible changes in clay structure and hydrationstate can be avoided. However, only a small number of the available MWX coreshad been protected from evaporation after recovery, and in many instances, itwas found that the adopted sealing procedure did not prevent drying. This, coupled with the problems of having enough preserved core samples containingfractures and then readily identifying them in their sealed state, made the useof preserved core infeasible. preserved core infeasible. JPT P. 1310

Intercondylar humeral fracture in the dog: A review of 20 cases

AbstractA review of 20 consecutive cases of intercondylar humeral fracture in dogs referred to Glasgow University Veterinary School (GUVS) was made. The majority of fractures followed apparently minimal trauma to adult animals. All cases were managed by open reduction and internal fixation. Some aspects of the authors preferred surgical technique are discussed. Long term outcome was assessed by owner questionnaire and, or, examination at GUVS. Satisfactory results were seen in 64 per cent of cases with follow up.

Stress fractures: clinical features and investigation

In the period 1972 to 1989, 92 sports men and women were treated for stress fracture. Symptoms included localized bony pain aggravated by activity. Physical examination demonstrated point tenderness and pain on loading the bone. The majority of fractures were in the lower limbs but axial skeleton and upper limb bones were also affected. Radiographs showed evidence in only 49% of fractures. Bone scanning, on the other hand, was found to be very accurate and indicative immediately. Therefore, patients with a clinical history of stress fracture and a normal radiograph should undergo a bone scan.

An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985)

A retrospective study was undertaken to assess mandibular fractures presenting over the period 1977–1985 in Dundee, Scotland. The data collected included age, sex, aetiology, month in which injury occurred, anatomical site of fracture, associated maxillofacial trauma and treatment modalities. The majority of fractures were sustained by males in the age group 20 to 29 years. Assault was the major cause of trauma followed by falls and road traffic accidents. The posterior body region was found to be the most common fracture site in the mandible. The level of such trauma has more than doubled, since a similar study was undertaken between the years 1961 to 1970.

当科における顎顔面部骨折に関する臨床的検討 Ｉ 臨床統計的観察

Clinical statistics were performed on 931 cases of maxillofacial fracture at theSecond Department of Oral Surgery, Tokyo Medical and Dental University hospital during the 23 years from 1962 to 1986 and the following conclusions were drawn.1) The number of patients with maxillofacial fractures increased every year from 1962 to 1986.2) The majority of the patients were between the ages of 10 and 20 years old, with the incidence occurring in the 20 years old group. The male/female ratio was 3. 9: 1.3) In our clinic, many patients visited in August.4) 560 of the cases visited our hospital within 1week after injury.5) The most common causes of maxillofacial fractures were traffic accident in both male and female.6) 656 of the cases were found in the mandible, 141 case in the maxilla, 62 cases in the combined mandible and maxilla.7) The majority of fractures were treated by closed reduction.

Patterns of long-bone fracture in two nubian cementeries

The analysis of traumatic fractures can provide valuable information concerning the affects of sociopolitical factors upon the health of prehistoric populations. However, such information can only be acquired by implementing a quantitative demographic approach. The present research applies such a method to longbone fractures in two medieval Christian populations excavated from ancient Nubia. Long-bones of two hundred and eighteen individuals from an early (550 to 750 A.D.) Christian cemetery and 188 individuals from a late (750 to 1450 A.D.) Christian cemetery were examined for evidence of traumatic fracture. Analysis included a determination of fracture rates, age and sex related fracture patterns, and rate of fracture per years at risk. The results of this study indicate that the majority of fractures in both cemeteries were likely caused by accidental falls. Fractures resulting from direct (possibly interpersonal) violence were found in both samples, though at a higher frequency in the early Christian population (27% versus 16%). Middle-aged adults (particularly males) of the early cemetery exhibited a higher than expected risk to fractures indicating an activity related cause of injury. In contrast, the late Christian population showed a marked increase in fractures among both children and the elderly. This distribution may reflect changes in health and residential architecture which occurred during the late Christian period.

A Long-Term Study Following Bennett’s Fracture

Twenty-five patients with documented Bennett’s Fractures were reviewed five to sixteen years following injury (Mean 9.6 years). The majority of fractures affected the dominant hand and occurred in males. Twenty-two patients were managed conservatively by plaster immobilisation. At review ten patients were asymptomatic and only two had significant symptoms. Examination revealed loss of movement in the trapeziometacarpal joint of the thumb in twenty-one cases. Five of these exhibited malrotation of the thumb. Review of the post reduction radiographs revealed separation of the fragments by 1 mm or more in sixteen patients, but symptoms at follow-up could not be correlated with accuracy of reduction. Twenty-three patients had a varus angulation of the first metacarpal base which could be correlated to the initial post-reduction displacement. There was no correlation with the restriction of movement. Although metacarpal length will only be maintained by reduction of the fracture, there was little evidence that imperfect reduction leads to significant symptomatic arthritis in the long term.

An Analysis of 2,067 cases of zygomatico-orbital fracture

A ten-year review of 2,067 cases of zygomatico-orbital fractures is presented. The age and sex distribution, anatomical types of fractures, associated maxillofacial and nonmaxillofacial trauma, and causes of the injuries are described. The majority of fractures were sustained by males and resulted from trauma inflicted in altercations. The most common associated facial fractures were mandibular; the most common associated nonmaxillofacial trauma was extremity fractures. Motorcycle accidents caused the most significant amount of associated trauma, followed by motor vehicle accidents in which no seat restraint was used by the victim. Treatment, when indicated, consisted of elevation via a temporal approach followed by fixation where necessary. The fixation methods used are presented and discussed.

Incidence of Adult Respiratory Distress Syndrome in Patients with Multiple Musculoskeletal Injuries

Records of 132 consecutive patients with multiple musculoskeletal injuries were examined for the purpose of assessing the relationship between the length of time from injury to the operative stabilization of major fractures and the incidence of adult respiratory distress syndrome (ARDS). To be included in the study patients had to have had at least two major long-bone fractures and a Hospital Trauma Index-Injury Severity Score (ISS) of 18 or higher. Early operative fracture stabilization (STAB) is defined as an operation in the first 24 hours postinjury at which the majority of fractures were stabilized without leaving a spine, pelvis, or femur fracture unstable. A stepwise logistic regression was performed on the data. The dependent variable was the presence or absence of ARDS. The independent variables were age, sex, number of injuries, days to first surgery, early operative fracture stabilization (STAB), units of blood the first week, and ISS and its major components: RESP, ABD, CV, EXT, NS, and SSQ. The two independent variables selected as significant by this procedure were STAB and ISS. For the overall data set, a delay in orthopedic surgery (greater than 24 hours) is associated with a five-fold increase in the incidence of ARDS (p less than 0.001). For the more severely injured patients (ISS greater than 40), the comparable rates are 17% with early surgery and 75% with delayed surgery (p less than 0.001). A Chi-square test for association between ARDS and STAB adjusting for changes due to ISS grouping is significant (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Fractures and fracture infillings of the Eye–Dashwa Lakes pluton, Atikokan, Ontario

Fractures in the Eye–Dashwa pluton near Atikokan, Ontario can be subdivided on the basis of their filling materials. These materials include aplite, epidote, chlorite, and gypsum–carbonate–clay, listed in order of decreasing age established from crosscutting relations. Textures indicate that infilling occurred during fracture growth. Continuous cooling of the pluton during fracturing is inferred from the expected crystallization temperatures of fillings. Fracturing began before the pluton was completely solidified (650–600 °C) and continued to temperatures below 100 °C. Many fractures appear to have been sealed by the filling materials after initiation but were subsequently sheared and filled by lower temperature materials. Apparently the majority of fractures formed during or immediately after pluton solidification and new fractures became smaller and more restricted in location as cooling progressed. Fractures and filling materials are seen as important features in assessing the possibility of movement of radionuclides in aqueous solutions away from a nuclear fuel waste repository.

FOREARM FRACTURES IN CHILDREN

A prospective survey of over 1,000 forearm fractures in children is presented. Individual fracture patterns are considered and specific complications and methods of treatment are discussed. Conservative treatment produces satisfactory results in the majority of fractures, provided that it is done with care and the patients are adequately followed up.

Children’s fracture: an experience from a zonal hospital in Nepal

A retrospective study of all paediatric fractures presenting to Bharatpur hospital in two years was undertaken. The aim of this study is to find out incidence of fractures in children attending Bharatpur Hospital, their risk factors, problem magnitude and problem areas, preventability, disease burden socio-economically, so that it will be helpful in formulations of plans and policies at national or regional level to prevent or to decrease the injury incidences among children in populations in Nepal. Details are collected from children with fractures attending Bharatpur hospital in emergency, outdoor and indoors including their variables, geographical distribution, injury mechanism and pattern, time of seeking treatment and places etc. the study period is from January 2008 to December 2009. 1216 children were treated ranging in age from 0 to 14 year. 35% of cases were from Chitwan district. Incidence of fracture increases with age. Left sided limbs had more fractures as they assume the role of protection. 67% of children's fractures occurred in males. The majority of fractures in children involve the upper limb i.e. 80%. Supracondylar fractures of humerus predominate all incidences. Mode of injury in majority of the cases was fall. Key words: Children; fractures; humerus DOI: 10.3126/jcmsn.v6i2.3611 Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 14-17

The clinical diagnosis of fat embolism

F AT embohsm can be defined as the introduction of Iiquid fat into the circmation and its transportation by the bIood stream to occIude the finer bIood vesseIs in various parts of the body. This condition is a frequent resuIt of fractures of the long bones or any other trauma which is associated with damage to adipose tissue. In the majority of cases only an insignificant grade of fat emboIism is produced by the types of injury mentioned. In a few instances, however, especiaIIy when the Iong bones of the Iower extremity are fractured, a Iarge quantity of fat may gain access to the bIood vesseIs and so interfere with the bIood suppIy of the vita1 organs that death resuIts. In most fractures of the Iong bones three factors are present which promote the deveIopment of fat emboIism. They are: (I) The destruction of fat ceIIs in the bone marrow and in the surrounding intermuscuIar tissues so that a Iarge amount of Iiquid oi1 is produced. (2) The tearing of the venuIes in the Haversian canaIs of the bones which cannot coIIapse readiIy because of the rigid waIIs in which they are encased. (3) A mechanism such as muscular spasm or manipuIation of the broken bones which increases interna pressure in the region of the fracture and so favors entrance of the fat into the veins. In the majority of fractures of the Iower extremities (80 per cent) the processes of repair are effective and prevent the entrance of any considerabIe quantity of fat into the bIood stream. For this reason, serious cases of fat emboIism are not common and when they occur it is probable that mechanica interference with the broken bones has interfered with the processes of repair.’ The way in which fat emboIism deveIops in the human subject is not known in a11 its detaiIs. Many have the conception that the fat enters the bIood as a coherent coIumn of oi1 which bIocks the puImonary artery and causes immediate asphyxia. This eventuaIity may occur in rare instances, but in the vast majority of cases it is more probabIe that the fat is forced into the veins at intervaIs as insuIts of various sorts are offered to the injured extremity. Symptoms are produced when sufficient emboIi accumuIate in the Iungs to impede the pulmonary circuIation. CIinicaIIy the serious and fatal cases of fat emboIism are separated into two types: I. Pulmonary Fat Embolism. In this type the fat is transported through the veins, the right heart, the puImonary artery, and finaIIy Iodges in the arterioIes and capiIIaries of the lungs. The flow of the puImonary circuIation is impeded and the patient shows signs of asphyxia. 2. Systemic or Cerebral Fat Embolism. In this type the fat emboIi in the puImonary capilIaries are forced by pressure in the right side of the heart into the puImonary veins, the Ieft side of the heart, and the aorta, whence they are distributed a11 over the body. Most of these emboIi reach the brain and cause definitedamage of the brain substance. Because of this the patient deveIops a coma which becomes deeper and deeper unti1 his death.

DOUBLE PULLEY TRACTION IN FRACTURES OF THE SHAFT OF THE HUMERUS

It has been the custom in the surgical service of the Beekman Street Hospital to treat the majority of fractures of the shaft of the humerus with skin traction, using the Blake board, the forearm being suspended at right angles to the arm. This method, while it has produced good functional results, has definite disadvantages. The anatomic result is often only fair and may occasionally be termed poor. It is not feasible in compound fractures. There is a constant tendency for the adhesive to slip, and in some cases the irritation of the skin constitutes a real problem. When the patient is an unusually muscular individual or the fracture is compounded, pin traction through the olecranon or the lower end of the humerus is employed. This is an operative procedure of some technical nicety, of use only in adults, and the end-result may be no better than with the use