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The Journal of Contemporary Dental... Mar 2015To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures.
BACKGROUND
To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures.
MATERIALS AND METHODS
A retrospective study of 11 cases of coronoid process fractures among 307 treated cases from 2008 to 2013 was conducted. Six patients were treated conservatively and 5 underwent ORIF with associated fractures. A statistical analysis of the data obtained after subjective and objective evaluation was done.
RESULTS
The incidence of coronoid process fractures was 3.58% of all mandibular fractures analyzed. There was no statistically significant difference found between two treatment modalities, but differences in maximum interincisal opening (MIO) and pain in the postoperative period were significant.
CONCLUSION
We recommend that linear coronoid fractures with minimal displacement can be managed with conservative treatment. For patients with significant displacement of coronoid process, limited mouth opening or concomitant mid-face or lower-face fractures, rigid internal fixation is recommended.
Topics: Adult; Conservative Treatment; Female; Follow-Up Studies; Fracture Dislocation; Fracture Fixation, Internal; Fractures, Multiple; Humans; India; Male; Mandibular Condyle; Mandibular Fractures; Middle Aged; Rare Diseases; Retrospective Studies; Zygomatic Fractures
PubMed: 26057922
DOI: 10.5005/jp-journals-10024-1665 -
The Journal of Craniofacial Surgery Sep 2023Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study...
BACKGROUND
Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of NOE fractures in children seen at a single institution.
METHODS
A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, fracture type, management, and outcomes.
RESULTS
Fifty-eight patients met inclusion criteria; 77.6% presented with Manson-Marcowitz Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). Glasgow Coma Scale and injury mechanism were not predictive of injury severity in the pediatric population ( P =0.353, P =0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures ( P =0.047). LeFort III fractures were more likely in type II fractures ( P =0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures.
CONCLUSIONS
These findings suggest that pediatric NOE fractures, although rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.
Topics: Child; Humans; Adolescent; Skull Fractures; Orbital Fractures; Fracture Fixation; Nasal Bone; Retrospective Studies; Maxillary Fractures; Fractures, Multiple
PubMed: 37458265
DOI: 10.1097/SCS.0000000000009514 -
The Orthopedic Clinics of North America Jul 2019The reamer-irrigator-aspirator (RIA) autograft provides large volumes of autogenous graft that exhibit excellent osteogenic, osteoinductive, and osteoconductive... (Review)
Review
The reamer-irrigator-aspirator (RIA) autograft provides large volumes of autogenous graft that exhibit excellent osteogenic, osteoinductive, and osteoconductive properties. These features, combined with the relative ease of graft harvest and low donor site morbidity when compared with the gold standard iliac crest bone graft (ICBG), have made RIA autograft a viable alternative to ICBG. Some suggest RIA autograft is superior to ICBG, particularly in the setting of large segmental bone defects managed with the induced membrane technique. Although significant complications such as fracture and cortical perforation have been reported, they are preventable if proper surgical strategy and tactics are used.
Topics: Adult; Bone Transplantation; Femoral Fractures; Fracture Fixation, Intramedullary; Fractures, Multiple; Fractures, Ununited; Humans; Humeral Fractures; Male; Middle Aged; Radiography; Tibial Fractures; Tissue and Organ Harvesting; Transplantation, Autologous
PubMed: 31084831
DOI: 10.1016/j.ocl.2019.03.001 -
The Cochrane Database of Systematic... Jul 2015Thoracic trauma (TT) is common among people with multiple traumatic injuries. One of the injuries caused by TT is the loss of thoracic stability resulting from multiple... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thoracic trauma (TT) is common among people with multiple traumatic injuries. One of the injuries caused by TT is the loss of thoracic stability resulting from multiple fractures of the rib cage, otherwise known as flail chest (FC). A person with FC can be treated conservatively with orotracheal intubation and mechanical ventilation (internal pneumatic stabilization) but may also undergo surgery to fix the costal fractures.
OBJECTIVES
To evaluate the effectiveness and safety of surgical stabilization compared with clinical management for people with FC.
SEARCH METHODS
We ran the search on the 12 May 2014. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), EMBASE Classic and EMBASE (OvidSP), CINAHL Plus (EBSCO), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), and clinical trials registers. We also screened reference lists and contacted experts.
SELECTION CRITERIA
Randomized controlled trials of surgical versus nonsurgical treatment for people diagnosed with FC.
DATA COLLECTION AND ANALYSIS
Two review authors selected relevant trials, assessed their risk of bias, and extracted data.
MAIN RESULTS
We included three studies that involved 123 people. The methods used for blinding the participants and researchers to the treatment group were not reported, but as the comparison is surgical treatment with medical treatment this bias is hard to avoid. There was no description of concealment of the randomization sequence in two studies.All three studies reported on mortality, and deaths occurred in two studies. There was no clear evidence of a difference in mortality between treatment groups (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.13 to 2.42); however, the analysis was underpowered to detect a difference between groups. Out of the 123 people randomized and treated, six people died; the causes of death were pneumonia, pulmonary embolism, mediastinitis, and septic shock.Among people randomized to surgery, there were reductions in pneumonia (RR 0.36, 95% 0.15 to 0.85; three studies, 123 participants), chest deformity (RR 0.13, 95% CI 0.03 to 0.67; two studies, 86 participants), and tracheostomy (RR 0.38, 95% CI 0.14 to 1.02; two studies, 83 participants). Duration of mechanical ventilation, length of intensive care unit stay (ICU), and length of hospital stay were measured in the three studies. Due to differences in reporting, we could not combine the results and have listed them separately. Chest pain, chest tightness, bodily pain, and adverse effects were each measured in one study.
AUTHORS' CONCLUSIONS
There was some evidence from three small studies that showed surgical treatment was preferable to nonsurgical management in reducing pneumonia, chest deformity, tracheostomy, duration of mechanical ventilation, and length of ICU stay. Further well-designed studies with a sufficient sample size are required to confirm these results and to detect possible surgical effects on mortality.
Topics: Cause of Death; Flail Chest; Fracture Fixation; Fractures, Multiple; Humans; Length of Stay; Randomized Controlled Trials as Topic; Respiration, Artificial; Ribs
PubMed: 26222250
DOI: 10.1002/14651858.CD009919.pub2 -
Pediatric Clinics of North America Aug 2015Fractures are common during childhood; however, they can also be the presenting symptom of primary or secondary causes of bone fragility. The challenge is to identify... (Review)
Review
Fractures are common during childhood; however, they can also be the presenting symptom of primary or secondary causes of bone fragility. The challenge is to identify those children who warrant further investigation. In children who present with multiple fractures that are not commonly associated with mild to moderate trauma or whose fracture count is greater than what is typically seen for their age, an initial evaluation, including history, physical examination, biochemistry, and spinal radiography, should be performed. In children with bone pain or evidence of more significant bone fragility, referral for specialist evaluation and consideration of pharmacologic treatment may be warranted.
Topics: Adolescent; Bone Density; Calcium, Dietary; Child; Female; Fractures, Bone; Humans; Male; Risk Factors; Sex Factors; Vitamin D; Weight-Bearing; Young Adult
PubMed: 26210620
DOI: 10.1016/j.pcl.2015.04.006 -
Orthopaedics & Traumatology, Surgery &... Oct 2022Fractures of the distal tibia involving the physis are relatively common in children. The data reported on long-term complication rates vary between studies.
BACKGROUND
Fractures of the distal tibia involving the physis are relatively common in children. The data reported on long-term complication rates vary between studies.
HYPOTHESIS
Pediatric distal tibial fractures cause medium- and long-term growth disturbances.
MATERIALS AND METHODS
This was a retrospective single-center study. We included physeal distal tibial fractures that were treated in the operating room with a minimum 12-month follow-up. The analysis included age, gender, weight status, circumstances and energy of the injury, fracture type, subsequent treatment, complications, duration of follow-up, radiologic findings and functional outcomes using the AOFAS.
RESULTS
A total of 46 patients were included with a mean age of 12.8 years (2.4-15.9 years) and a mean follow-up of 35.8 months (12-119). At the longest follow-up, 7 patients (15.2%) had growth disturbances. The mean AOFAS score was 95/100 and a decreased ankle range of motion was observed in 18 patients, but it was always less than 10°. High-energy injuries (20 patients) resulted in worse clinical outcomes and a significantly higher rate of growth disturbances (p=.03).
DISCUSSION
This study confirmed the presence of growth disturbances following pediatric distal tibial fractures, especially in cases of high-energy trauma. Therefore, these fractures should be monitored until the end of the growth period.
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Child; Fractures, Multiple; Growth Plate; Humans; Retrospective Studies; Tibia; Tibial Fractures
PubMed: 35031515
DOI: 10.1016/j.otsr.2022.103199 -
Journal of Clinical Densitometry : the... 2017Identifying children most susceptible to clinically significant fragility fractures (low trauma fractures or vertebral compression fractures) or recurrent fractures is... (Review)
Review
Identifying children most susceptible to clinically significant fragility fractures (low trauma fractures or vertebral compression fractures) or recurrent fractures is an important issue facing general pediatricians and subspecialists alike. Over the last decade, several imaging technologies, including dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, have become useful to identify abnormal bone mineralization in children and in adolescents. This review aimed to summarize the latest literature on the utility of these modalities as they pertain to use in pediatrics. In addition, we review several disease states associated with poor bone health and increased fracture risk in children, and discuss the implications of low bone mineral density in these patients. Finally, we will highlight the gaps in knowledge with regard to pediatric bone health and make recommendations for future areas of research.
Topics: Absorptiometry, Photon; Adolescent; Bone Diseases; Bone and Bones; Calcification, Physiologic; Cancellous Bone; Child; Child, Preschool; Fractures, Spontaneous; Humans; Infant; Risk Assessment; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 28729046
DOI: 10.1016/j.jocd.2017.06.007 -
Journal of Bone and Mineral Research :... Mar 2021Systemic bone loss after initial fracture contributes to an increased risk of secondary fracture. Clinical research has revealed an association between the risk of...
Systemic bone loss after initial fracture contributes to an increased risk of secondary fracture. Clinical research has revealed an association between the risk of future fracture and the number or magnitude of prior fractures. However, the change in systemic bone mass after single versus multiple fractures is unknown. We used ipsilateral femur and tibia fractures as multiple fractures and a femur or tibia fracture as a single fracture to investigate the influence of single versus multiple fractures on systemic bone mass. Seventy-two adult male C57BL/6J mice underwent transverse osteotomies of the ipsilateral femur and/or tibia with subsequent internal fixation. The dynamic change of in vivo whole-body BMD was assessed at 4 days, 2 weeks, and 4 weeks after fracture. The microstructure of the L vertebral body and contralateral femur was assessed using micro-CT (μCT) and biomechanical tests (vertebral compression test and three-point bending test) at 2 and 4 weeks. Tartrate-resistant acid phosphatase (TRAP) staining, sequential fluorescence labeling, and systemic inflammatory cytokines were also quantified. A greater decrease in whole-body BMD was observed after multiple than single fractures. The trabecular bone volume fraction, trabecular number, and trabecular thickness of the L vertebral body were significantly reduced. There were no significant differences in cortical thickness, trabecular bone microstructure, or bone strength in the contralateral femur. At 4 days and 2 weeks, we observed significant increases in the serum levels of IL-6 and TNF-α. We also observed an increase in the osteoclast number of the L vertebral body at 4 days. These data indicate that systemic bone loss might increase with the number or severity of prior fractures, and the mechanism may be partly associated with an increased osteoclast number and a more severe inflammatory response. © 2020 American Society for Bone and Mineral Research (ASBMR).
Topics: Animals; Bone Density; Bone Diseases, Metabolic; Fractures, Multiple; Male; Mice; Mice, Inbred C57BL; Spinal Fractures
PubMed: 33181861
DOI: 10.1002/jbmr.4211 -
Pediatric Radiology May 2021Ehlers-Danlos syndrome is a real diagnosis that is erroneously used to explain multiple fractures in suspected child abuse. This paper reviews the clinical and molecular... (Review)
Review
Ehlers-Danlos syndrome is a real diagnosis that is erroneously used to explain multiple fractures in suspected child abuse. This paper reviews the clinical and molecular diagnostic criteria for Ehlers-Danlos syndrome. This knowledge can help prevent misdiagnosis and support clinicians when evaluating infants and young children with multiple fractures.
Topics: Child; Child Abuse; Child, Preschool; Ehlers-Danlos Syndrome; Humans; Infant; Radiologists
PubMed: 33999243
DOI: 10.1007/s00247-020-04856-1 -
Plastic and Aesthetic Nursing
Topics: Humans; Maxillary Fractures; Fractures, Multiple
PubMed: 36450081
DOI: 10.1097/PSN.0000000000000441