Fracture Risk Following an Atypical Femoral Fracture

Atypical femoral fractures (AFFs) occurring during the course of osteoporosis treatment usually lead to discontinuation of anti-resorptive (AR) drugs. However, the risk of fracture after an AFF is unknown. We conducted a follow-up study of patients with AFF matched 1:3 for age and gender with patients with a peripheral major osteoporotic fracture (pMOF), in the setting of a fracture liaison service, to investigate the incidence of subsequent low-trauma fractures. Fifty-five patients with AFF (95% women, age [mean ± standard deviation] 75 ± 10 years, 89% exposed to AR drugs), followed for 6.2 ± 3.7 years, were compared to 165 matched controls with a pMOF (hip 85%) followed for 4.3 ± 2.6 years. During the follow-up, 38% of patients in the AFF group and 16% in the pMOF group received AR therapies. Continuation of AR drugs after an AFF was associated with contralateral AFF in 27% of subjects. The risks of new low-trauma, major osteoporotic and imminent (within 2 years) fractures, were similar between the two groups: incidence rate ratio (95% confidence interval [CI]) of subsequent fracture following AFF relative to pMOF, 1.30 (95% CI, 0.82–2.04), 1.28 (95% CI, 0.74–2.15), and 1.11 (95% CI, 0.54–2.15), respectively. Moreover, the risk of sustaining multiple fractures per participant was significantly increased among patients with AFF compared to pMOF (hazard ratio 1.48 [95% CI, 1.00–2.19]; p = 0.049). When taking mortality into account, the risk of subsequent fractures tended to be higher in the AFF group (sub-hazard ratio 1.42 [95% CI, 0.95–2.12]). In conclusion, patients who sustained an AFF are at high risk of subsequent fragility fractures, at least equal or even greater to the risk observed after a pMOF. However, continuation of AR drugs increases the risk of contralateral AFF. Therefore, optimal modalities for secondary fracture prevention after AFF require further evaluation. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

BackgroundWe assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.MethodsFifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity.ResultsThe patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome.ConclusionsPosterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.     

新型跟骨钢板治疗跟骨骨折

目的研究和评估切开复位治疗跟骨骨折及跟骨钢板在跟骨骨折治疗中的作用.方法为18例跟骨骨折患者行切开复位跟骨钢板内固定.结果18例中15例获随访≥12个月.所有病例均完全愈合,无1例发生钢板螺钉松动、断裂等并发症.结论AO新型钢板能提供有效的固定节段稳定性,是治疗跟骨骨折较好的内植物,为临床提供了一个良好的治疗跟骨骨折的方法.     

Smith's Fracture

Smith's fracture is not common below the age of 20 years. The left wrist is more commonly involved. The ratio between Types 1, 2 and 3 of the fracture is 4:2:1. Pronation injury is the commonest mechanism. A fall on the back of the hand and compression with shearing force are the other two mechanisms. Closed manipulation and immobilisation in plaster extending from the middle of the arm up to the knuckles with the forearm in full supination is an excellent method of treatment. We have obtained excellent, good or fair results in 86.4% of our cases.     

High Fibular Fracture in Association with Triplane Fracture: Reexamining This Unique Pediatric Fracture Pattern

A case of a high fibular fracture in association with a triplane fracture in a 12-year-old boy is presented and this unique fracture pattern examined. Whether from blunt trauma or an external rotation mechanism, it appears that trans-syndesmotic fixation is not needed to satisfactorily repair this injury. Because of the rarity of the condition, there is limited previously published information describing this particular injury, although surgeons should be aware of it and the underlying mechanism of the fracture.     

单一前外侧切口治疗伴有腓骨骨折的Pilon骨折

目的:探讨经小腿前外侧单一切口治疗伴有腓骨骨折的Pilon骨折的可行性。方法:选择收治的33例伴腓骨下端骨折的Pilon骨折患者,均需行骨折切开复位钢板内固定。采用单盲试验随机分成两组,其中A组17例予以传统前内加后外侧切口行切开复位内固定,B组16例应用单一前外侧切口行切开复位内固定治疗,记录手术时间,观察创面愈合情况,按Mazur评定标准评估疗效。结果:所有患者均未出现钢板外露、感染等严重的手术并发症。其中A组17例患者有4例术后出现局部皮肤小面积坏死,3例2周内自行愈合,1例3周后愈合;按照Mazur评分标准评估疗效,其中优11例,良5例,可1例。B组行16例患者手术有2例患者出现局部皮肤小面积坏死,1周内自行愈合;按照Mazur评分标准评估疗效,其中优10例,良4例,可2例。评价两组临床疗效及软组织恢复情况,均获良好,且应用单一前外侧切口较传统入路并未增加手术时间,统计学分析二组手术时间和疗效无差异。结论:小腿前外侧改良单一切口治疗伴有腓骨骨折的Pilon骨折,可避免局部软组织进一步损伤。     

颈椎骨折或骨折脱位的早期外科治疗

本文报告了对３６例颈椎骨折及骨折脱位的病人早期施行颈椎前路减压及稳定性重建的结果，其中３４例获得随访，２５例不完全损伤者神经功能均有不同程度的改善。对颈椎骨折及骨折脱位的治疗应以及时、彻底的减压，纠正畸形、重建颈椎的稳定性为原则，前路手术是达到手术目的的理想方式，手术的时机应在病人全身情况良好的条件下尽早进行．减压及植骨融合后若辅以颈椎前路钢板内固定，将使融合节段更加稳定。     

踝关节骨折中后踝骨折的治疗分析

目的通过对踝关节骨折伴有后踝骨折术后病人进行回顾性研究,探讨创伤类型、受伤后施行手术的时间、手术方法及不同年龄的治疗效果,总结经验,为临床工作提供参考。方法选取1999年1月～2007年12月确诊为踝关节骨折伴有后踝骨折并行切开复位内固定者65例,针对不同创伤类型采取不同手术方法,对相关资料进行统计学分析,以确定上述相关因素对术后功能恢复的影响。结果65例随访平均38个月。踝关节术后功能在伤后实施手术时间及所采用的手术方法方面差异无明显统计学意义(P=0.660,P=0.865),但在年龄和创伤类型方面差异有明显的统计学意义(P=0.018,P=0.001)。结论年龄及创伤类型是影响踝关节骨折伴后踝骨折术后关节功能的主要因素。     

骨折髋支撑关节治疗股骨颈骨折

目的介绍骨折髋支撑关节治疗股骨颈骨折的临床疗效。方法骨折髋支撑关节由骨折髋臼杯、塑料髋臼和骨折人工股骨头组成。股骨颈骨折多钉固定,髋关节内放置骨折髋支撑关节,加大股骨头包容,减少股骨头负重,使股骨头颈得以修复。结果放置骨折髋支撑关节30例(30髋),术后3周持拐行走,3～4个月逐渐恢复工作与生活。髋关节活动功能接近正常。X线片显示股骨颈骨折及股骨头愈合良好。结论骨折髋支撑关节为股骨颈骨折治疗提供了一种较理想的方法。     

Importance of Recent Fracture as Predictor of Imminent Fracture Risk

Purpose of Review

To examine the importance of recent fracture as a predictor of imminent fracture risk, review the importance of prior fracture type and timing, and identify risk factors for recurrent osteoporotic fracture.

Recent Findings

Prior fracture type and timing impact risk of subsequent fracture that is largely independent of bone mineral density. Site of re-fracture is similar to original major osteoporotic fracture. Incidence of recurrent major osteoporotic fracture is greatest within the first year. Other risk factors include those that pertain to individual characteristics. Approved osteoporosis therapies reduce risk of recurrent fracture.

Summary

Prior fracture timing, type, and individual characteristics are important components of predicting the risk of future fracture. Initiation of osteoporosis medication therapy should be started after initial fracture to reduce the risk of future fracture, though these medications typically take 6–12 months to have an effect, during which time is the highest rate of imminent re-fracture.

     

髋臼骨折

髋臼骨折的早期诊断与治疗大多数髋臼骨折为高能量撞击伤,常伴有生命危险。早期急救可包括输液、血管造影、手术内固定和牵引治疗。早期内固定无明显优点,急性损伤必须等病情稳定后再手术。在急性动力性出血的病人,开腹探查血管造影是控制出血的有利的治疗措施,血管造影对骨折后臀上A出血的诊断非常有用,出血的部位常在坐骨大切迹。开放性骨盆与髋臼骨折有很高的死亡率,需要早期诊断及固定,此种损伤也常合并长骨骨折。通常骨盆正位像仅作为了解骨折的大致程度。Judet位（髂骨斜位与闭孔斜位）和CT用以了解骨折的损伤类型及手术与否…