Total Number Of Fractures Research Articles

Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women — results of the Danish Osteoporosis Prevention Study

Objectives: To study the fracture reducing potential of hormonal replacement therapy (HRT) in recent postmenopausal women in a primary preventive scenario. Methods: Prospective controlled comprehensive cohort trial: 2016 healthy women aged 45–58 years, from three to 24 months past last menstrual bleeding were recruited from a random sample of the background population. Mean age was 50.8±2.8 years, and the number of person years followed was 9335.3. There were two main study arms: a randomised arm (randomised to HRT; n=502, or not; n=504) and a non-randomised arm (on HRT; n=221, or not; n=789 by own choice). First line HRT was oral sequential oestradiol/norethisterone in women with intact uterus and oral continuous oestradiol in hysterectomised women. Results: After five years, a total of 156 fractures were sustained by 140 women. There were 51 forearm fractures in 51 women. By intention-to-treat analysis ( n=2016), overall fracture risk was borderline statistically significantly reduced (RR=0.73, 95% CI: 0.50–1.05), and forearm fracture risk was significantly reduced (RR=0.45, 95% CI: 0.22–0.90) with HRT. Restricting the analysis to women who had adhered to their initial allocation of either HRT ( n=395) or no HRT ( n=977) showed a significant reduction in both the overall fracture risk (RR=0.61, 95% CI: 0.39–0.97) and the risk of forearm fractures (RR=0.24, 95% CI: 0.09–0.69). Compliance with HRT was 65% after five years. Conclusions: It is possible to reduce the number of forearm fractures and possibly the total number of fractures in recent postmenopausal women by use of HRT as primary prevention.

Epidemiology of scaphoid fractures in Bergen, Norway.

During a three-year period, 330 fractures of the scaphoid were diagnosed, 273 of these in subjects resident in Bergen, Norway. The population at risk was 211719, and 82% of the fractures occurred in male subjects. The mean (range) age was 25 (11-79) years. The annual incidence was 4.3/10000 people. The age-specific incidence for men was highest between the ages of 20-30 years followed by a rapid decrease. The age-specific incidence for men was significantly higher than the corresponding rates for women up to about 50 years of age, whereas the rates for men and women over 60 were similar. Fractures of the scaphoid accounted for about 2% of the total number of fractures in our area, 11% of the hand fractures, and 60% of the carpal fractures.

Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam.

The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38-month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9-31.4) for women and 8.2 (95% CI, 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9-7.5%) to 59. 2% (95% CI, 24.1-86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0-0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4-32. 2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures.

Quantitative Description of Fracturability Changes in Puffed Corn Extrudates Affected by Sorption of Low Levels of Moisture

ABSTRACTFracturability is a defining textural characteristic of extruded and crunchy products such as puffed snacks and cereals. Even low levels of moisture can significantly affect deformation properties and texture due to changes in the distribution of fracture intensities. The fracturability of puffed corn extrudates produced at two specific mechanical energy (SME) levels, which greatly influenced extrudate structure and deformation behavior, was measured by compression testing before and after equilibration of samples at 33% rh. Significant changes in fracturability due to moderate moisture sorption were manifest in a reduced total number of fractures occurring during compression, an indication of plasticization that was confirmed independently by differential scanning calorimetry (DSC) studies as reductions in glass transition temperature (Tg). However, in both instances, mean fracture intensity and average compressive resistance increased after equilibration, indicating a qualitative toughening or hardening of the products, despite increased moisture and decreased Tg. These textural developments were also reflected in changes in the parameters of fitted fracture intensity distributions. Thus, the influence of processing conditions (quantified in terms of SME) on the creation of new micro and macrostructures, and the effect of low levels of moisture on these structures, can be identified by using fracturability characteristics and Tg. Furthermore, fracturability parameters can demonstrate complexity in the deformation patterns of products that thermal measurements confirm to be plasticized.

Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof.

To review the risk factors and the radiological appearance of insufficiency fractures of the sacrum and acetabular roof. Twenty patients with sacral and acetabular roof insufficiency fractures were reviewed retrospectively. There were 16 women (80%) and 4 males (age range 48-86 years, excluding an 8-year-old boy). Thirteen patients had a known tumour, and nine had received pelvic irradiation. All patients, except one who was asymptomatic, presented with low back or hip pain. In patients with a known tumor, metastases were suspected. Plain radiography (20), bone scintigrams (16), MR examinations (20), and bone densitometry (14) were performed. Nine patients also each had a CT scan. In three cases the CT scan performed 10-25 days after onset of symptoms was interpreted as normal. MR examination performed a few days after the CT scan showed in each of these three patients a fracture line with a band of edema. Scintigraphy was very sensitive, but the H-shaped pattern of sacral uptake, specific for an insufficiency fracture, was detected in only three of 16 cases. The earliest MR sign was medullary edema, seen as early as 18 days after the onset of symptoms. On spin echo (SE) T1-weighted images (T1WI), the hypointense signal of edema could mask a fracture line. On SE T2WI the fracture line could be detected within the hyperintense edema (10 of 17 patients with examinations including SE T2WI). However, in four patients a fracture of the sacrum was not seen on T2WI, these having been obtained in the axial plane. For this reason, intravenous gadolinium was injected, revealing a fracture line in 12 of 14 examinations, or fat suppression sequences were performed, revealing a fracture line in five of five cases. The total number of fractures detected was 17 [15 fractures of the sacrum (bilateral in 10 cases) and two of the acetabular roof]. At a later stage, the edema resolved and the fracture was clearly seen. The two cases of fracture of the acetabular roof were easily recognized at MRI, particularly in the sagittal plane.

HIP FRACTURES: CHANGING PATTERNS IN HOSPITAL BED USE IN NSW BETWEEN 1979 AND 1990

Osteoporotic hip fractures are associated with significant medical, social and financial costs. To examine trends in hip fracture incidence, acute hospital admissions, bed use and outcome for these fractures were reviewed for the period 1979-90. In this period, there was a 45% increase in the total number of fractures. In women aged 65 and over increases in admission rate were found between 1979 and 1986. Fracture admission rates for women stabilized after 1986, but remained approximately 7% higher than in the baseline year of 1979. In men aged 65 years and over there was no discernible change in fracture incidence. Length of stay in hospital was inversely related to the total number of proximal femoral fracture cases in each year. As a result of the large decreases in length of stay, overall bed use in 1991 was very similar to that in 1979, in spite of the large increase in fracture admissions. This reduction in length of stay may reflect, not only the pressures of greater demand, but also improved surgical and postoperative management and the effects of early intervention and rapid transit treatments.

下肢を中心とした多発性骨傷の治療経験

Fifty-four cases of multiple fractures included lower extremities were studied during the past eight years in our hospital.The total number of fractures were two hundred (lower extremities 129, upper extremities 38, and bodies 33).Fifty were open fractures. Five out of 54 cases were treated by conservative management, 35 by operative management and 9 by both. Complications were skull injuries (8 cases), thoracic injuries (2 cases), abdominal injuries (9 cases) and the others (3 cases).Those caused a long duration of hospitalization and time to healing. The end result was poor for ten of twelve patients of simultaneous ipsilateral femoral and tibial fractures; so called “floating knee fracture”.

Fractures and dislocations of the wrist and hand, then and now

Current preoccupation with the Bone and Joint Injury Committee activities for the International Federation of Societies for Surgery of the Hand gave the senior author reason to mentally review his 35 years of experience in this field. About 20 years ago , while still serving as a military hand surgeon, the senior author surveyed 3 consecutive years of experience in the management of a series of 1621 fractures and dislocations of the wrist and hand as seen in his hand clinic . Of these, fractures were seen in 123 distal phalanges (Table I) , 174 distal interphalangeal joints (Tables I and II), 66 middle phalanges (Table II), 259 proximal interphalangeal (PIP) joints (Tables II and III), 229 proximal phalanges (Table III) , 107 metacarpophalangeal (MP) joints (Tables III and IV) , 358 metacarpals (Table IV) , 66 carpometacarpal joints (Table IV), and 213 carpal bones (Table V). There were 34 fracture/dislocations or instabilities (Table V) and 79 dislocations of hand joints other than the carpals (Table VI) . The total number of fractures and dislocations of the carpal and digital joints involved 932 articular segments . From thi s study it was interesting to note that (I) more than half of the fractures and dislocations of the hand and wrist involved the jointsl; (2) the wrist and PIP joints were most commonly involved; (3) most articular fractures healed in time , even if a fragment was displaced; (4) more than 50% of the soft tissue avulsion injuries of the finger joints involved a bony fragment; and (5) a stable although limited arc of motion was present after reduction of most articular fractures and dislocations and many nonarticular fractures and dislocations. Through the ensuing 20 years, there has been no reason to alter these observations . The greatest change in incidence results from recognition of many more carpal injuries than were known at that time. 2• 3 Therefore, a current incidence survey should show more carpal bone fractures and dislocations involving all of the carpal bones or groups of bones . For instance , fractures of the trapezoid and pisiform that were not included in Dobyns ' original survey are now well-known entities . Furthermore , both may be dislocated as can any individual carpal bone. Now recognized are dislocations involving groups of carpal bones, such as those of the scaphotrapezium-trapezoid joints and of the entire thumb axis group including the trapezium , trapezoid, and scaphoid, and similar axial dislocations involving radial, central, or ulnar

COLLESʼ FRACTURE

From a study of a total of 2,132 cases of Colles' fracture from the files of the Workmen's Compensation Board, New York State Department of Labor, New York City District, the following conclusions were drawn:1. Colles' fracture constituted 60.0 per cent. of fractures of the radius.2. Incidence of Co