Paratrochanteric fractures、pertrochanteric fractures和peritrochanteric fractures解剖释义探讨

在英文文献中，股骨转子区骨折的名词术语繁杂，称谓颇多，包括： Paratrochanteric fractures ,pertrochanteric fractures,intertrochanteric fractures.peritrochanteric fractures,infratrochanteric fractures以及subtrochanteric fractures.     

Do osteoporosis-related vertebral fractures precede hip fractures?

AIM: To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis. METHODS: In this retrospective study, 154 Saudi Arabian patients with osteoporosis-related hip fractures were analyzed for the presence of a vertebral fracture. Radiographs were retrieved from the IPAC (Image Picture Archiving and Computing) System, an imaging retrieval system, and were reviewed independently by two of the authors, Abid Hussain Gullenpet, and Mir Sadat-Ali, and later reviewed jointly. Patients admitted with proximal hip fracture who were ≥ 50 years and had undergone Thoraco-lumber imaging and a dual energy X-ray absorptiometry (DEXA) scan were included in the study. Patients with a history of significant trauma to the spine and those with a malignancy or connective tissue disorder were excluded from the analysis. RESULTS: Out of 154 patients with hip fractures, 78 had a fracture of the femoral neck while 76 had an intertrochanteric hip fracture. Of the 111 patients who were finally included in the study, after applying inclusion and exclusion criteria, 76 patients with an average age of 67.28 ± 12 years had no fractures of the spine. Thirty-five patients with an average age of 76.9 ± 14.5 years (31.53%) had a total of 49 vertebral fractures. Patients with vertebral fractures were significantly older than those without fractures P < 0.001. Overall, 24.7% of these patients had an asymptomatic vertebral fracture. Further analysis showed that 11 males (18.96%) and 24 females (45.28%) had suffered a previous asymptomatic vertebral fracture. Interestingly, all women who participated in this study and who presented with a femoral neck fracture had experienced a prior asymptomatic vertebral fracture. CONCLUSION: We recommend that all elderly patients who go to the radiology department for a chest X-ray also have a DEXA scan and a lateral thoracic spine radiograph.     

A cetabular fractures

AMEDLINE searchwas conducted to identify studies published between January 1999 and November 2003 on OR IF and THA for tream ent of ace tabu lar fractu res. The search strategy identified 37 articles on OR1F and 56 articles on THA. From those identified, …     

Operative strategy of acetabular fractures

Anatomic structure of acetabular fractures are complex and operative exposure and fixation are extremely difficult. For those obviously displaced acetabular fractures, close reduction is doomed to cause deformative healing. Open reduction with internal fixation (ORIF) not only results in anatomic reduction, but also brings complications. No matter which method will be adopted, traumatic arthritis or avascular necrosis of femoral head might occur. In order to treat acetabular fractures more effectively, orthopedic surgeons should be required to fully master the acetabular anatomy,biomechanics, classification and the necessary knowledge for complication prevention.     

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

Introduction

The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus^® Radius 2.5 mm by Medartis^®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients.

Patients

Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist.

Results

There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group.

Conclusion

We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures.     

Intraarticular calcaneal fractures Operative management

AMEDLINEsearchwasperformedtoidentifystudiespublishedinthelast3years(January2000toSeptember2002)ontheoperativemanagementofin-traarticularfracturesofthecalcaneal.Fromalistof55articlesidentifiedfromthesearchstrategy,sevenreportedontheoperativemanagementofthesefractures,andthesearticlesareincludedinthisappraisal.Allwereretrospectivecaseseries.Weexcludedstudiesevaluatingthenonoperativemanagementofthesefractures,theuseofbonegraftingtechniques,orprimarysubtalararthrodesis.StudiesStudy1HuangPJ,H…     

Can radiographs of hip fractures predict subsequent hip fractures? A shape modelling analysis

IntroductionThe geometrical shape of the proximal femur has previously been shown to predict primary hip fractures. Hip fractures are routinely diagnosed on plain radiographs of the pelvis, and these have both hips viewable. We have investigated if statistical shape modelling of the uninvolved hip on plain radiographs, at the time of the first hip fracture episode, could predict a subsequent ‘second fracture’ on that (uninvolved) side.Materials and methods60 radiographs taken at the time of the index hip fracture were blinded and separated into two arms; patients sustaining one hip fracture only (n = 30), and those who went on to sustain a second fracture (n = 30), over the three-year follow-up period. Two separate shape models were used for these groups and compared using t-tests or Mann–Whitney U-tests, along with Cohen's d to measure the effect size of each measure.ResultsWe found no statistically significant difference in the shape of the femur between the first fracture and second fracture group (p > 0.05) and no results reached a “medium” effect size (Cohen's d <0.5).ConclusionsShape modelling is feasible and can be applied in the routine clinical setting. However, we were unable to elucidate any predictive value in this relatively small sample. A reliable radiograph-based method of identifying patients at risk of second fracture would be of value in planning prevention, service provision, and cost analysis. Further work is required and a study with more patients might exclude the type 2 error in our work.     

Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989–2008

Summary

The incidence of the most common fracture types in Iceland is reported based on individual data from the Reykjavik Study 1967–2008. Time trend is reported for the major osteoporotic fractures (MOS) 1989–2008.

Introduction

This study aims to assess the incidence of all fractures in Iceland, with emphasis on the rate of hip fractures, and compare the incidence with other populations as well as examine the secular changes.

Methods

Individuals from the prospective population-based cohort Reykjavik Study were examined between 1967 and 2008 (follow-up 26.5 years), which consisted of 9,116 men and 9,756 women born in 1907–1935, with age range 31–81 years. First fracture incidence was estimated using life table methods with age as the timescale.

Results

Fracture rate increased proportionally with age between the sexes for vertebral and proximal humerus but disproportionally for hip and distal forearm fractures. The ratio of first fracture incidence between the sexes varied considerably by site: 2.65 for hip fractures and the highest for distal forearm fractures at 4.83. By the age of 75, 36.7 % of women and 21 % of men had sustained a fracture, taking into account competing risk of death. The incidence of hip fractures was similar to results previously published from USA, Sweden, Norway, and Scotland. The incidence of MOS fractures in both sexes decreased over the last decade, except hip fractures in men, which remained unchanged, as reflected in the women/men ratio for the hip, which changed from 2.6 to 1.7.

Conclusion

This study adds information to scarce knowledge on the relative fracture incidence of different fractures. The incidence of MOS fractures increased in the latter part of the last century in both sexes and declined during the last decade, less dramatically for men. This information is important for planning health resources.     

Surgical treatment for complicated acetabular fractures

Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures.Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures,7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.     

Surgical treatment for complex acetabular fractures

Objective ： To explore the effect of surgical treatment on complex acetabular fractures. Methods： The data of 46 patients （38 males and 8 females, aged 16-75 years, mean = 38. 5 years ） with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included flioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8. Results： All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients （78.3%）, the surgical procedure was successful （Harris hip score 〉 80 points）. The rate of excellent and good was about 86 %. Conclusions ： The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.     

Proximal humeral fractures treated with arthroplasty

P74ro50x%iyme aaolrfs h houulmdm.eer raAalfl t effrrraa cactgtuuerr ee5ss0,ainc wc oopumanteiten nf othsra vomeldo reaer m tthhucaanhnhigher incidence of proximal humeral fractures thanmen.In patients younger than50years old,high-energy trauma is the most common cause of proximalhumeral fractures,and after age50,minimal-to-moderate trauma is the most common cause.1Neer s classification,the most popularclassification system for proximal humeral fractures,isbased on the anatomical relationship o…     

Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?

BACKGROUND: Recommendations for surgical treatment and expected outcomes differ for two unstable patterns of supination-external rotation ankle injuries. We compared the demographic characteristics and functional outcome following surgical stabilization between the two types of supination-external rotation type-4 fractures: distal fibular fracture with a deltoid ligament rupture and bimalleolar fracture. METHODS: Demographic data on 456 patients in whom an unstable fracture of the ankle was treated surgically were entered into a database and the patients were prospectively followed. Two hundred and sixty-six of these patients sustained either a bimalleolar fracture or a lateral malleolar fracture with insufficiency of the deltoid ligament and widening of the medial clear space. No medial fixation was used in the patients with a deltoid ligament injury. All patients followed a similar postoperative protocol. The patients were followed clinically and radiographically at three, six, and twelve months after the surgery. Function was assessed with the Short Musculoskeletal Function Assessment and the American Orthopaedic Foot and Ankle Society score. RESULTS: Bimalleolar fractures were more commonly seen in female patients, in those older than sixty years of age, and in patients with more comorbidities. There was no significant association between the fracture pattern and either diabetes or the length of the hospital stay. At a minimum of one year postoperatively, the patients with a bimalleolar fracture had significantly worse function, even after we controlled for all other variables. The overall complication rate, including elective hardware removal, was also higher in the group with a bimalleolar fracture (seventeen compared with nine patients). CONCLUSIONS: At one year after surgical stabilization of an unstable ankle fracture, most patients experience little or mild pain and have few restrictions in functional activities. However, the functional outcome for those with a bimalleolar fracture is worse than that for those with a lateral malleolar fracture and disruption of the deltoid ligament, possibly because of the injury pattern and the energy expended.     

Management of acetabular fractures： challenging work

Acetabular fractures are complex and special intraarticular fractures. For most orthopaedic surgeons management of acetabular fractures is hard and challenging because the fractures are the results of high-energy trauma, and usually accompany with severe associated injuries. In addition,these fractures are uncommon except in a few trauma centers. The number of cases a surgeon can encounter is scarce.     

Corticosteroids for fat embolism after multiple fractures

Fat embolism is a common complication of multiple fractures. Corticosteroids are usually prescribed in prophylactic and treatment of fat embolism. A case of fat embolism followed multiple fractures was hospitalized, and we searched best evidences about corticosteroids for fat embolism so as to provide best therapeutics for the patient.     

Which Colles' fractures should be manipulated?

Ninety-two patients with displaced Colles' fractures were followed prospectively after manipulation under regional anaesthesia. Radiographs were taken before and after manipulation and after 3 months when a functional assessment was also made. A correlation was sought between outcome and radiological measurements. Final radial shortening of 3mm or more was associated with a significantly worse functional outcome after 3 months (P < 0.001). Where the initial radial shortening was 3 mm or more, the probability of malunion was 65% whereas with less than 3mm, the probability of malunion was 28% (P < 0.001). With 5 mm or more of radial shortening at presentation, the probability of malunion was 73% (P < 0.01). The decision to manipulate remains a matter of judgement but a high failure rate renders simple manipulation and plaster cast fixation a poor treatment option in fractures with 5mm or more of radial shortening at presentation.     

Interprosthetic fractures—a challenge of treatment

The incidence of periprosthetic femoral fractures rises continuously as both the number of hip and knee replacements and the life expectancy of the population are increasing. Likewise, interprosthetic femoral fractures, occurring between ipsilateral total hip and total knee arthroplasties, are an increasingly common and challenging problem. The majority of these fractures is localized at the femoral supracondylar region. Their treatment is not only technically demanding but also susceptible to complications. It has to be decided depending on the fracture type, surrounding bone stock, fracture localization, stability of the prosthesis, and the general condition of the often multimorbid patients whether osteosynthesis, revision of the prosthesis, or—when combined with periprosthetic infection—an amputation is indicated in the individual case. The modified Vancouver classification for interprosthetic femoral fractures was used for a systematic presentation of the indications, surgical techniques, and results.     

Clavicular midshaft fractures Operative versus nonoperative treatment

There is some evidence to suggest that midshafl clavicular fractures can be successfully treated With either operative or nonoperative methods but that there are fewer complications associated with nonoperative techniques. Most available data come from case series, and comparative studies are needed to determine the veracity of this preliminary data.