Overall Incidence Of Fractures Research Articles

INCIDENCE OF FRACTURE IN SMALL RUMINANTS: A RETROSPECTIVE STUDY

The availability of information or data regarding various affections forms a powerful tool for rendering appropriate treatment. The present study was designed to acquire data on fracture in small ruminants. This study will act as a base for policymakers to implement future projects in orthopedics for different species of animals. All the cases of bone affection at the indoor surgery clinic, Department of Veterinary Surgery, the University of Veterinary and Animal Sciences, Lahore, for four years from 2016 to 2019 were enrolled in the study. The diagnosis was based on the clinical history, signs, and clinical examination and by radiograph. Treatment as medicinal or surgical interventions was provided wherever feasible. The data concerning species, sex, age, bone, type of fracture, and cause were compiled and analyzed by using the Chi-Square test. The overall incidence of fracture was found to be 4.47%. Caprine was the most common (96.136%) subject exposed to bone fracture. The fracture incidence was highest between 7 and 12 months of age, 76.40% in goats and 67.857% in sheep. Furthermore, male subjects were more prone to fracture (69.617%) and (15.405%) than females (30.383%), and (6.527%) in goats and sheep, respectively. The metacarpal (43.953%) in goats was affected bone most commonly with fracture, followed by the metatarsal (28.319%), tibia fibula (14.159%), radius–ulna (11.504%), humerus (1.475%), femur (0.590%). While in the case of sheep, metacarpal (40.476%) was followed by metatarsal (22.619%), tibia-fibula (26.190%), and radius–ulna (10.714%). Moreover, in bovines, the overall incidence of fracture was 1.82%. Similarly, in equines, fractures were mostly of radius-ulna (16.66%) and metatarsal (23.33%). The most common site of the fractures was located in the mid-shaft of a bone. Trauma (46.018%) was the most common cause of a fracture in goats, while in sheep, it fell from a height (40.476%). It was concluded that the metacarpal bone fracture was the most common fracture in goats than other animals.

Association of preterm birth and low birthweight with bone fractures during childhood.

Preterm birth and low birthweight have been associated with increased fracture risk in children. Our aim was to analyze bone fractures during childhood in preterm, and low-birthweight newborns compared to full term and normal birthweight newborns. We conducted a nationwide register-based cohort study in Finland from 1998 to 2017 and utilized the Medical Birth Register and Care Register for Healthcare. All newborns alive 28 days after birth were included and data on all fracture visits in specialized healthcare units were gathered. Incidences per 100,000 person-years with 95% confidence intervals (CI) were calculated, and comparisons were made by incidence rate ratios (IRR). Kaplan-Meier analysis was used to analyze the timing of fractures during childhood (0-20 years). We included a total of 997,468 newborns and 95,869 fractures, the mean follow-up was 10.0 years and the overall incidence of fractures 963 per 100,000 person-years. Very preterm (<32 gestational weeks) newborns had 23% lower fracture incidence than term newborns (IRR 0.77; CI 0.70-0.85). Preterm newborns (32 to 36 gestational weeks) had similar fracture rate (IRR 0.98; CI 0.95-1.01) to term newborns. Birthweight showed linear increase in the fracture rates as newborns with birthweight less than 1000 g had the lowest fracture incidence 773 per 100,000 person-years and the highest incidence (966 per 100,000 person-years) was among newborns with birthweight 2500 g or more. Children born very preterm or with extremely low birth weight have in general a lower fracture incidence during childhood compared to children born full term and with normal birthweight. These findings possibly reflect, in addition to improvements of neonatal intensive care and early nutrition, the fact that childhood fracture incidences are more dependent on other issues than early life events.

Fracture risk and impact in boys with Duchenne muscular dystrophy: A retrospective cohort study.

Boys with Duchenne muscular dystrophy (DMD) are at increased risk of fracture. This study investigated the incidence of fractures, factors contributing to risk of first fracture with emphasis on body mass index (BMI), and the impact of fractures on functional capacity in an Australian cohort of boys with DMD. A retrospective cohort study included boys with DMD who attended a pediatric neuromuscular clinic from 2011 to 2018. Information regarding fractures, anthropometry measurements, body composition and functional assessment was collected. Factors associated with first fracture risk were analyzed with Cox-proportional hazards. Longitudinal analysis of function post-fracture was also conducted. This study included 155 boys with DMD. At least one fracture occurred in 71 (45%) boys; overall incidence of fractures was 399-per-10,000 persons-years. The first fracture was vertebral in 55%; 41% had non-vertebral fractures and 4% had both. Vertebral fractures occurred in significantly older (12.28 vs 9.28 y) boys with longer exposure to glucocorticoids (5.45 vs 2.50 y) compared to non-vertebral fractures. Boys with a history of fracture(s) had a steeper rate of functional decline (measured by Northstar Ambulatory Assessment score) than those with no recorded fractures. A high fracture burden was observed in a large Australian cohort of boys with DMD. Further investigation is required to understand preventative strategies and modifiable risk factors to reduce the incidence of fractures in DMD. The impact on fractures on ambulatory capacity should be closely monitored.

Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

Accuracy of Ottawa ankle rules for midfoot and ankle injuries.

Background:The management of ankle sprains is common practice in emergency departments. Traditionally, physicians would order radiographs for all ankle injuries although the overall incidence of fractures are less than 15% . The Ottawa Ankle Rules (OAR) have been developed to predict the necessity of radiographs in acute ankle injuries.Material and Method:This is a prospective study of consecutive patients aged 16 years or older with acute non-penetrating ankle or foot injuries and who had a radiography of ankle or foot or both.Results:499 cases were included in the study. 56.90 % of the patients were male and the median age of the patients was 30 (IQR 22,44). 22.85 % (114/499) of patients with ankle or midfoot injuries had fractures. The sensitivity, specificity, PPV and NPV of OAR for ankle and midfoot injuries were 100, 45.26, 26.00, 100 and 100, 43.71, 19.92 and 100 respectively. In this study 792 x rays were ordered from 499 patients. According to OAR 509 (%64.27) of them were indicated whereas 283 (% 35.73) were not. When the weight bearing test is sole criteria 303 ( 38.26%) x rays were obtained to find out three fractures.Conclusion:OAR should be safely used in emergency departments. Implantation of this rule prevents patients from unnecessary radiation exposure. It is a reasonable approach to reassess the patient if symptoms not resolve several days later for avoiding unnecessary x ray exposure when the weight bearing test exist as the only positive criteria. (www.actabiomedica.it)

Comparative pattern of fracture in different animals

Incidence of bone fracture is very common in both medical and veterinary profession. There is lots of fracture management techniques applied for bone fracture. A total of 6163 clinical cases were recorded from May, 2017 to April, 2018 at the Sahidul Alam Quadery Teaching Veterinary Hospital (SAQTVH), CVASU. The objectives of the study were to find out the incidence of fracture in dogs, cats, goats and cattle and parameters were also studied for fracture occurrence in breed, age, sex and different nature and causes of fractures. A total of 6163 cases were recorded out of which 829 were surgical cases and 85 were fracture cases (dog-20, cat-19, goat-36 and cattle-10). The overall incidence of fracture was recorded as1.38% for all four species (dogs, cats, goat and cattle) of animals and 10.25% for all surgical cases of animals. Goat was the most common (42.35%) species to have a fracture among four species. Local breeds were more susceptible for fracture in dog, cat and cattle but jamunapari breeds were common in goats. Overall males were more prone for fracture and age less than six months old were also more vulnerable for fracture among four species. Closed unilateral hind limb fractures were more in all cases. Among different bones, femur fracture was the most common in dogs and cats but metacarpal bone was more common in goat and tibial bone in cattle and most of the fractures were oblique in nature. Falling from height (34.11%) was the major cause of fracture comparison to other causes but according to four species, automobile accident was common cause of fracture in dogs.

Fracture incidence rates in Norwegian children, The Tromsø Study, Fit Futures.

Fractures are common injuries during childhood. Incidence rates and patterns vary, but population-based data are scarce. The aim of this study was to describe the sex-, age- and maturation-specific incidence of fractures in a representative population-based sample from a region in Norway. All fractures in the population based convenient cohort Fit Futures, comprising 961 adolescents under 18years, were recorded retrospectively from the local hospital. Details on individual's age and fracture site were recorded. A radiologist confirmed all fractures. In the period from birth to cohort scanning, the register recorded 316 fractures in 253 individuals. Fractures were more common in boys (35%) than in girls (31%). The overall annual fracture incidence was 204 per 10,000 persons-year under the age of 18 and 205 under the age of 16. The majority of fractures involved the upper extremities and the most common site of fracture was the forearm with 24% of the fractures followed by phalanges with 23% of the fractures. Fractures peaked in girls at sexual maturation stage 3. Boys had a peak in stage 2. Timing of subsequent fractures was also consistent with stages of sexual maturation. The overall incidence of fractures in childhood in Northern Norway corresponds with other reports from Scandinavia, although the proportion of fractures in girls is higher than in other studies. Both sexes seem especially vulnerable at stages related to sexual maturation. Whether this reflects bone vulnerability or other changes related to puberty requires further investigation.

Higher Incidence of Treatment-Related Toxicities in Non-Hispanic Patients Undergoing Therapy for Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia on Dana-Farber Cancer Institute ALL Consortium Protocol 05-001

Background: Risk-adapted treatment strategies have contributed to excellent outcomes in pediatric acute lymphoblastic leukemia (ALL); however, treatment-associated acute and long-term toxicities persist. Therapy-associated toxicities of note in pediatric ALL are related to a treatment backbone that relies heavily on corticosteroids (prednisone and dexamethasone) and asparaginase (ASP). The most frequently observed toxicities include, but are not limited to, serious infection, pancreatitis, thrombosis and bony morbidities including osteonecrosis (ON) and fracture. Previous studies suggest that children of racial and ethnic minorities are at higher risk for treatment-associated toxicities. We assessed the incidence of treatment-related toxicities in Hispanic and non-Hispanic patients undergoing treatment for pediatric ALL.Patients and Methods: Retrospective cohort study investigating the incidence of treatment-related toxicities including infection, allergy to ASP, pancreatitis, thrombosis and bony morbidities in Hispanic and non-Hispanic children and adolescents with newly diagnosed ALL undergoing therapy on Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 05-001. The ethnicity of each patient was designated at the time of study enrollment by research coordinators. Descriptive statistics were calculated, mean +/- SD for continuous variables and frequency and percentages for categorical variables. Toxicity rates were based on number of patients. Comparison between groups was done by Chi-square test or FisherÕs exact test and p -value < 0.05 was considered significant.Results: Between 2005 and 2011, 794 children and adolescents (ages 1 - 18 years) were enrolled on Protocol 05-001, 730 of whom were evaluable for this investigation: 150 Hispanic (18%), 580 non-Hispanic (73%). Sixty-four patients did not have ethnicity documented. There was no significant difference in disease-risk group, age or gender between the two groups. Weight was significantly higher in Hispanic patients (31.9 ± 24.4 kg in Hispanic and 26.9 ± 18.7 kg in non-Hispanic, p = 0.021). There was no significant difference in the incidence of ASP-related toxicities (allergy, pancreatitis, thrombosis) between Hispanic and non-Hispanic patients. There was no significant difference in the overall incidence of infection between the two groups (42% in Hispanic and 50% in non-Hispanic, p = 0.081). Non-Hispanic patients had significantly higher rates of opportunistic infection (Pneumocystis pneumonia) than Hispanic patients (0.7% in Hispanic and 4% in non-Hispanic, p = 0.041). A similar difference in the incidence of bacteremia between the two groups approached, but did not reach statistical significance (p = 0.052). The overall incidence of fracture in all patients was 14.5% and was significantly higher in non-Hispanic patients (6% in Hispanic and 16.7% in non-Hispanic, p < 0.001). The overall incidence of ON was 8.9% and was significantly higher in non-Hispanic patients (3.3% in Hispanic and 10.3% in non-Hispanic, p = 0.007). (Table 1)Conclusion: The incidence of opportunistic infections and bony morbidities was significantly higher in non-Hispanic patients undergoing treatment for pediatric ALL on the DFCI ALL Consortium Protocol 05-001. The risk for, and impact of therapy-related toxicities varies by a patientÕs treatment tolerance, perhaps as a function of age and gender or as a result of disease biology or genetic polymorphisms affecting drug metabolism. Additionally, non-biologic factors such as medication adherence and nutritional status may also contribute to toxicity incidence in patients undergoing treatment for pediatric ALL. Prospective studies to further investigate our findings are warranted.TableAll Patients, (N = 730)Non-Hispanic, (N = 580)Hispanic, (N = 150)p -valueOverall Infection353/730 (48.4%)290/580 (50%)63/150 (42%)0.081Bacteremia289/730 (39.6%)240/580 (41.4%)49/150 (9.3%)0.052Opportunistic Infection24/730 (3.3%)23/580 (4%)1/150 (0.7%)0.041Fracture106/730 (14.5%)97/580 (16.7%)9/150 (6%)<0.001Osteonecrosis65/730 (8.9%)60/580 (10.3%)5/150 (3.3%)0.007Thrombosis*36/730 (4.9%)26/580 (4.5%)10/150 (6.7%)0.271Pancreatitis*78/730 (10.7%)60/580 (10.3%)18/150 (12%)0.559ASP Allergy*76/730 (10.4%)57/580 (9.8%)19/150 (12.7%)0.310*ASP-related toxicity DisclosuresNo relevant conflicts of interest to declare.

Fracture Occurrence Pattern in Animals

The overall incidence of fracture was recorded as 0.95 per cent for all species of animals. The incidence of fracture in dog was 0.76 per cent. Dog was observed as the most common species presented with a fracture followed by goat and other species. The mean age was recorded to be 26.32±5.14 months. Fifteen animals (78.95%) were noticed in age group of 12–36 months. Majority of animals were non-descript (42.10%). Fracture was recorded more in male animals (77.78%). An automobile accident (42.10%) emerged to be the major cause of fracture, whereas a fall from height (31.58%) was second common cause of fracture. The femur was found to be the most common bone (47.37%) involved in the fracture, seconded by tibia-fibula (36.84%), which was followed by radius-ulna (15.79%). The radiographic examination conducted in two orthogonal views revealed that 14 (73.68%) fractures were multiple whereas, 5 (26.32%) fractures were comminuted.

Incidence of fractures requiring inpatient care

Background — The overall incidence of fractures has been addressed in several studies, but there are few data on different types of fractures that require inpatient care, even though they account for considerable healthcare costs. We determined the incidence of limb and spine fractures that required hospitalization in people aged ≥ 16 years.Patients and methods — We collected data on the diagnosis (ICD10 code), procedure code (NOMESCO), and 9 additional characteristics of patients admitted to the trauma ward of Central Finland Hospital between 2002 and 2008. Incidence rates were calculated for all fractures using data on the population at risk.Results and interpretation — During the study period, 3,277 women and 2,708 men sustained 3,750 and 3,030 fractures, respectively. The incidence of all fractures was 4.9 per 103 person years (95% CI: 4.8–5.0). The corresponding numbers for women and men were 5.3 (5.1–5.4) and 4.5 (4.3–4.6). Fractures of the hip, ankle, wrist, spine, and proximal humerus comprised two-thirds of all fractures requiring hospitalization. The proportion of ankle fractures (17%) and wrist fractures (9%) was equal to that of hip fractures (27%). Four-fifths of the hospitalized fracture patients were operated. In individuals aged < 60 years, fractures requiring hospitalization were twice as common in men as in women. In individuals ≥ 60 years of age, the opposite was true.

Implant-related Fractures in Children

To our knowledge, there are no comprehensive clinical studies of implant-related fractures in children. Our goal was to identify the incidence, skeletal location, and associated diagnoses of implant-related fractures. We reviewed our institutional database to identify cases of implant insertion (7584 cases) in patients less than 18 years old from January 1, 1995 through December 31, 2009. We calculated the overall incidence of these fractures and stratified the incidence by skeletal location and preoperative diagnoses. Fisher exact test was used to ascertain differences in fracture incidence. Risk ratios were calculated when appropriate. Significance was set at P<0.05. There were 25 cases of implant-related fractures: 22 in the femur, 2 in the tibia, and 1 in the radius. The overall incidence of implant-related fracture was 0.33%; the incidence by skeletal location was: femur, 0.89%; tibia, 0.1%; and radius, 0.14%. Associated diagnoses were cerebral palsy (9 cases), hip dysplasia (3 cases), spina bifida (2 cases), and avascular necrosis (1 case); 10 cases were associated with "other diagnoses," which included various skeletal syndromes (5 cases) and traumatic fractures (5 cases). The incidences of implant-related fractures by diagnoses were: cerebral palsy, 1.1%; hip dysplasia, 1.1%; spina bifida, 1.3%; and avascular necrosis, 0.35%. The incidence of implant-related fracture in the "other diagnoses" group was 0.16%, and the incidence of fracture in otherwise healthy patients was 0.084%. The femur was 15.2 times more likely to fracture than other bones (P<0.001). Diagnoses of cerebral palsy, hip dysplasia, spina bifida, and avascular necrosis were 6.1 times more likely to be associated with implant-related fractures than the "other diagnoses" (P<0.001). The mean time to fracture in the study was 2.8 years. The overall implant removal rate at our institution was 24.3%, and it varied significantly by patient diagnosis (P<0.01). Skeletal location and preoperative diagnosis should be factors of consideration in a surgeon's decision about removing implants to prevent implant-related fractures. Prognostic Level III.

Subtrochanteric fracture after free vascularised fibular grafting for osteonecrosis of the femoral head

The aim of this study was to determine the incidence and factors associated with subtrochanteric fracture after free vascularised fibular grafting for osteonecrosis of the femoral head, and to analyse clinical and radiological outcomes of open reduction and internal fixation. From April 1991 to May 2004, eight such fractures were managed by Rowe plate fixation. Factors examined included age, gender, side of operation, cause and preoperative and postoperative stage of osteonecrosis, and preoperative and postoperative functional assessment. The osteonecrosis was caused by alcohol consumption in six, steroid use in one and was idiopathic in one case. The overall incidence of fracture was 4.1% (13.9% in bilateral operations) and all occurred in men of mean age 36.3 years, were induced by low-energy injury and were attributed to defects created in the lateral femoral cortex for graft placement. Seven of the eight fractures (87.5%) developed within 12 weeks and all fractures healed at a mean of 16.6 weeks after internal fixation. No major complications occurred and no significant differences were found in clinical or radiological results between the fracture and non-fracture groups. Our findings indicate that strict education and mandatory protection from full weight bearing are required for 12 weeks after free vascularised fibular grafting for osteonecrosis of the femoral head.

Fracture of ProFile nickel–titanium rotary instruments: a laboratory simulation assessment

To determine the incidence of ProFile nickel-titanium rotary instrument fracture in an endodontic laboratory simulation. Three hundred and sixty dental students used 2880 ProFile nickel-titanium rotary instruments to prepare 1440 simulated root canals in 720 plastic teeth, and another 2880 ProFile nickel-titanium rotary instruments to prepare 1440 natural root canals in 720 extracted teeth. A standardized crown-down rotary instrumentation technique was used, which included measures to prevent fracture. Rotary instrument fracture was monitored during and after completion of the laboratory simulation exercises to determine the incidence of fracture. When fracture occurred, data were collected concerning the size of the instrument, the length of the instrument fragment, the location of the fragment in the canal and the curvature of the canal in which the instrument fractured. The incidence of instrument fracture was 0.41% in plastic simulated canals and 0.31% in natural root canals. The overall incidence of instrument fracture was 0.36%. Of the instruments that fractured 67% were size 25, 0.04 taper; and 81% of the fragments were located in the apical third of the canal. The mean, median and mode of the fragment lengths were all 3 mm. The low overall incidence of fracture in this study suggests that ProFile rotary instruments are safe for use by dental students in laboratory simulations and that if preventive measures are taken the incidence of instrument fracture can be minimized.

Spine fractures in falling accidents: analysis of multidetector CT findings.

The purpose of the present study was to assess incidence, fracture type, and location of spine fractures due to falls. All emergency room CT requests during a time period of 26 months were reviewed retrospectively. Patients who had fallen or jumped and were initially examined with multidetector CT (MDCT) were included. The MDCT studies were evaluated by two radiologists for trauma location, fracture type, and multiple level involvement. A total of 237 patients (184 males, 53 female, age range 16-86 years, mean age 42 years) met the inclusion criteria. A total of 203 vertebral fractures were seen in 127 patients. Burst fracture (n=78) was the most frequent type of trauma, usually located in the thoracolumbar junction (50%). Also, compression fracture (n=52) was most common in the thoracolumbar junction (39%). Posterior column fracture (n=52) was most frequently detected in the cervical spine (40%). Multiple-level spine fractures were seen in 41 (32%) of the injured patients, of which 12 (29%) had fractures at noncontinuous levels. With increasing height the overall incidence of fractures increased, and burst fractures and multiple level spine fractures became more frequent. Age had no effect on fracture type or location. Spine fractures due to falls are common. Burst fracture is the most common fracture type and most frequently seen in the thoracolumbar junction. Multiple-level fractures were seen in 32% of the cases, of which 29% were seen at noncontinuous levels. Serious spine fractures are seen in all falling height and age groups.

Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures.

To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors. Prospective cohort study, mean follow-up of 9.8 years. Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures. Five hundred twenty-seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures. The overall incidence of fracture was 7.3/1,000 person-years. Twenty-seven percent of the fractures were intra-articular; 73% were extra-articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm(2)) at the distal radius ( relative risk ( RR)=1.8, 95% confidence interval ( CI)=1.6-2.1), a history of recurrent falls ( RR=1.6, 95% CI=1.2-2.0), and having had a previous fracture since age 50 ( RR=1.3, 95% CI=1.1-1.6). Current use of oral estrogen was protective ( RR=0.6, 95% CI=0.4-0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra-articular fractures occurred more than twice as frequently in women with diabetes mellitus. This is the first large long-term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.

Trauma in the Elderly: What Proportion of Fractures are a Consequence of Osteoporosis?

Results Over 0 months 1,013 people sustained a total of 1,044 fractures. Only 128 (12%) of these were a result of major trauma; half Involved tabs on steps or stairs, a quarter frivotved road traffic accidents. Among these elderly subjects the absolute incidence of such fractures (2.6/1,000/year) was independent of their age. The overall incidence of fracture was higher In women and older subjects, and the proportion of fractures due to major trauma was correspondingly lower in these subgroups. In women 8% of all fractures foBowed major trauma, compared wtth 28% In men. In subjects over the age of 80 only 7% of aD fractures foiowed major trauma, compared to 18% in those aged 80-80 years.

Fracture incidence in England and Wales: a study based on the population of Cardiff

Despite the importance of fractures as an economic and health problem, and consequent interest in osteoporosis, few workers have previously attempted to define the overall incidence of fracture. This population based study was based in the Accident and Emergency Department of Cardiff Royal Infirmary and identified all patients presenting with fractures of any type. Over a single year a total of 6467 fractures were identified among the 306,600 people who live in the city of Cardiff. This gives an overall fracture incidence of 21.1/1000/year, (23.5/1000/year in males and 18.8/1000/year in females); a result very similar to those from similar work in the USA, Australia and Norway. This result is over twice the previous estimate of fracture incidence in the UK; the figure of 9/1000/year from the only equivalent study performed since the 1960s. In part, this discrepancy appears to reflect our more rigorous definition of the study population, and our improved ascertainment of minor fractures. We believe our result to offer the most accurate estimate of fracture incidence currently available for a UK population.

Risk factors for osteoporotic fractures in elderly men

Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic studies in men. Potential risk factors for osteoporotic fractures were assessed in 820 elderly men aged 60 years or above in the city of Dubbo (Australia). During the follow-up period of 1989-1994, the overall incidence of fractures (determined from x-ray reports) was 220 fractures per 10,000 person-years. Higher risk of fracture was associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity, and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model), femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (Cl) 1.25-1.73 per 0.12 g/cm), quadriceps strength (OR = 1.43, 95% Cl 1.18-1.73 per 10 kg), and body sway (OR = 1.25, 95% Cl 1.07-1.45 per 5.15 cm) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence of osteoporotic fracture and hence improve the survival among men. Am J Epidemiol 1996; 144:255-63.

Risk Factors for Osteoporotic Fractures in Elderly Men

Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic studies in men. Potential risk factors for osteoporotic fractures were assessed in 220 elderly men aged 60 years or above in the city of Dubbo (Australia). During the follow-up period of 1989-1994, the overall incidence of fractures (determined from x-ray reports) was 220 fractures per 10,000 person-years. Higher risk of fracture was associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity, and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model), femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (CI) 1.25-1.73 per 0.12 g/cm2), quadriceps strength (OR = 1.43, 95% CI 1.18-1.73 per 10 kg), and body sway (OR = 1.25, 95% CI 1.07-1.45 per 5.15 cm2) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence of osteoporotic fracture and hence improve the survival among men.

Fractures of allografts. Frequency, treatment, and end-results.

One of the major complications of implantation of a massive frozen cadaveric allograft in the treatment of a tumor is fracture of the allograft. To determine the incidence, risk factors, appropriate management, and results of treatment of this complication, the records of the Orthopaedic Oncology Unit of the Massachusetts General Hospital were reviewed. Forty-three patients were identified in whom a tumor had been treated with an allograft that had subsequently fractured. The over-all incidence of fracture was almost 16 per cent. When the several risk factors (age and sex of the patient, stage and site of the lesion, and so on) for the forty-three patients who had a fracture were compared with those for the rest of the series, the only correlation was the incidence of non-union at the site of the host-donor junction, which was significantly higher in the patients who had a fracture. The mean time to fracture was 28.6 months after the operation. Three types of fractures occurred: Type I (two patients), rapid dissolution of the graft; Type II (twenty-two patients), fracture of the shaft, which was observed more frequently in male patients and which occurred a mean of 27.6 months after the operation; and Type III (nineteen patients), fragmentation of the joint, which usually occurred later (a mean of 31.6 months postoperatively) and was found more frequently in female patients.(ABSTRACT TRUNCATED AT 250 WORDS)