Transverse Fracture Line Research Articles

Analysis of scaphoid fracture displacement by three-dimensional computed tomography

Scaphoid fracture displacement was studied in twenty-five patients using three-dimensional computed tomography. Fracture displacement was more readily detected and distinct in three-dimensional computed tomography images than in plain radiography. Two different types of offset of the distal fragment with respect to the proximal fragment are described on three dimensional computed tomography; volar type and dorsal type. In the volar type, the distal fragment overhung in the volar direction relative to the proximal fragment and was frequently accompanied by humpback deformity and axial rotation. In the dorsal type, the distal fragment slipped dorsal on the proximal fragment and was commonly accompanied by humpback deformity. The volar type had a transverse or vertical fracture line on both the volar and dorsal surfaces of the scaphoid, while the dorsal type had a horizontal fracture line. The volar type was frequently found when the fracture was distal, whereas the dorsal type was noted more frequently for proximally located fracture.

A Case of Pycnodysostosis

A girl aged eighteen years fell down in her school on April 30, 1968. She was diagnosed as the right tibial fracture and treated. But abnormal bone sclerosis was found radiologically and she was referred to our clinic. She has fracture history of the right tibia three times. There is no imbalance in her four limbs and trunk but she is considerably short. A large head and small face are unbalanced. There are palpable grooved concavities along the sutures and fontanelles. The row of teeth is irregular. Both index fingers are clubbed and development of the nails is poor.Roentgenographic examination revealed separation of the coronal, sagittal and lambdoid sutures. The fontanelles were open. The mandibular angle was flattened. There was no pneumatization of the frontal, maxillary or sphenoid sinuses. Configuration of the sella turcica was normal. A transverse fracture line was found in the middle of the right tibia. The uniform sclerosis of all bones was similar to marble bone disease. But the alternate dense and less dense bands seen in the osteopetrosis were not found. Laboratory examinations were normal, Chromosome analysis revealed no abnormality.A case of pycnodisostosis was presented with some discussions of the literature.

March Fracture of the Articular Surface of the Tibia and Its Relation to Osteoarthropathy

The availability of x-ray examination to the large number of individuals in the Armed Services has brought to light many minimal injuries which tend to be ignored or overlooked in a comparable civilian population, while the rigors of training have increased the incidence of such injuries. There have been many reports on march fractures of the metatarsals observed during training periods and following marches. To the metatarsal fracture have been added march fracture of the femoral neck (1), march fracture of the femur (2), of the tibia (3), of the fibula (4), and even march fracture of the pelvis (5). These fractures have been called, also, insufficiency fractures and fatigue fractures. They are not new. The march fracture of the metatarsal has long been known. It was noted among recruits in the French army, where it was called pes marches. It was frequent, also, among the German troops, especially after practising the “goose-step” of the old Imperial Army, being known as Füssgeschwulst. Insufficiency fractures of the tibia were noted in the Swedish army by Aleman (6) in 1929, about 100 cases being reported yearly in recruits. Callus formation was noted about the tibia, but the fracture line was never demonstrable. The condition was called periostitis tibiae ab exercito. Glogau (7) reported a “recruits' disease” in the German army, having observed 30 cases of indirect fractures of the shaft of the fibula in soldiers, attributed to muscle pull. All these fractures occur in civilian life, but the injury is usually too trivial to bring the patient for x-ray examination. To the accumulating literature on march fractures, the author wishes to add another type of injury. This is a linear fracture of the articular surface of the tibial plateau. As with march fractures elsewhere, there is no history of definite trauma. Pain in the knee is often first noted after a long hike. More than likely the soldier was carrying a full pack, which adds to the weight supported by the tibial plateau. It is significant that but 2 cases occurred in officers. Usually the patient reports to the dispensary some days or weeks later, with pain in the knee aggravated by walking but with no limitation in motion. The usual clinical diagnosis is synovitis, arthritis, or derangement of the knee joint. Physical examination in cases of long standing may show some limitation of motion; otherwise the findings are normal, X-ray examination demonstrates a linear transverse fracture line on the tibial plateau. There is no predilection as to site, although the internal condyle is more frequently involved than the external. A review of all the roentgenograms of knees taken at this hospital in a period of twenty-four months showed 64 cases of march fracture of this type out of a total 1,900 knees. All knee examinations were made bilaterally.