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European Journal of Orthopaedic Surgery... Aug 2023The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment...
PURPOSE
The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies.
METHODS
All adult (≥ 18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed.
RESULTS
A total of 223 patients were admitted with concurrent ipsilateral rib and scapula fractures. A total of 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only, and seven patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax and revision surgery) between groups.
CONCLUSION
Injury severity resulted in different treatment modalities. As a result, different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible; however, the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.
Topics: Adult; Humans; Rib Fractures; Retrospective Studies; Flail Chest; Thoracic Injuries; Fracture Fixation, Internal; Treatment Outcome; Length of Stay
PubMed: 36401000
DOI: 10.1007/s00590-022-03437-2 -
Endocrine Reviews Sep 2023Recent data suggest an increase in the overall incidence of parathyroid disorders, with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder....
Recent data suggest an increase in the overall incidence of parathyroid disorders, with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder. PHPT is associated with morbidities (fractures, kidney stones, chronic kidney disease) and increased risk of death. The symptoms of PHPT can be nonspecific, potentially delaying the diagnosis. Approximately 15% of patients with PHPT have an underlying heritable form of PHPT that may be associated with extraparathyroidal manifestations, requiring active surveillance for these manifestations as seen in multiple endocrine neoplasia type 1 and 2A. Genetic testing for heritable forms should be offered to patients with multiglandular disease, recurrent PHPT, young onset PHPT (age ≤40 years), and those with a family history of parathyroid tumors. However, the underlying genetic cause for the majority of patients with heritable forms of PHPT remains unknown. Distinction between sporadic and heritable forms of PHPT is useful in surgical planning for parathyroidectomy and has implications for the family. The genes currently known to be associated with heritable forms of PHPT account for approximately half of sporadic parathyroid tumors. But the genetic cause in approximately half of the sporadic parathyroid tumors remains unknown. Furthermore, there is no systemic therapy for parathyroid carcinoma, a rare but potentially fatal cause of PHPT. Improved understanding of the molecular characteristics of parathyroid tumors will allow us to identify biomarkers for diagnosis and novel targets for therapy.
Topics: Humans; Adult; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Parathyroidectomy; Genetic Testing; Renal Insufficiency, Chronic
PubMed: 36961765
DOI: 10.1210/endrev/bnad009 -
Instructional Course Lectures 2024Tweener fractures are defined as long bone or metadiaphyseal fractures in a pediatric population for which multiple treatment options may be used. It is important to...
Tweener fractures are defined as long bone or metadiaphyseal fractures in a pediatric population for which multiple treatment options may be used. It is important to focus specifically on patients nearing skeletal maturity who present with length-unstable femoral shaft fractures, both-bone forearm fractures, distal radius metadiaphyseal fractures, and adolescent tibial shaft fractures. Although there is no gold standard of treatment for any of these fracture patterns, it is important to discuss the risks and benefits, proper application, and important technical aspects of each treatment method to allow surgeons to make an informed decision and optimize surgical outcomes in this patient population.
Topics: Humans; Child; Adolescent; Tibial Fractures; Forearm; Radius Fractures; Treatment Outcome
PubMed: 38090917
DOI: No ID Found -
Hand Clinics Feb 2024Although distal radius fractures are common injuries, nonunion is extremely rare. Nonunion has been associated with increased metaphyseal comminution, concomitant distal... (Review)
Review
Although distal radius fractures are common injuries, nonunion is extremely rare. Nonunion has been associated with increased metaphyseal comminution, concomitant distal ulna fracture, inadequate immobilization, and patient factors. Nonunion should be suspected in patients with persistent pain, limited range of motion, and worsening wrist deformity after wrist remobilization. Treatment selection depends on presence of infection, status of the radiocarpal and distal radioulnar joints, and type of prior surgical interventions. Multiple surgical techniques exist for managing distal radius nonunions including open reduction and internal fixation of the nonunion site with/without bone graft augmentation versus total wrist arthrodesis.
Topics: Humans; Radius; Radius Fractures; Radiography; Ulna Fractures; Fracture Fixation, Internal; Range of Motion, Articular; Treatment Outcome
PubMed: 37979990
DOI: 10.1016/j.hcl.2023.08.002 -
Arthritis Research & Therapy Sep 2023Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures.
METHODS
We conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.
RESULTS
Of 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71).
CONCLUSION
Symptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.
Topics: Humans; Osteoarthritis, Hip; Accidental Falls; Risk Factors; Fractures, Bone; Osteoarthritis, Knee
PubMed: 37770969
DOI: 10.1186/s13075-023-03179-4 -
The American Surgeon Sep 2023The 5-factor modified frailty index (mFI-5) has been used as a prognostic tool to identify patients at higher risk for complications and mortality but has not been used...
The 5-factor modified frailty index (mFI-5) has been used as a prognostic tool to identify patients at higher risk for complications and mortality but has not been used to assess the relationship between frailty and extent of injury following ground-level falls. The aim of this study was to determine if mFI-5 is associated with increased risk for combined femur-humerus fractures compared to isolated femur fractures in geriatric patients. A retrospective analysis of 2017-2018 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) data identified 190 836 patients with femur fractures and 5054 patients with combined femur-humerus fractures. In multivariate analysis, gender was the only statistically significant predictor for risk of combined vs isolated fractures (OR 1.69, 95% CI [1.65, 1.74], < .001). While outcome data for the mFI-5 repeatedly shows increased risk for adverse events, this tool may over-estimate the disease specific risk factors rather than the overall frailty state of the patient and diminish its predictive power.
Topics: Humans; Aged; Frailty; Risk Assessment; Retrospective Studies; Femoral Fractures; Fractures, Multiple; Humeral Fractures; Postoperative Complications; Risk Factors
PubMed: 37225247
DOI: 10.1177/00031348231173967 -
Frontiers in Endocrinology 2023Alzheimer's disease (AD) is a neurodegenerative disorder that is the major cause of dementia in the aged population. Recent researches indicate that patients with AD... (Review)
Review
BACKGROUND
Alzheimer's disease (AD) is a neurodegenerative disorder that is the major cause of dementia in the aged population. Recent researches indicate that patients with AD have a significantly increased fracture risk, but the pathological mechanisms are still unclear.
OBJECTIVE
We systematically reviewed studies regarding bone fracture risk in AD to uncover links between the pathologies of osteoporosis and AD.
METHODS
We searched the literature using the databases of PubMed, Web of Science, Embase and Cochrane Library. Studies were included if they evaluated bone fracture risk in AD patients and if they explored the pathogenesis and prevention of bone fractures in these patients.
RESULTS
AD patients had a significantly higher risk of bone fractures than age-matched controls. Multiple factors contributed to the increased risk of bone fractures in AD patients, including the direct effects of amyloid pathology on bone cells, abnormal brain-bone interconnection, Wnt/β-catenin signalling deficits, reduced activity, high risk of falls and frailty, and chronic immune activity. Exercise, prevention of falls and fortified nutrition were beneficial for reducing the fracture risk in AD patients. However, the efficacy of anti-osteoporotic agents in preventing bone fractures should be further evaluated in AD patients as corresponding clinical studies are very scarce.
CONCLUSION
Alzheimer's disease patients have increased bone fracture risk and decreased bone mineral density owing to multiple factors. Assessment of anti-osteoporotic agents' efficacy in preventing bone fractures of AD patients is urgently needed.
Topics: Humans; Aged; Alzheimer Disease; Fractures, Bone; Osteoporosis; Amyloidogenic Proteins; Brain
PubMed: 37635980
DOI: 10.3389/fendo.2023.1190762 -
Hand Clinics Feb 2024Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly... (Review)
Review
Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly improve motion, grip strength, and patient-reported outcome measures. Meticulous planning and technical precision are required with the possible need for multiple surgical approaches and both volar and dorsal implants. Arthroscopic assistance may be used to visualize the joint and articular reduction. Custom 3-dimensional planning guides are helpful in addressing complex multiplanar deformities. Regardless, intervention may not change the natural history of these injuries and post-traumatic arthritis is to be expected.
Topics: Humans; Radius; Radius Fractures; Treatment Outcome; Fractures, Malunited; Wrist Joint; Range of Motion, Articular
PubMed: 37979992
DOI: 10.1016/j.hcl.2023.08.015 -
Journal of Orthopaedic Trauma Oct 2023The stability of intertrochanteric fractures depends upon multiple factors including the fracture displacement, location and pattern, the type of fixation used for...
The stability of intertrochanteric fractures depends upon multiple factors including the fracture displacement, location and pattern, the type of fixation used for stabilization, and the loading that the fracture undergoes postfixation. Traditional classification systems are of limited utility because they typically stratify intertrochanteric fractures as stable or unstable based purely on the fracture pattern without consideration of the stability after fixation. Biomechanical studies evaluating the stability of various fixation constructs should include physiologic loading, including rotation around the axis of the femoral neck, and reproduce clinical failure modes to be clinically relevant. A growing body of evidence indicates that the type of fixation substantially affects postoperative stability of intertrochanteric fractures.
Topics: Humans; Hip Fractures; Femur Neck; Postoperative Period
PubMed: 37710368
DOI: 10.1097/BOT.0000000000002675 -
Operative Orthopadie Und Traumatologie Dec 2023Distal ulna plate fixation for ulnar neck and head fractures (excluding ulnar styloid fractures) aims to anatomically reduce the distal ulna fracture (DUF) by open... (Review)
Review
OBJECTIVES
Distal ulna plate fixation for ulnar neck and head fractures (excluding ulnar styloid fractures) aims to anatomically reduce the distal ulna fracture (DUF) by open reduction and internal fixation, while obtaining a stable construct allowing functional rehabilitation without need for cast immobilization.
INDICATIONS
Severe displacement, angulation or translation, as well as unstable or intra-articular fractures. Furthermore, multiple trauma or young patients in need of quick functional rehabilitation.
CONTRAINDICATIONS
Inability to surgically address concomitant ipsilateral extremity fractures, thus, limiting early active rehabilitation. Stable, nondisplaced fractures. Need for bridging plate or external fixator of distal radiocarpal joint.
SURGICAL TECHNIQUE
An ulnar approach, with a straight incision between the extensor and flexor carpi ulnaris. Preservation of the dorsal branch of the ulnar nerve. Reduction and plate fixation with avoidance of plate impingement in the articular zone.
POSTOPERATIVE MANAGEMENT
Postoperatively, an elastic bandage is applied for the first 24-48 h. In isolated DUF with stable fixation, a postoperative splint is often unnecessary and should be avoided. For the first four weeks, only light weightbearing of everyday activities is allowed to protect the osteosynthesis. Thereafter, heavier weightbearing and activities are allowed and can be increased as tolerated.
RESULTS
The best available evidence likely shows that for younger patients with a DUF, with or without concomitant distal radius fractures, open reduction and internal fixation can be safely achieved with good functional outcome and acceptable union and complication rates as long as proper technique is ensured.
Topics: Humans; Treatment Outcome; Radius Fractures; Ulna Fractures; Wrist Joint; Fracture Fixation, Internal; Wrist Fractures; Bone Plates; Ulna
PubMed: 37943321
DOI: 10.1007/s00064-023-00835-5