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Journal of Ultrasound in Medicine :... Mar 2022Low-intensity pulsed ultrasound (LIPUS) is a developing technology, which has been proven to improve fracture healing process with minimal thermal effects. This... (Review)
Review
Low-intensity pulsed ultrasound (LIPUS) is a developing technology, which has been proven to improve fracture healing process with minimal thermal effects. This noninvasive treatment accelerates bone formation through various molecular, biological, and biomechanical interactions with tissues and cells. Although LIPUS treatment has shown beneficial effects on different bone fracture locations, only very few studies have examined its effects on deeper bones. This study provides an overview on therapeutic ultrasound for fractured bones, possible mechanisms of action, clinical evidences, current limitations, and its future prospects.
Topics: Bone and Bones; Fracture Healing; Fractures, Bone; Humans; Ultrasonic Therapy; Ultrasonic Waves
PubMed: 33949710
DOI: 10.1002/jum.15738 -
Injury Jun 2021Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of... (Review)
Review
Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of injury severity, comorbidities, patient medication and infection. The majority of nonunions occur after long bone fractures with the tibia, femur, forearm, humerus and clavicle predominating. Despite interest in the biological augmentation of fracture healing, the majority of nonunions can be effectively managed with conventional surgical techniques. In this review we present a review of risk factors for nonunion and the outcome following surgical management.
Topics: Clavicle; Fracture Healing; Fractures, Bone; Fractures, Ununited; Humans; Retrospective Studies; Risk Factors
PubMed: 33221036
DOI: 10.1016/j.injury.2020.11.029 -
Swiss Medical Weekly Jan 2020The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea... (Review)
Review
The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture. Undisplaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique. In most cases, hardware has to be removed after fracture healing because of implant-related pain. Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons. Failure to restore the articular surface contour results in posttraumatic arthritis. Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis. Typically, fracture classification and thus treatment choice are based on anteroposterior and lateral radiographs of the knee, but when computed tomography of the knee was performed pre-operatively, both the classification and treatment were modified thanks to a better understanding of the fracture complexity. The purpose of this article is to review current treatment strategies and optimise the management of adult patients with patellar fractures.
Topics: Fractures, Bone; Humans; Knee Injuries; Orthopedic Procedures; Patella
PubMed: 31940427
DOI: 10.4414/smw.2020.20165 -
Nature Reviews. Endocrinology Nov 2021Fracture risk is increased in patients with type 2 diabetes mellitus (T2DM). In addition, these patients sustain fractures despite having higher levels of areal bone... (Review)
Review
Fracture risk is increased in patients with type 2 diabetes mellitus (T2DM). In addition, these patients sustain fractures despite having higher levels of areal bone mineral density, as measured by dual-energy X-ray absorptiometry, than individuals without T2DM. Thus, additional factors such as alterations in bone quality could have important roles in mediating skeletal fragility in patients with T2DM. Although the pathogenesis of increased fracture risk in T2DM is multifactorial, impairments in bone material properties and increases in cortical porosity have emerged as two key skeletal abnormalities that contribute to skeletal fragility in patients with T2DM. In addition, indices of bone formation are uniformly reduced in patients with T2DM, with evidence from mouse studies published over the past few years linking this abnormality to accelerated skeletal ageing, specifically cellular senescence. In this Review, we highlight the latest advances in our understanding of the mechanisms of skeletal fragility in patients with T2DM and suggest potential novel therapeutic approaches to address this problem.
Topics: Absorptiometry, Photon; Animals; Bone Density; Bone and Bones; Diabetes Mellitus, Type 2; Fractures, Bone; Humans
PubMed: 34518671
DOI: 10.1038/s41574-021-00555-5 -
International Orthopaedics Apr 2021The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures. (Review)
Review
PURPOSE
The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures.
METHODS
Review of recent and historical literature.
RESULTS
Acetabular fractures are difficult to treat. The first descriptions of this injury already appeared in ancient Greek history, but intensive development started in the second half of the twentieth century after Judet and Letournel's seminal work. Their classification is still the gold standard today. It is actually a pre-operative planning system and is used to determine the most appropriate surgical approach. The therapy of choice for dislocated fractures is open reduction and internal fixation. Recent modern techniques based on high-tech computerized planning systems and 3D printing have been successfully integrated into orthopaedic trauma practice.
CONCLUSION
There is no ideal surgical approach for acetabulum fracture treatment, so new approaches have been developed in recent decades. The best outcome series have shown good or excellent results, between 70 and 80%.
Topics: Acetabulum; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Printing, Three-Dimensional; Spinal Fractures; Treatment Outcome
PubMed: 32964295
DOI: 10.1007/s00264-020-04806-4 -
Clinics in Orthopedic Surgery Jun 2020Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach... (Review)
Review
Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.
Topics: Clavicle; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators
PubMed: 32489533
DOI: 10.4055/cios20010 -
Journal of Orthopaedic Trauma Jan 2020Fracture-related infection (FRI) is a severe complication after bone injury and can pose a serious diagnostic challenge. Overall, there is a limited amount of scientific...
Fracture-related infection (FRI) is a severe complication after bone injury and can pose a serious diagnostic challenge. Overall, there is a limited amount of scientific evidence regarding diagnostic criteria for FRI. For this reason, the AO Foundation and the European Bone and Joint Infection Society proposed a consensus definition for FRI to standardize the diagnostic criteria and improve the quality of patient care and applicability of future studies regarding this condition. The aim of this article was to summarize the available evidence and provide recommendations for the diagnosis of FRI. For this purpose, the FRI consensus definition will be discussed together with a proposal for an update based on the available evidence relating to the diagnostic value of clinical parameters, serum inflammatory markers, imaging modalities, tissue and sonication fluid sampling, molecular biology techniques, and histopathological examination. Second, recommendations on microbiology specimen sampling and laboratory operating procedures relevant to FRI will be provided. LEVEL OF EVIDENCE:: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Topics: Biomarkers; Consensus; Fractures, Bone; Humans; Specimen Handling; Surgical Wound Infection
PubMed: 31855973
DOI: 10.1097/BOT.0000000000001614 -
Osteoporosis International : a Journal... Nov 2020In elderly women with osteoporosis, prior fracture, low BMD, impaired physical functioning, poorer general health, and recent falls were all direct predictors of...
UNLABELLED
In elderly women with osteoporosis, prior fracture, low BMD, impaired physical functioning, poorer general health, and recent falls were all direct predictors of imminent (in next year) fracture risk. Prior fracture, older age, worse health, impaired cognitive functioning, and recent falls indirectly increased imminent risk by reducing physical functioning/general health.
INTRODUCTION
This study was designed to examine determinants of imminent risk of osteoporotic fracture (i.e., next 1-2 years) in postmenopausal women.
METHODS
This retrospective cohort study used data from Caucasian women age 65 or older with osteoporosis who participated in the observational Study of Osteoporotic Fractures (SOF). We examined potential direct and indirect predictors of hip and nonvertebral fractures in 1-year follow-up intervals including anthropometric measures, bone mineral density (T-score), fracture since age 50, physical function, cognition, medical conditions, recent (past year) falls, and lifestyle factors. Clinically related variables were grouped into constructs via factor analysis. These constructs and selected individual variables were incorporated into a theoretical structural equation model to evaluate factors that influence imminent risk.
RESULTS
Among 2261 patients, 19.4% had a nonvertebral fracture and 5.5% had a hip fracture within 1 year of a study visit between 1992 and 2008. Prior fracture, lower T-scores, lower physical functioning, and recent falls all directly increased 1-year risk of nonvertebral fracture. For both nonvertebral and hip fractures, prior fracture and recent falls influenced risk indirectly through general health, while cognition influenced risk via physical functioning. Age influenced both physical functioning and general health.
CONCLUSIONS
Several established risk factors for 10-year fracture risk also played a role in predicting imminent risk of fracture (e.g., T-scores, prior fracture), as did falls, cognition, physical functioning, and general health. Fracture risk assessments should also consider falls and fall risk factors as well as established bone-related risk factors in assessing imminent fracture risk.
Topics: Activities of Daily Living; Aged; Bone Density; Female; Fractures, Bone; Humans; Middle Aged; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Postmenopause; Retrospective Studies; Risk Factors
PubMed: 32613410
DOI: 10.1007/s00198-020-05294-3 -
Lakartidningen Jun 2019This article suggests algorithms for diagnosis and treatment of scaphoid fractures. A clinical suspected scaphoid fracture without signs of fracture on conventional... (Review)
Review
This article suggests algorithms for diagnosis and treatment of scaphoid fractures. A clinical suspected scaphoid fracture without signs of fracture on conventional radiographs should have a supplementary MRI done within 5-7 days. Displaced fractures and all proximal fractures should be classified by CT. Fracture union should be evaluated by CT. 90 procent of non- or minimally displaced waist fractures are healed after 6 weeks of conservative treatment. Non- or minimally displaced fractures with signs of instability can be treated conservatively, but require prolonged immobilisation. Fractures with a displacement ≥1,5 mm as well as the majority of proximal scaphoid fractures should be treated surgically with internal fixation.
Topics: Acute Disease; Algorithms; Fracture Healing; Fractures, Bone; Humans; Magnetic Resonance Imaging; Practice Guidelines as Topic; Radiography; Return to Sport; Return to Work; Scaphoid Bone; Tomography, X-Ray Computed
PubMed: 31211404
DOI: No ID Found -
British Journal of Hospital Medicine... Aug 2023Fracture-related infection is a serious complication which can occur following musculoskeletal injury and is associated with significant morbidity. These complications...
Fracture-related infection is a serious complication which can occur following musculoskeletal injury and is associated with significant morbidity. These complications can be challenging to recognise, and experts have provided a clearer definition of fracture-related infection to help with the diagnosis and detection of these infections. This system includes clinical, radiological and laboratory-based diagnostic features which are either confirmatory or suggestive of fracture-related infection. Treatment requires a multifaceted approach with multidisciplinary involvement, and generally a combination of surgical techniques and prolonged antibiotics, the timing and choice of which should be optimised. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of fracture-related infections.
Topics: Humans; Fractures, Bone; Anti-Bacterial Agents; Laboratories; Orthopedics
PubMed: 37646543
DOI: 10.12968/hmed.2022.0545