Unsolved Fracture Research Articles

Fractures of the proximal humerus in adults.

Fractures of the proximal humerus are a common upper-extremity injury, particularly in the elderly. The literature suggests that the results of treatment of displaced fractures are generally unsatisfactory. Since Neer's articles in 1970 we found little reported in the literature on these fractures. We conclude from our review of 90 fractures that the results of treatment of displaced fractures continue to be unsatisfactory, and we believe that displaced proximal humeral fractures, along with femoral neck fractures, should be classified as unsolved fractures.

A Clinical Analysis Femur Neck Fracture in Elderly Patients

Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture in itself were noted, but we have analyzed 18 femur neck fracture of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slipdown accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. Undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with preexisting disease in the same hip joint (total hip replacement).

Prosthetic Replacement in Femoral Neck Fractures

Despite refinement of the guidelines for the use of an endoprosthesis in the management of femoral neck fractures and for the use of bone cement, no universally accepted treatment regimen currently exists. In order to collect statistically significant data about the "unsolved fracture," prospective studies from several centers must be undertaken. However, until such data are available, we submit the following conclusions about the patient with a cemented endoprosthesis for a femoral neck fracture. The early results are satisfactory--patients experience relatively little pain. Femoral fixation is enhanced--loosening occurs less frequently. The complications of prosthetic replacement are not increased by the use of cement fixation.

The Classic The Unsolved Fracture

The Classic The Unsolved Fracture

Another Approach to the Unsolved Fracture of the Hip

Another Approach to the Unsolved Fracture of the Hip

The Unsolved Fracture

The Unsolved Fracture

Trends in orthopedic surgery.

THE UNSOLVED FRACTURE IN 1934 Kellogg Speed used term the unsolved in a discussion of intracapsular fracture of neck of femur. Since that time so many changes have been made that Dr. H. R. McCarroll 1 has considered this to be a suitable time to review his experiences and to restate problem as it exists today. Internal fixation is method that is almost universally accepted as preferred procedure in early treatment. In McCarroll's series of 203 cases, aseptic necrosis occurred in 60 and nonunion in 50; hence, results leave much to be desired despite fact that fracture may be seen early, accurately reduced, and adequately pinned. Some type of reconstructive procedure is called for if a complication such as aseptic necrosis, displacement of fragments, or nonunion occurs. In this study results obtained by employing reconstructive methods were

Has a solution for the unsolved fracture been found? Problems and complications of fractures of femoral neck.

In a paper on fractures presented before the American College of Surgeons in 1934, Kellogg Speed used the title The Unsolved Fracture for discussion of the intracapsular fracture of the neck of the femur. He stated, fracture was chosen for discussion because for more than a century its treatment and the results have been a matter of controversy and inquiry among surgeons, and because, although the results obtained today show improvement, they are not at all comparable to those of other fractures. He advised treatment of this fracture by the Whitman 1 method, which consisted of gentle reduction by traction, inversion, abduction to the degree indicated, and plaster immobilization. He added, however, that a few might prefer the use of early surgery, employing selected methods, in an attempt to minimize the period of immobilization and to avoid feared complications. Speed concluded that treatment of the fracture of the femur

Surgical problems of duodenal ulcer.

Dr. Kellogg Speed once described fracture of the neck of the femur as the unsolved fracture. Duodenal ulcer may well be termed the unsolved ulcer. It has become more and more of a problem of surgical therapy and, even with the best of surgery, unforeseen complications may result. There are, I believe, four definite indications for surgical intervention. They are (1) massive gastric hemorrhage, which demands an immediate operative procedure in order to save life; (2) recurrent hemorrhages of sufficient moment to have exsanguinated the patient despite adequate and prolonged medical care; (3) gastric retention, with persistent vomiting of food retained for a considerable period—manifested on physical examination by an audible splash and on roentgenologic examination by deformity in the region of the pylorus and evidence that the stomach does not empty itself and is becoming definitely dilated; (4) pain that has not been relieved by thorough medical therapy, including

Hip injuries: Solution of the “unsolved fracture”

W ITH all due regard to our early preceptor, RoyaI Whitman, probably the first to put the treatment of fractures of the neck of the femur (the “ unsoIved fracture”) on a scientific basis, his method or any other that requires proIonged confinement in bed in a body cast or any fixed form of externa1 spIinting, is passing into obsoIescence for any but exceptional cases. Enough cases are now on record to show that interna fixation provides a much higher percentage of union, Iower incidence of stiffening of the knee joint and other complications, and Iower mortaIity rates. In addition, the patient is happier and his hospita1 stay is much shortened. For many years we have been firm advocates of the interna method of fixation in certain fractures. Since SmithPetersen, some seven years ago, first devised his three-flanged nai1 for fixation of hip fractures, there has been increasing interest on the part of a11 fracture men in this form of treatment. AIthough many types of screws, nails, and pins have been devised by different surgeons, we believe the Smith-Petersen nai1, in its present perfected form, is superior both in its mechanica efficiency and in the simpIicity with which it is appIied. Experimenta work is now being carried on with different metaIs in an endeavor to find a combination which wiI1 have the requisite tensile strength and hardness, be non-corrosive, and give the Ieast irritation to body structures.’ It is probabIe that in the near future we shaI1 have an aIIoy of vitaIIium in which vanadium is substituted for the chromium. This aIIoy wiI1 fuIf3 these requirements. When the metaIIurgists soIve the probIem, the FederaI Bureau of Standards should require the instrument WISCONSIN