-
JCEM Case Reports Sep 2023Children with hepatoblastoma have an increased incidence of fractures, but data are limited. Previous reports document an average of 4 fractures per child with...
Children with hepatoblastoma have an increased incidence of fractures, but data are limited. Previous reports document an average of 4 fractures per child with hepatoblastoma. We present a severe case of a premature 4-month-old with multiple fractures in the setting of Beckwith-Wiedemann syndrome and hepatoblastoma. Although prematurity is a known risk for metabolic bone disease, it did not entirely explain the severity. Our patient underwent chemotherapy and surgical resection of his hepatoblastoma. Once deemed stable, he received a dose of zoledronic acid (ZA). One month post treatment with ZA, a skeletal survey revealed healing of the rib and femoral fractures and no new fractures. Five months post ZA, the skeletal survey revealed no new fractures and motor development was appropriate. An extensive search revealed scant literature on the rate or cause of pathologic fractures in patients with newly diagnosed hepatoblastoma. A better understanding of fracture risk in this population may guide prevention strategies, screening, and treatment. In our case, prematurity and substantial chronic illness may have compounded the known fracture risk associated with hepatoblastoma and may provide insight into the pathophysiology and prevention of fractures in this setting.
PubMed: 37908208
DOI: 10.1210/jcemcr/luad110 -
Skull Fracture Patterns and Morphologies Among Fatal Motorcycle Traffic Accident Victims in Vietnam.The American Journal of Forensic... Mar 2021We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective...
We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective cross-sectional study based on forensic reports of fatal motorcycle accident victims. Between January 2013 and August 2019, a total of 226 fatal motorcycle accident patients with skull fracture diagnoses were enrolled. Linear and depressed fractures were the common patterns (46.0% and 37.2% of cases, respectively), whereas stellate (11.5%) fractures were rare. Fractures of the temporal bone (68.6% of cases) and basilar skull (60.6%) were the most common, whereas fractures of the parietal bone were the least common (9.7%). Two or more patterns of skull fracture were recorded in 25.5% of cases, and 2 or more fracture locations were recorded in 76.6% of cases. Fractures of the parietal bone were associated with victims not wearing a helmet. In addition, fractures of the basilar skull were more likely to occur among victims with alcohol consumption. We found the common pattern of skull fractures was linear and depressed fractures, and the common location of skull fractures was temporal and basilar bone. Further studies that include larger sample sizes and collect more information should be conducted to better understand relationships between skull fractures and related factors.
Topics: Accidents, Traffic; Adult; Alcohol Drinking; Cross-Sectional Studies; Female; Fractures, Multiple; Humans; Male; Middle Aged; Motorcycles; Retrospective Studies; Skull Fractures; Vietnam; Young Adult
PubMed: 33074839
DOI: 10.1097/PAF.0000000000000627 -
Evidence-based Complementary and... 2021To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of...
Analysis of Influencing Factors of Medication Compliance in Patients with Recurrent Vertebral Fractures after Percutaneous Kyphoplasty and the Role of Family-Centered Education Intervention.
OBJECTIVE
To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of family-centered education intervention.
METHODS
From January 2018 to January 2021, the general disease-related data survey form and medication compliance questionnaire made by our hospital were used to evaluate the scores of 198 patients with recurrent vertebral fractures after PKP in the Department of Orthopedics of our hospital. Single-factor and multiple linear regression analyses were used to explore the influencing factors of medication compliance in patients with recurring vertebral fractures after PKP. From 198 patients, 80 eligible patients were selected for further research. According to a random number table method, they were divided into the control group ( = 40) given only antiosteoporosis drug treatment and care and the experimental group ( = 40) combined with family-centered education intervention. After 12 months of intervention, the two groups were evaluated for their knowledge of osteoporosis, medication compliance, and physical health.
RESULTS
Of the 198 patients, only 65 had good medication compliance, 90 had poor medication compliance, and 43 were acceptable. Univariate analysis showed that the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP include the patient's education, living style, per capita monthly income, combined other diseases, number of hospitalizations, and time since the last hospitalization ( < 0.05). Multiple linear regression analysis showed that patients with recurring vertebral fractures after PKP with high education, living with spouse or children, combined with other diseases, frequent hospitalizations, and short time from the last hospitalization had higher medication compliance ( < 0.05). After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group ( < 0.0001). After the intervention, the medication compliance and health status of the experimental group were significantly better than those of the control group ( < 0.05).
CONCLUSION
The medication compliance of patients with recurrent vertebral fractures after PKP is generally poor, and medical staff need to take targeted interventions based on the main factors that affect the patients' medication compliance. Family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP.
PubMed: 34721630
DOI: 10.1155/2021/3974674 -
Osteoporosis International : a Journal... Nov 2022Childhood fracture is common, but whether it predicts adult fracture is not clear. Repeat childhood fracture was associated with adult (≤ 45 years) fracture, and in...
UNLABELLED
Childhood fracture is common, but whether it predicts adult fracture is not clear. Repeat childhood fracture was associated with adult (≤ 45 years) fracture, and in women, lower areal bone density was associated with repeat childhood fracture. Identifying fracture-prone children can modify adult fracture risk management.
INTRODUCTION
A quarter of boys and 15% of girls will suffer multiple fractures, but it is not clear whether multiple fractures during growth predict fracture risk and areal bone density in adulthood. This study evaluated whether children who repeatedly fracture were at increased risk of low areal bone density, abnormal body composition, and fractures by age 45.
METHODS
A subsample of a large birth cohort study with childhood fracture cases had areal bone density assessed at age 45 years. Participants were questioned regularly across their lifetime about fractures during childhood (ages 0-18 years of age) and adulthood (any fracture between 18 and 45 years). The number of fractures was collapsed into three categories: no fractures; 1 fracture; and > 1 fracture, separately for child and adult groups.
RESULTS
At age 45 years, areal bone mineral density (g/cm) and body composition were measured with dual X-ray absorptiometry in n = 555 participants. Compared to no fractures, twice as many girls (14% vs 7%, P = 0.156) and boys (31.4% vs 14.1%, P = 0.004) who repeatedly fractured in childhood sustained multiple fractures as adults. Both girls and boys who were fracture-free tended to remain fracture-free as adults (79.8% compared with 62.8%, P = 0.045, and 64.8% compared with 51.4%, P = 0.025, in males and females, respectively). Participants were more than twice as likely to fracture repeatedly as adults if they had sustained multiple fractures as a child (OR 2.5 95% CI: 1.4, 4.6). Women who repeatedly fractured during childhood had lower areal bone density, whereas repeated fracturing during childhood was not associated with areal bone density or body composition in men, even after adjustment for other factors known to influence fracture history.
CONCLUSION
Childhood fracture history is associated with persistent skeletal fragility in adulthood (≤ 45 years), even after adjustment for behavioral and demographic factors known to influence fracture history.
Topics: Absorptiometry, Photon; Adolescent; Adult; Body Composition; Bone Density; Child; Child, Preschool; Cohort Studies; Female; Fractures, Bone; Fractures, Multiple; Humans; Infant; Infant, Newborn; Male; Middle Aged
PubMed: 35918403
DOI: 10.1007/s00198-022-06500-0 -
International Journal of Sport... Sep 2022Bone stress injuries (BSIs) are common among athletes and have high rates of recurrence. However, risk factors for multiple or recurrent BSIs remain understudied. Thus,...
Bone stress injuries (BSIs) are common among athletes and have high rates of recurrence. However, risk factors for multiple or recurrent BSIs remain understudied. Thus, we aimed to explore whether energy availability, menstrual function, measures of bone health, and a modified Female Athlete Triad Cumulative Risk Assessment (CRA) tool are associated with a history of multiple BSIs. We enrolled 51 female runners (ages 18-36 years) with history of ≤1 BSI (controls; n = 31) or ≥3 BSIs (multiBSI; n = 20) in this cross-sectional study. We measured lumbar spine, total hip, and femoral neck areal bone mineral density by dual-energy X-ray absorptiometry, bone material strength index using impact microindentation, and volumetric bone mineral density, microarchitecture, and estimated strength by high-resolution peripheral quantitative computed tomography. Participants completed questionnaires regarding medical history, low-energy fracture history, and disordered eating attitudes. Compared with controls, multiBSI had greater incidence of prior low-energy fractures (55% vs. 16%, p = .005) and higher modified Triad CRA scores (2.90 ± 2.05 vs. 1.84 ± 1.59, p = .04). Those with multiBSI had higher Eating Disorder Examination Questionnaire (0.92 ± 1.03 vs. 0.46 ± 0.49, p = .04) scores and a greater percentage difference between lowest and highest body mass at their current height (15.5% ± 6.5% vs. 11.5% ± 4.9% p = .02). These preliminary findings indicate that women with a history of multiple BSIs suffered more prior low-energy fractures and have greater historical and current estimates of energy deficit compared with controls. Our results provide strong rationale for future studies to examine whether subclinical indicators of energy deficit contribute to risk for multiple BSIs in female runners.
Topics: Absorptiometry, Photon; Adolescent; Adult; Athletes; Bone Density; Cross-Sectional Studies; Female; Female Athlete Triad Syndrome; Fractures, Stress; Humans; Young Adult
PubMed: 35523419
DOI: 10.1123/ijsnem.2021-0323 -
Cureus Apr 2023Bone disease and bone loss are common features in certain monogenic diseases such as RASopathies, including neurofibromatosis (NF). Similarly, bone complications are...
Bone disease and bone loss are common features in certain monogenic diseases such as RASopathies, including neurofibromatosis (NF). Similarly, bone complications are frequent in hemoglobinopathies, another group of Mendelian diseases. This paper reports a young patient with both NF and hemoglobin SC (HbSC) diseases who had multiple vertebral fractures with osteopenia. We also discuss the cellular and pathophysiological mechanisms underlying both diseases and the factors responsible for bone pain and low bone mass in NF and hemoglobinopathies such as HbSC. This case emphasizes the importance of careful evaluation and management of osteoporosis in patients with HbSC and NF1, as both are relatively common monogenic diseases in certain communities.
PubMed: 37223189
DOI: 10.7759/cureus.37868 -
Archives of Gerontology and Geriatrics 2020The study aimed to evaluate the impact of osteoporosis (OP) medication persistence on subsequent fractures and all-cause mortality in patients with hip fracture.
OBJECTIVE
The study aimed to evaluate the impact of osteoporosis (OP) medication persistence on subsequent fractures and all-cause mortality in patients with hip fracture.
METHODS
In this retrospective cohort study, we included patients aged ≥ 40 years with fragility hip fracture from the Taiwan's National Health Insurance Research Database. OP medication persistence was categorized as yes (≥ 12 months) or no (< 12 months). A multivariate Cox proportional hazard model was used to evaluate the association between OP medication persistence and recurrent fractures (including hip, vertebral, and upper and lower limb fractures) and all-cause mortality.
RESULTS
A total of 946 patients were included in the study (86.5 % of them aged ≥ 65 years) and 210 patients persistently received OP medications. Persistent OP medication use was associated with lower fracture risk (adjusted hazard ratio [aHR] = 0.64; 95 % CI = 0.41-0.99; P = .043) in the follow-up period. The strongest predictors for all-cause mortality were age ≥ 80 years (HR = 5.68, 95 % CI = 1.36-23.64, P = .017), male sex (HR = 1.55; 95 % CI = 1.18-2.03; P = .002), and Charlson Comorbidity Index ≥ 3 (aHR = 1.56; 95 % CI = 1.07-2.27; P = .022). Kaplan-Meier curves showed a lower cumulative incidence of recurrent fractures in the persistent group than that in the non-persistent group (P = .028).
CONCLUSION
Persistent OP medication use was associated with a lower risk of recurrent fractures but not with mortality in patients with hip fracture.
Topics: Adult; Aged; Female; Hip Fractures; Humans; Incidence; Male; Middle Aged; Osteoporosis; Osteoporotic Fractures; Proportional Hazards Models; Retrospective Studies
PubMed: 32058125
DOI: 10.1016/j.archger.2020.104021 -
Plastic and Reconstructive Surgery May 2021Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures...
BACKGROUND
Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients.
METHODS
This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures.
RESULTS
Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients.
CONCLUSIONS
High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Topics: Child; Child, Preschool; Cohort Studies; Ethmoid Bone; Female; Fractures, Multiple; Humans; Male; Maxillary Fractures; Nasal Bone; Orbital Fractures; Retrospective Studies; Skull Fractures; Treatment Outcome; Zygomatic Fractures
PubMed: 33835093
DOI: 10.1097/PRS.0000000000007836 -
Ground Water Mar 2023Mass transport and heat transfer in the single fracture situated in the rock matrix have been investigated extensively in the past decades. Extended from the single...
Mass transport and heat transfer in the single fracture situated in the rock matrix have been investigated extensively in the past decades. Extended from the single fracture, the model of parallel fractures in the rock matrix considers the interactions of multiple fractures and the ambient rock matrix. Heat transfer in such discrete fractures is important to understand thermal energy transfer in the fractured porous media. In this study, an analytical solution is developed for transient heat transfer in discrete parallel fractures in the rock matrix. The newly proposed model accounts for thermal convection, conduction, and dispersion in the fractures, transverse thermal conduction in the rock matrix, and the interactions between parallel fractures. The analytical solutions of the spatiotemporal temperature distributions in the fractures and rock matrix are derived in the Laplace domain and verified with the previous study. The results illustrate that: (1) the fracture aperture and spacing are important to the temperature evolutions in the system. Heat transfers faster when discrete parallel fractures are wide and closely spaced; (2) different roles of longitudinal thermal conduction are observed at high and low flow velocities in the fractures; (3) thermal dispersivity in the fractures is important for temperature evolution and should not be ignored; (4) when the fractures are closely spaced, transverse thermal conduction in the rock matrix has minor influence on fracture temperature. It becomes important when the fractures are sparsely distributed; and (5) the sensitivity analysis indicates that the parallel fracture-rock matrix is most sensitive to fracture thermal dispersivity.
Topics: Models, Theoretical; Hot Temperature; Groundwater; Temperature; Porosity
PubMed: 35025108
DOI: 10.1111/gwat.13174 -
Annals of Hematology Jun 2023The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the... (Review)
Review
Risk-benefit ratio of percutaneous kyphoplasty and percutaneous vertebroplasty in patients with newly diagnosed multiple myeloma with vertebral fracture: a single-center retrospective study.
The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving antimyeloma therapy. The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the nonsurgical group in the NDMM patients. Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and nonsurgical groups was 66 and 62 years, respectively (p = 0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II + III 96.9% vs. 71.8%, p = 0.03; RISS stage III 96.9% vs. 71%, p = 0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short-term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months). Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the nonoperative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the nonsurgical group (75% vs. 2.9%, p = 0.001). The time interval between the first visit and definitive diagnosis of MM was longer in the surgical group than in the nonsurgical group (6.1 months vs. 1.6 months, p = 0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the nonsurgical group (48.2 months vs. 66 months, p = 0.04). Application of PKP/PVP surgery for pain relief in NDMM patients without antimyeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with antimyeloma therapy prior to any consideration for PKP/PVP surgery.
Topics: Humans; Kyphoplasty; Spinal Fractures; Retrospective Studies; Vertebroplasty; Fractures, Compression; Multiple Myeloma; Treatment Outcome; Pain; Risk Assessment; Osteoporotic Fractures
PubMed: 36997718
DOI: 10.1007/s00277-023-05202-9