Seizure-induced muscle force can caused lumbar spine fracture

Patients suffering form epilepsy have an increased risk for fractures. Beside fractures caused by fall or accident muscles forces alone generated during tonic-clonic seizure can result in severe musculoskeletal injury. Contractions of strong paraspinal muscles can lead to compression fracture of the mid-thoracic spine. We report a patient who had suffered from a tonic-clonic seizure during early morning hours. After a cracking sound the patient woke up in a state of post-ictal disorientation, loss of urine and tongue bite. He was admitted to our facilities with the suspected vertebral fracture albeit he just reported of mild lower back pain. Native X-rays and computer-tomography scans showed instable burst fractures of L2 and L4. The fractures were stabilised with a dorsally instrumented internal fixator from L1 to L5 followed by hemi-laminectomy and ventral spondylodesis. Muscle force alone can result in severe skeletal trauma including vertebral fractures. This example emphasizes the importance of critical examination of patients after grand mal seizures. Seizures-induced injuries can appear clinically asymptomatic and can easily be overseen due to absence of trauma and post-ictal impairment of consciousness.     

Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center

IntroductionTraumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management.Patients and methodsRetrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures.ResultsPatients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died.ConclusionsIn Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.     

四肢多发骨折并发胸腔积液的危险因素分析

目的:探讨四肢骨折合并胸腔积液的危险因素,为预防胸腔积液的发生提供参考。方法：自2010年1月至2019年12月采用手术治疗的137例四肢多发骨折患者,男102例,女35例,年龄16~92（48.34±15.85）岁。四肢多发骨折定义为全身有两处以上的四肢骨折,所有入选患者术前具有完整的临床,影像及实验室检查资料,包括术前胸部CT,性别,年龄,体质量指数（body mass index,BMI）,红细胞压积（hematocrit,HCT）,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级,创伤严重度评分（injury severity score,ISS）,吸烟史,手术史,糖尿病史,高血压史,入院至手术时间,骨折部位,血小板计数,白蛋白,C-反应蛋白和D-二聚体等因素。记录患者是否合并胸腔积液,计算胸腔积液量,并对相关危险因素进行统计学分析。结果：四肢骨折均接受了手术治疗,术后患者切口愈合良好,无伤口感染和急性肺损伤或急性呼吸窘迫综合征等并发症出现。通过多因素回归分析示：ISS>16分（P=0.000）、吸烟史（P=0.001）和肋骨骨折（P=0.000）是四肢多发骨折合并胸腔积液的危险因素。多因素线性回归分析显示：吸烟史,ISS及肋骨骨折是四肢多发骨折胸腔积液量增多的危险因素。结论：四肢多发骨折合并胸腔积液与ISS、吸烟史以及肋骨骨折相关;胸腔积液量与吸烟史、ISS及肋骨骨折有关。对ISS>16分,有吸烟史或合并肋骨骨折的多发骨折患者应提高警惕,尽早干预,降低合并胸腔积液量的风险。     

Delayed unrelated presentation of a lumbar burst fracture consequent to a remote episode of a single convulsive seizure: A diagnostic challenge

Non-traumatic vertebral fractures occurring as a sole consequence of the violent muscle forces generated during the first episode of a GTCS(generalized tonic clonic seizure) in a previously healthy non-epileptic individual are very rare. Being clinically asymptomatic they are easily overseen at the time of initial presentation due to their rarity of occurrence and the presence of potentially distracting factors in the post-ictal phase. We present a 52-year-old healthy non-epileptic male who presented with unrelenting back pain and neurodeficit secondary to a four-month-old unstable burst fracture of the first lumbar vertebra sustained during an isolated single episode of a witnessed GTCS. A detailed inquiry revealed no history of a significant traumatic event either during the convulsive episode or thereafter. A meticulous history taking, a thorough clinical and neurological examination combined with a comprehensive radiological evaluation established the unusual etiology of the fracture and the presence of a thoracolumbar kyphotic deformity with compression of conus medullaris. A detailed neurological, and laboratory work-up, confirmed no attributable organic or metabolic cause for the seizure. His BMD(Bone Mineral Density) was normal. Patient was managed with posterior instrumented deformity correction by a posterior column shortening osteotomy, neural decompression and fusion of D12-L1 facets. Patient had complete neurological recovery with good clinical and functional outcomes at 28-months follow-up. A few cases of seizure-induced non-traumatic spinal fractures have been published in literature. A majority of these fractures occurred in individuals with either seizure-provoking risk factors (epileptics with recurrent seizures, brain tumors, drug overdose/withdrawal, metabolic disorders, or electrolyte imbalance) or in those with an increased susceptibility to fracture due to decreased BMD. This case demonstrates the rare occurrence of a non-traumatic vertebral fracture during the first episode of a GTCS in an otherwise healthy non-epileptic individual with normal BMD and no seizure-provoking risk factors. This is the first case report of a delayed unrelated presentation of a non-traumatic lumbar vertebral fracture with complications (spinal deformity and neurodeficit) consequent to a remote episode of a single convulsive seizure. It emphasizes the need for a high index of clinical suspicion,a meticulous history taking, thorough musculoskeletal and neurological examination in any individual presenting with a seemingly benign back pain following a remote isolated episode of seizure, even in the absence of overt trauma. A detailed radiological evaluation guided by a meticulous history taking and detailed clinical examination is essential to rule out a fracture unless proven otherwise. It also shows that a single convulsive seizure can result in a potentially unstable fracture that when neglected, can result in devastating complications like spinal deformity and neurodeficit.Level of evidenceLevel IV.     

Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease. A case report

Introduction and importanceBilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes.Case presentationA 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture.Intervention and outcomeThe medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture.ConclusionIn cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients.     

单节段经皮椎体成形术后继发相邻椎体骨折的危险因素

目的探讨经皮椎体成形术(PVP)治疗单节段骨质疏松性椎体压缩性骨折(OVCF)术后继发相邻椎体骨折的危险因素。方法回顾性分析2013年3月—2017年3月在宁波市第二医院骨科因单节段OVCF行PVP治疗的140例患者的临床资料,以术后是否继发相邻椎体骨折将患者分为继发骨折组(A组,38例)和无继发骨折组(B组,102例)。记录所有患者术后继发相邻椎体骨折的潜在影响因素,包括非手术因素(年龄、性别、体质量指数、椎体骨密度、楔形角范围、骨折位置、有无外力参与、是否合并糖尿病、是否有糖皮质激素治疗史)和手术因素(骨水泥填充材料、注入量、注入方式、渗漏情况),采用独立样本t检验和χ2检验分析以上因素组间差异是否具有统计学意义,并对差异有统计学意义的因素采用Logistic回归分析评价其与术后相邻椎体骨折的相关性。结果组间比较,椎体骨密度、楔形角范围、骨折位置、有无糖皮质激素治疗史及有无外力参与5个方面差异有统计学意义(P 0.05),纳入相关分析;其余统计数据组间差异无统计学意义。Logistic回归分析显示上述5个指标进入方程,与术后相邻椎体骨折具有相关性。结论椎体骨密度低、楔形角≥15°、骨折位于胸腰交界处、有糖皮质激素治疗史及外力作用5个指标是术后继发相邻椎体骨折的影响因素,手术因素不会增加继发相邻椎体骨折风险。     

Fragility fracture following total hip arthroplasty

BackgroundWhile periprosthetic fractures following total hip arthroplasty (THA) are a well-known phenomenon for orthopedic surgeons, fragility fractures following THA are also a significant, though less studied, concern. Furthermore, patients who have undergone THA have several additional risk factors for fragility fractures, including motor weakness, bone atrophy, and limping. The aims of this study were to evaluate the incidence of fragility fractures following THA and to clarify the characteristics of these fractures.MethodsThis study included 5678 primary THA procedures in 4589 female patients. This study evaluated body morphology data, disease type leading to THA, Japanese Orthopaedic Association hip score, range of motion of the hip joint, and medical history. Distal radius and patella fractures were defined as fragility fractures. Risk factors for fragility fractures after THA were calculated by comparing the fragility fracture group with the non-fracture group.ResultsFifty-three fragility fractures were confirmed in 53 patients (distal radius fracture: 32 fractures in 32 patients, patella fracture: 21 fractures in 21 patients). In the univariate analysis, the following eight risk factors for fragility fractures were significantly different between the groups: height, weight, follow-up period, developmental dysplasia of the hip, primary osteoarthritis, abduction before THA, internal rotation before THA, and external rotation before THA. Medical histories were not significantly different between the groups. There was no difference in any study factor and in the time of occurrence between the radius fractures and patella fractures analyzed as fragility fractures.ConclusionsThis study revealed that there are significant preoperative factors of fragility fractures following THA. These factors will serve as useful data for THA treatment strategies, preoperative explanations, and future studies.     

The fourth column of the spine: Prevalence of sternal fractures and concurrent thoracic spinal fractures

Study designRetrospective analysis.ObjectiveThis study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures.Summary of Background DataThe sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components.MethodsThis is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008–2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information.Results107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15–90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years (P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] (P = 0.012). Patients with additional rib (P < 0.001), scapula (P = 0.01), clavicle fractures (P = 0.01), and those with multiple other thoracic fractures (P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] (P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures.ConclusionsThe prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course.     

Exposing the incidence of ileus in pelvic and acetabular fractures: a retrospective case analysis

BackgroundParalytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury.  Prior to this study, there were no reported figures for the incidence of ileus in patients presenting with pelvic and/or acetabular fractures.MethodsAll patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data collected included patient demographics, injury pattern, fracture management and presence of ileus. As in previous studies, patients were identified as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay.ResultsAn incidence of ileus of 40.35% was observed in the 57 included patients. Across all patients, ileus was three times more common in patients with a diagnosis of diabetes mellitus (p= 0.56) and 2.5 times more common in the presence of an open pelvic/ acetabular fracture (p= 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p= 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors for ileus.Conclusion/ FindingsThis is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Due to the morbidity and cost associated with this condition, further research is required to assess the effect of interventions to reduce its incidence in this patient subgroup.     

Timing of intervention for spinal injury in patients with polytrauma

ObjectiveThe optimal timing of surgical intervention of spinal fractures in patients with polytrauma is still controversial. In the setting of trauma to multiple organ systems, an inappropriately timed definitive spine surgery can lead to increased incidence of pulmonary complications, hemodynamic instability and potentially death, while delayed surgical stabilisation has its attendant problems of prolonged recumbency including deep vein thrombosis, organ-sp ecific infection and pressure sores.MethodsA narrative review focussed at the epidemiology, demographics and principles of surgery for spinal trauma in poly-traumatised patients was performed. Pubmed search (1995–2020) based on the keywords – polytrauma OR multiple trauma AND spine fracture AND timing, present in “All the fields” of the search tab, was performed. Among 48 articles retrieved, 23 articles specific to the management of spinal fracture in polytrauma patients were reviewed.ResultsSpine trauma is noted in up to 30% of polytrauma patients. Unstable spinal fractures with or without spinal cord injury in polytrauma require surgical intervention and are treated based on the following principles - stabilizing the injured spine during resuscitation, acute management of life-and limb-threatening organ injuries, “damage control” internal stabilisation of unstable spinal injuries during the early acute phase and, definitive surgery at an appropriate window of opportunity. Early spine fracture fixation, especially in the setting of chest injury, reduces morbidity of pulmonary complications and duration of hospital stay.ConclusionRecognition and stabilisation of spinal fractures during resuscitation of polytrauma is important. Early posterior spinal fixation of unstable fractures, described as damage control spine surgery, is preferred while a delayed definitive 360° decompression is performed once the systemic milieu is optimal, if mandated for biomechanical and neurological indications.     

Atraumatic diplaced bilateral femoral neck fracture in a patient with hypophosphatemic rickets in postpartum period: A missed diagnosis

IntroductionSimultaneous bilateral femoral neck fracture is an uncommon condition. There are very few cases reported in the literature and most of these cases have underlying bone pathologies such as renal osteodystrophy and osteomalacia. In some cases bilateral femoral neck fractures occur due to generalized seizures or high-energy trauma.Presentation of caseIn this case report “atraumatic bilateral femoral neck fracture in a 26 year old woman in postpartum period with hypophosphatemic rickets disease” is presented.DiscussionFemoral neck fractures are more frequently seen in elderly because of the reduction of bone quality and developing osteoporosis. In the literature generalized epilepsy, osteomalacia, hypovitaminosis D and chronic renal failure are shown as facilitating causes of bilateral femoral neck fractures. In patients without any additional pathology electric shock, electroconvulsive therapy, and high-energy trauma can lead to femoral neck fractures. In our patient there was also an underlying pathology, she has been followed due to autosomal recessive hypophosphatemic rickets disease since she was one year old. In the treatment of bilateral femoral neck fractures open/closed reduction internal fixation or hip arthroplasty are applied.ConclusionFor patients with bone metabolic diseases and/or the patients in pregnancy and postpartum period, preventive measures should be increased to reduce the risk of pathologic fracture. Admitting to the hospital physicians must be more careful about detecting fractures in these patients.     

初次创伤骨折术后和二次创伤骨折术后机体凝血状态变化的差异性研究

目的：通过比较初次骨折与二次骨折术后机体凝血状态的变化,探讨骨折手术病史对于二次骨折后机体凝血状态的影响。方法：选新西兰大免10只,5-6月龄,雌雄各半,体重2．4～2．6k,无孕。先制作初次创伤骨折术后模型,12周后再进行二次创伤骨折术后造模,分别于两次骨折术后1d、5d取静脉血测量血浆凝血酶原时间（PTT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）及D-二聚体（D—D）5个指标,比较两次骨折术后同一时间各指标的变化。结果：二次创伤骨折术后1d与初次创伤骨折术后1d比较,PT、APTT值差异无统计学意义（P〉0．05）,TT、FIB、D—D值均升高,差异有统计学意义（P〈0．05）;二次创伤骨折术后5d与初次创伤骨折术后5d比较,FTT值差异无统计学意义（P〉0．05）,APTT、TT、FIB、D—D值均升高,差异有统计学意义（P〈0．05）。结论：骨折手术病史使二次创伤骨折后血液更加处于高凝状态。     

Sternal Fracture Should Prompt the Evaluation of the Entire Spine in Trauma Patients

Abstract Background and Purpose: Sternal fracture has traditionally been considered an indicator of a severe mechanism of trauma, which warrants careful evaluation of the patient for accompanying injuries. The purpose of this study is to determine the incidence, distribution and mechanisms of spinal fractures associated with fractures of the sternum. Material and Methods: Trauma registry data, medical records and X-rays of all patients admitted to the Trauma Unit at Hillel-Yaffe Medical Center, Hadera, Israel, with a diagnosis of sternal fracture during a 6-year period, between January 1, 1997 and December 31, 2002, were reviewed retrospectively. Results: 147 patients with sternal fracture were eligible for analysis. The combination of spinal fracture in association with sternal fracture was found in 19 patients (13%), ten males (52.7%) and nine females (47.3%). Mean age was 49 years and mean Injury Severity Score (ISS) 18.6. Motor vehicle accidents were the most common cause of these fractures. An unusually high proportion of cervical spine fractures (36.8%) was noted. Three of the 19 patients (15.5%) with sternal and spinal fractures also suffered from cardiac contusion, confirmed by an elevation of the MB fraction of creatine phosphokinase, ECG changes, and regional hypokinetic areas on echocardiography. Conclusion: Recent studies indicate that the incidence of sternal fracture has risen while its association with accompanying serious injuries has lessened. This is most likely due to the increased use of seat belts in motor vehicle accidents. In both theory and practice spinal fracture is an associated injury in cases of sternal fracture, and usually involves the thoracic level. The authors describe an almost equal distribution of the level of spinal injury, with an unusually high proportion of cervical involvement. They also found a high incidence of myocardial contusion among patients with combined sternal and spinal fractures. Therefore, X-ray evaluation of the entire spine in patients suffering from a fractured sternum, and closer cardiac monitoring of patients with both sternal and spinal fractures are recommended.     

Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study

Osteoporosis management is suboptimal even for high-risk people with a history of prior fracture. There is also evidence that individuals with moderate trauma fracture have a lower bone density and are at higher risk of subsequent fracture. This study aimed to define factors influencing the management of individuals at risk for osteoporosis and to examine the risk profiles of individuals with minimal and moderate trauma fractures. Consecutive fracture patients ( n =218) treated in the outpatient fracture clinic in St Vincents Hospital, Sydney, over a 15-month period (February 2002–July 2003) were interviewed. Fracture risk factors, prior investigation and treatment for osteoporosis were collected and participants were contacted after 3 months to ascertain follow-up. Risk factors for osteoporosis including family history, low dietary calcium and conditions associated with bone loss were similar between low- and moderate-trauma groups and between sexes. Even though half of participants had had a prior fracture, only 34% had a bone density scan and 16% were on anti-resorptive treatment. There was a minimal (6%) increase in the rates of investigation and treatment at the 3-month follow-up, and less in the moderate trauma group and males. Independent predictors for being investigated for osteoporosis were: age over 50, prior fracture and female gender, while predictors for treatment were: age over 50 and having been investigated. This study has confirmed low rates of investigation and treatment even in individuals who have already suffered a prior fracture, and especially in those <50 and in males. People with moderate and minimal trauma fractures had similar risk factors for osteoporosis, including a similarly high proportion of prior fractures. These findings support the concept that people with moderate trauma fractures are at higher subsequent fracture risk, yet are neither investigated nor treated. This study highlights the need for further exploration of barriers to osteoporosis management.     

Traumatic enucleation of the left globe after a road traffic accident – A case report of an uncommon occurrence in maxillofacial trauma

IntroductionSerious injuries of the globe are uncommon in closed maxillofacial trauma, as the anatomical configuration of the orbit offers important protective mechanisms against external trauma. Thus, the objective of this work is to report a case of a rare traumatic enucleation of the globe resulting from maxillofacial blunt trauma.Presentation of caseA 42-year-old man was hit by a car with a major complaint of facial pain. The patient had several facial fractures including: Le Fort I, naso-orbit-ethmoidal, anterior sinus wall and an exposed fracture of the orbit-zygomatic complex (OZC). The patient underwent to open reduction and internal fixation of facial fractures and enucleation of the left globe, however, evolved with postoperative infection and complications associated with, a so far unknown, type 2 diabetes. After secondary surgeries for removal infected bones and diabetes control, all injuries were fully healed, and the patient remained with major sequels.DiscussionIn this case, we hypothesized a high-energy trauma resulting in multiple facial fractures, especially involving the OZC, dislocated the thick lateral wall of the orbit within the orbital cavity and reduced the orbital volume. This resulted in an exaggerated increase in intraorbital pressure, which exceeded the capacity of all anatomical protective mechanisms of the globe, and pushed the globe outwards, causing a complete avulsion.ConclusionBesides all anatomical structures to protect the globe, rarely high energy maxillofacial trauma can cause severe damage to the globe resulting in loss of vision and globe avulsion.     

小夹板改良外固定治疗小儿前臂双骨折的临床观察

目的:探讨保守治疗儿童创伤的优势,观察评价保守外固定治疗儿童前臂双骨折的临床疗效。方法:自2007年6月至2008年6月,手法整复、小夹板改良外固定治疗前臂双骨折52例,男33例,女19例;年龄4～15岁,平均8.6岁;病程1 h～7 d。所有患者均有明确的外伤史,治疗前拍摄X线片显示尺桡骨双骨折。结果:52例均获得随访,时间6～14个月,平均9.4个月。所有骨折均达骨性愈合,骨折临床愈合时间4～8周,平均6周。采用Berton评定标准对治疗效果进行评价,优37例,良15例。结论:严格按照适应证,使用小夹板改良外固定治疗儿童前臂双骨折,操作安全,创伤小,费用低,功能恢复好。     

Trauma and Fracture of the Mandible

AbstractBackground: The mandible is one of the most frequently fractured bones. The objective of this prospective study was to determine and illustrate fracture patterns of the mandible in relation to various etiologic factors.Patients and Methods: A total of 218 patients with mandibular fractures were included in this study. Data regarding age, gender, causes and anatomic sites of fractures and treatment modalities were collected. Conventional plain radiographs of the mandible were obtained in all patients. The plain radiographs included such projections as Towne and Waters in patients suspected of having subcondylar fractures or associated facial fractures. Radiographs were scanned using a high-resolution scanner, and fracture lines were marked. The lines were copied and pasted to a graphic image of the mandible. All fracture lines were confirmed on surgical explorations of the fractures when the patients were under general anesthesia. Results: Traffic accidents (67%) were the most frequent cause of mandibular fractures. 51% of the patients had multiple fractures including fractures of the parasymphysis and angle, which were the most commonly affected sites (33.3%). 49% of the patients had a single fracture. The body of the mandible was the most frequently affected site in these patients (26.2%). Conclusion: Weak points of the mandible and etiologic factors were the determinants of mandibular fracture sites. We speculate that the main determinants of fracture sites were characteristics of the mandible in those fractures caused by motor vehicle accidents, while the other etiologic factors themselves determined the fracture sites for the other types of trauma.     

Risk factors for cervical spine injury

IntroductionThe early recognition of cervical spine injury remains a top priority of acute trauma care. Missed diagnoses can lead to exacerbation of an existing injury and potentially devastating consequences. We sought to identify predictors of cervical spine injury.MethodsTrauma registry records for blunt trauma patients cared for at a Level I Trauma Centre from 1997 to 2002 were examined. Cervical spine injury included all cervical dislocations, fractures, fractures with spinal cord injury, and isolated spinal cord injuries. Univariate and adjusted odds ratios (ORs) were calculated to identify potential risk factors. Variables and two-way interaction terms were subjected to multivariate analysis using backward conditional stepwise logistic regression.ResultsData from 18,644 patients, with 55,609 injuries, were examined. A total of 1255 individuals (6.7%) had cervical spine injuries. Motor Vehicle Collision (MVC) (odds ratio (OR) of 1.61 (1.26, 2.06)), fall (OR of 2.14 (1.63, 2.79)), age <40 (OR of 1.75 (1.38–2.17)), pelvic fracture (OR of 9.18 (6.96, 12.11)), Injury Severity Score (ISS) >15 (OR of 7.55 (6.16–9.25)), were all significant individual predictors of cervical spine injury. Neither facial fracture nor head injury alone were associated with an increased risk of cervical spine injury. Significant interactions between pelvic fracture and fall and pelvic fracture and head injury were associated with a markedly increased risk of cervical spine (OR 19.6 (13.1, 28.8)) and (OR 27.2 (10.0–51.3)).ConclusionsMVC and falls were independently associated with cervical spine injury. Pelvic fracture and fall and pelvic fracture and head injury, had a greater than multiplicative interaction and high risk for cervical spine injury, warranting increased vigilance in the evaluation of patients with this combination of injuries.     

Risk Factors for Perimenopausal Fractures: A Prospective Study

This prospective study was aimed at determining the risk factors for the development of fractures in perimenopausal women. The study group (n= 3068) was comprised of a stratified population sample of women aged between 47 and 56 years. During the follow-up period of 3.6 years, 257 (8.4%) of the women sustained a total of 295 fractures. After adjustment for covariates, the relative risk (RR) of sustaining a fracture was found to be 1.4 [95% confidence interval (CI) 1.2–1.6] for a 1 standard deviation (SD) decrease in the spinal and femoral neck bone mineral density (BMD). Women with a previous fracture history were found to have an increased risk of fracture [RR 1.7 (95% CI 1.3–2.2)] and those reporting three or more chronic illnesses exhibited a RR of 1.4 (95% CI 1.0–1.9). Women not using hormone replacement therapy (HRT) had a RR of 1.5 (95% CI 1.1–2.2) for all fracture types. When osteoporotic fractures (vertebral, hip, proximal humerus and wrist fractures; n= 98) were used as an endpoint, the independent risk factors were found to be a low BMD (RR for a 1 SD decrease in both spinal and femoral neck BMD was 1.6, 95% CI 1.3–2.0), a previous fracture history (RR 1.9, 95% CI 1.3–2.9) and nonuse of HRT (RR 2.2, 95% CI 1.3–4.0). The independent risk factors for all other fractures (n = 158) were a low BMD (RR for a 1 SD decrease in the spinal BMD was 1.4, 95% CI 1.2–1.6 and in the femoral neck BMD was 1.3, 95% CI 1.1–1.5), a previous fracture history (RR 1.6, 95% CI 1.1–2.2), smoking (RR 1.8, 95% CI 1.1–2.7) and having had three or more chronic illnesses (RR 1.6, 95% CI 1.1–2.2). Weight, height, age, menopausal status, maternal hip fracture, use of alcohol, coffee consumption or dietary calcium intake were not independently associated with the development of any particular type of fracture. We conclude that the independent risk factors for perimenopausal fractures are a low bone density, previous fracture history, nonuse of HRT, having had three or more chronic illnesses and smoking, the gradient of risk being similar for spinal and femoral neck BMD measurements in the perimenopausal population. The risk factors are slightly different for perimenopausal osteoporotic than for other types of fractures. Received: 6 April 1999 / Accepted: 18 August 1999