Temporal bone fractures

This report has illustrated the variety of temporal bone fractures that involve the zygomatic, squamous, and petromastoid components of the temporal bone. Complications as they relate to each type of fracture have been emphasized. Although longitudinal and transverse fractures can be identified, temporal bone trauma usually creates unique fractures constellations that must be individually described. In each case, a careful inspection of the ossides, otic capsule (vestibule/cochlea), internal auditory, and facial nerve canal must be undertaken. When a patient presents with temporal bone fracture and facial nerve paralysis, identification of the site of facial nerve injury may now lead to surgical decompression of this area of the facial nerve canal and possible nerve grafting.     

Temporal bone fractures: a clinical diagnosis.

Temporal bone fractures may be complicated by intracranial haemorrhage, C.S.F. leakage and infection, damage to the middle and inner ear and damage to the seventh and eighth cranial nerves. Accurate early diagnosis is important to enable adequate investigation and prompt treatment of any complications. We present eight cases seen in a 12 month period in which a temporal bone fracture was not diagnosed at presentation in spite of a full clinical examination and standard skull radiographs. Five of these cases developed complications which resulted in their referral. The absence of a visible fracture on plain skull radiographs does not exclude a fracture, and those patients with clinical signs of a fracture should be treated appropriately and further investigations performed. Therefore the clinical examination is vital in diagnosing temporal bone fractures and must include careful otoscopy together with assessment of the function of the seventh and eighth cranial nerves.     

Temporal bone fractures in children: a review of 34 cases.

Head injuries are commonly seen in accident and emergency (A&E) departments and within this group a small proportion will have a temporal bone fracture. Thirty-four such cases were identified from a 7-year period and their case notes were reviewed. The mechanisms of injury included:falls outdoors (15 cases), falls in the home (eight cases), road traffic accidents (RTAs; seven cases), missiles (three cases) and non-accidental injury (one case). In 20 cases the fracture involved more than one cranial bone, and the implications of this with regard to non-accidental injury are discussed. CT scans were carried out in 14 cases and 11 of these showed intracranial haematoma. The criteria for CT scan following head injury in general, and temporal bone fracture in particular are discussed. Outcome measures indicated that those injured as a result of RTAs had the poorest outcome, followed by those who fell outdoors and then those who fell in the home.     

Temporal bone trauma

Temporal bone trauma has numerous manifestations, many of which are detectable by current imaging techniques. Our discussion of temporal bone trauma is subdivided into fractures and pseudofractures, fistulous communication, hearing loss, and facial nerve involvement.     

超声诊断骨折进展

超声可通过多方位扫查观察骨折部位、大小、断端移位及周围组织水肿或血肿，已用于诊断肋骨、掌骨、软骨、鼻骨等部位骨折，为临床诊断骨折、尤其隐匿性骨折提供重要依据。本文对超声成像技术在骨折诊断中的应用和发展进行综述。     

可吸收棒治疗短管状骨骨折

目的：探讨可吸收棒治疗短管状骨骨折的手术疗效。方法：应用可吸收棒治疗30例短管状骨骨折。结果：所有病例均随访5～18个月,平均8个月,均未发生感染或骨不愈合。30例关节功能恢复良好,X线结果显示多数病例在6～8个月后痊愈。结论：应用可吸收棒内固定是一种有效的治疗短管状骨骨折的方法。     

Temporal bone radiography: a screening survey approach.

For preliminary evaluation of the temporal bone, a combination of conventional radiographs and hypocycloidal tomography in the frontal projection is advocated. If significant abnormalities are detected in this screening survey, a more in-depth study can then be pursued.     

Building bone to reverse osteoporosis and repair fractures

An important, unfilled clinical need is the development of new approaches to improve fracture healing and to treat osteoporosis by increasing bone mass. Recombinant forms of bone morphogenetic protein 2 (BMP2) and BMP7 are FDA approved to promote spinal fusion and fracture healing, respectively, and the first FDA-approved anabolic drug for osteoporosis, parathyroid hormone, increases bone mass when administered intermittently but can only be given to patients in the US for two years. As we discuss here, the tremendous explosion over the last two decades in our fundamental understanding of the mechanisms of bone remodeling has led to the prospect of mechanism-based anabolic therapies for bone disorders.     

Factors influencing bone fractures in severely disabled persons

OBJECTIVES: Factors affecting bone fracture in severely disabled persons were evaluated. DESIGN: Bone mineral density was measured, and the ratio against the average values in healthy subjects was calculated. Seventy-three subjects were selected from among 113 inpatients with severe mental and physical handicaps. The subjects were classified into four levels of mobility. RESULTS: Multiple logistic regression analysis was conducted to determine the contribution of variables to the history of bone fracture. Age, medication of sodium valproate, and bone mineral density percentage were found to significantly affect bone fracture. CONCLUSIONS: Increase of bone mineral density is the protective or preventive factor in bone fracture.     

骨修复材料在骨折及骨缺损治疗中的价值

背景:人工骨材料作为骨移植替代物修复骨缺损,是医学和生物材料学领域内的一项重要研究课题.目的:总结近年有关骨修复材料在骨折及骨缺损中的应用现状.方法:由作者应用计算机检索维普数据库中与骨修复材料治疗骨折、骨缺损有关的文献,检索时限为1998-01/2009-10.检索关键词为"骨折,骨修复,假体置换,材料".纳入标准:①选取针对性强,相关度高的文献.②排除一些重复性研究.对资料进行初审,并查看每篇文献后的引文.最终纳入26篇文献进入结果分析.结果与结论:目前研究较多的骨修复材料有纳米羟基磷灰石/聚酰胺66,脱钙骨基质,硫酸钙颗粒,纳米晶羟基磷灰石/胶原复合材料等.纳米级组织工程骨材料则是利用纳米技术在纳米结构单元或纳米数量级(1~100 nm)下生产的新型材料,研制成的纳米羟基磷灰石/胶原骨经动物实验研究证实,比普通羟基磷灰石有更为优越的生物相容性和生物活性,无细胞毒性,能促进和加快骨创的愈合.     

可吸收人工骨粉修复跟骨粉碎性骨折

背景：目前对 SandersⅢ型、Ⅳ型骨折手术治疗恢复破坏的跟骨距下关节面和跟骨形态,以减少创伤性关节炎的发生已达成共识,而对于跟骨骨折术中是否植骨一直是个有争议性的问题。目的：观察Genex人工合成骨填充材料及锁定钢板治疗粉碎性跟骨骨折的临床疗效。方法：回顾性分析21例SandersⅢ型、Ⅳ型跟骨骨折患者的临床资料,其中男16例,女5例,年龄22-55岁,采用外侧“L”形入路,跟骨骨折复位后将调好成面团样的 Genex 人工骨粉填塞缺损区,再将外侧壁骨块复位,将预弯好的锁定钢板置入。随访观察骨折愈合情况、Bolher角及Maryland足部评分。结果与结论：21例患者均获随访,随访时间8-16个月,骨折均愈合,无移位、塌陷及排斥反应,人工骨粉约6个月被降解,1年后完全被吸收,并为新骨所取代;按Maryland足部评分优良率达86%,Bolher角从治疗前的（5.30±3.35）°恢复至末次随访后的（24.30±1.06）°。结果表明 Genex 人工骨粉是一种完全吸收、可塑性好、支撑力强的生物材料,能够充分填充骨缺损,便于骨折复位、诱导成骨、促进骨折愈合。     

Computational simulation of axial dynamization on long bone fractures

BACKGROUND: Axial dynamization has been shown in previous studies to promote callus formation, improve bone healing at fracture sites, and enhance bone remodeling. However, the possibility of non-axial movements or uniform fracture site compression during dynamization, and the appropriate relaxation of fixator joints to achieve such function, have not been investigated. METHODS: This study used previously developed computational models based on two commercially available unilateral external fixators (Dynafix and Orthofix) to analyze the fixator joint adjustments used and the fracture site movements generated during dynamization. FINDINGS: When none of the fixator's sliding joints were parallel to the long bone axis, significant non-axial movements occurred during dynamization. The dual sliding joint design of the Dynafix fixator was beneficial in reducing these non-axial movements. When all of the fixator joints were allowed to adjust simultaneously during dynamization, exact axial movement or uniform compression at a complicated fracture site was achievable. INTERPRETATION: This study revealed that significant non-axial movements may occur during dynamization, and that such a deficiency can be corrected by relaxing certain fixator joints in addition to the sliding mechanism. The same modeling technique can also be applied in bone lengthening application to assure desirable limb alignment during the distraction process. These analysis results can aid the performance assessment of an external fixator and facilitate appropriate application of such a device to achieve either active or controlled axial movement.     

骨折患者的发病特点及预防对策

目的 探讨镇区住院骨折患者骨折发生的规律,提出健康教育要点及相应的预防对策.方法 采用回顾性调查法,对镇区4家医院2004-2006年住院的5982例骨折患者资料进行统计分析.结果 骨折患者中男性比例高于女性,其中20～59岁年龄组发生骨折比例较高,骨折多为摔倒引起,平均住院日为23 d,入院方式以急诊为主.结论 对劳动人群和易发生骨折人群应加强健康教育.及提高防护意识,预防骨折发生.