-
BMJ Case Reports Jul 2021Heterotopic ossification (HO) is a rare sequela of sports injuries with a predominance in young active males located within bulky muscle planes. In most cases it is... (Review)
Review
Heterotopic ossification (HO) is a rare sequela of sports injuries with a predominance in young active males located within bulky muscle planes. In most cases it is self-limiting and spontaneous resolution can occur. Fractures of HO are sparsely reported within the literature. We present a rare case of a professional athlete with a recurrent fracture of mature HO within the deep fascial plane between the anterior and posterior thigh compartments. The heterotopic mass and associated fracture had restricted return to sport and thus necessitated surgical management. The athlete successfully returned to sport following surgical excision with postoperative medical therapy to inhibit recurrence.
Topics: Athletes; Fractures, Bone; Humans; Male; Ossification, Heterotopic; Retrospective Studies; Sports; Thigh
PubMed: 34210702
DOI: 10.1136/bcr-2021-242715 -
European Review For Medical and... Nov 2022The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis...
OBJECTIVE
The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis location, on the patient's status and on the residual functional capacity. Metadiaphysis is an area of conflict in the choice between megaprosthesis implant and intramedullary nail osteosynthesis. This study compares these two surgical procedures in terms of reacquired functionality and local control of metastasis.
PATIENTS AND METHODS
Thirty-eight patients (17 males and 21 females; mean age: 66 years old) treated in our institution between January 2010 and December 2020 for pathological humeral metadiaphyseal fractures caused by metastasis, were included in this study. We choose the Musculoskeletal Tumor Society rating system (MSTS) and the Quick Disability of Arm-Shoulder-Hand (QuickDASH) scores for the evaluation of the upper limb function after surgery.
RESULTS
Eighteen (47%) pathological fractures were treated by resection and megaprosthesis implantation, twenty (53%) were treated by medullary nail osteosynthesis. A reduction in pain and greater mechanical stability in the immediate post-operative period was found in all patients. Twenty-two patients died (58%) and sixteen survived (42%). Long-term functional recovery of patients undergoing osteosynthesis is greater than megaprothesis group.
CONCLUSIONS
Both medullary nail osteosynthesis and resection and megaprosthesis implantation guarantee excellent recovery at 72 months after surgery, improvement in quality of life and pain relief. Patients treated with osteosynthesis showed a great short-term functional recovery since the joint portion of the limb is not involved, whereas patients treated with megaprosthesis showed better local oncologic control. It is therefore possible to define the type of treatment not only on the localization of the fracture (diaphysis or epiphysis) but above all on the conditions and characteristics of the patient.
Topics: Adult; Female; Male; Humans; Aged; Shoulder; Fractures, Spontaneous; Quality of Life; Humerus; Epiphyses; Fractures, Bone; Bone Neoplasms; Upper Extremity; Pain
PubMed: 36448865
DOI: 10.26355/eurrev_202211_30288 -
Age and Ageing Jun 2021Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with... (Review)
Review
BACKGROUND
Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group.
METHODS
MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term 'non-weight bearing'. All study types were included. Analysis was by narrative synthesis.
RESULTS
No papers were identified from a search using the key phrase 'non-weight bearing'. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing.
DISCUSSION
These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process.
Topics: Aged; Consensus; Fractures, Bone; Frailty; Humans; Lower Extremity; Nutritional Status
PubMed: 33993209
DOI: 10.1093/ageing/afab071 -
European Review For Medical and... Oct 2014Normal healing of fractures is a complex process that relies heavily on a cascade of consecutive activations of immune cells and mediators. This mechanism somewhat... (Review)
Review
Normal healing of fractures is a complex process that relies heavily on a cascade of consecutive activations of immune cells and mediators. This mechanism somewhat overlaps with all processes related to bone metabolism, from the absence of unions to heterotopic ossifications and osteoporosis. We aimed to review and describe this intricate process of bone metabolism with particular focus on abnormal function and to exemplify it with a series of clinical cases which could justify their practical importance. The elbow has great potential for fracture healing but it is very sensitive to prolonged immobilization which can easily lead to intra-articular adherences and stiffness. In addition, the interosseus membrane facilitates communication between the regenerative environments when both radius and ulna are fractured. Such extensive injuries, around the proximal forearm, can lead to heterotopic ossifications and synostosis, which decrease sagittal range of motion through impingement and even block rotational movement through bone bridges. Increased knowledge and awareness of the biological mechanism of fracture healing, will have great improvement in the pharmacological adjuvant treatment of elbow injuries.
Topics: Animals; Elbow; Fracture Healing; Fractures, Bone; Humans; Osteoporosis; Range of Motion, Articular; Elbow Injuries
PubMed: 25339478
DOI: No ID Found -
Hand Surgery & Rehabilitation Oct 2023Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome.
OBJECTIVES
Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome.
MATERIAL AND METHODS
Children and adolescents up to the age of 16 years who sustained a carpal fracture other than in the scaphoid between 2004 and 2021 were reviewed in this single-center retrospective study.
RESULTS
In a series of 209 children and adolescents with carpal fractures, 22 had fractures other than the scaphoid. Mean age was 13 years (range 8-16) years, with a total of 41 fractures, with highest incidences for the capitate (10), trapezium (6), triquetrum (4) and pisiform (4). Twenty-nine of these 41 fractures were missed on initial X-ray. Non-displaced fractures were treated with a short arm spica cast including the thumb. Four patients were operated on for displacement fracture or carpometacarpal subluxation. All fractures united, and patients returned to full activities. At the final consultation at a median 14 months (range 6-89) post-injury, all patients with non-displaced fractures were free of symptoms, with excellent Mayo Wrist Scores (MWS). However, three patients with operated trapezium fractures developed early radiological signs of osteoarthritis, two of them with residual pain and MWS rated only good.
CONCLUSION
Non-displaced pediatric carpal fractures treated by forearm cast have excellent prognosis. Fractures of the trapezium with displacement or first carpometacarpal subluxation incur a risk of osteoarthritis despite anatomical reduction and internal fixation.
Topics: Adolescent; Humans; Child; Retrospective Studies; Fractures, Bone; Scaphoid Bone; Wrist; Wrist Injuries; Joint Dislocations; Hand Injuries; Osteoarthritis
PubMed: 37356568
DOI: 10.1016/j.hansur.2023.06.009 -
International Orthopaedics Nov 2012Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for... (Review)
Review
Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for mangled upper extremities, amputation and salvage reconstruction. With advances in our understanding of human physiology and basic science, and with the development of new fixation devices, modern microsurgical techniques and the possibility of different types of bony and soft tissue reconstruction, the clinical and functional outcomes are often good, and certainly preferable to those of contemporary prosthetics. Early or even immediate (emergency) complete upper extremity reconstruction appears to give better results than delayed or late reconstruction and should be the treatment of choice where possible. Before any reconstruction is attempted, injuries to other organs must be excluded. Each step in the assessment and treatment of a mangled extremity is of utmost importance. These include radical tissue debridement, prophylactic antibiotics, copious irrigation with a lavage system, stable bone fixation, revascularization, nerve repair, and soft tissue coverage. Well-planned and early rehabilitation leads to a better functional outcome. Despite the use of scoring systems to help guide decisions and predict outcomes, the decision to reconstruct or to amputate still ultimately lies with the surgical judgment and experience of the treating surgeon.
Topics: Amputation, Surgical; Antibiotic Prophylaxis; Clinical Competence; Debridement; Decision Making; Fracture Fixation, Internal; Fractures, Open; Humans; Lacerations; Limb Salvage; Postoperative Complications; Plastic Surgery Procedures; Recovery of Function; Soft Tissue Injuries; Therapeutic Irrigation; Time-to-Treatment; Trauma Severity Indices; Upper Extremity
PubMed: 22923227
DOI: 10.1007/s00264-012-1638-y -
BMC Public Health Sep 2022Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb...
BACKGROUND
Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb fractures are common in adolescents due to various risk factors. Many injuries are predictable and can be prevented by identifying the risk factors. The aim of the study was to determine the risk factors for upper limb fractures among adolescents in Sri Lanka.
METHODS
A case control study was undertaken with 450 cases and 450 controls. Cases were recruited consecutively from all major hospitals among the adolescent victims who had admitted with newly diagnosed upper limb fractures in the district of Colombo. Controls were apparently healthy adolescents from the same district and excluded who had previous upper limb fractures. The age and gender were not matched in selecting controls since these two factors were potential risk factors for adolescent fractures according to previous literature. Risk factors for upper limb fractures were assessed by odds ratio (OR) with 95% confidence interval (CI) and adjusted for possible confounding by performing logistic regression analysis.
RESULTS
The mean age of the cases was 13.62 years with a Standard Deviation (SD) of 2.8 and controls was 12.75 years (SD = 2.7) respectively. Having a high standard of living index (OR = 3.52; 95%CI: 2.3-5.2, p < 0.001), being in a high social class category (social class I & II) (OR = 2.58, 95%CI: 1.7-3.92, p < 0.001), engage in physical or sports activity (OR = 9.36; 95%CI: 3.31-26.47, p < 0.001), watching television (OR = 1.95; 95%CI: 1.18 -3.22, p = 0.009), playing video or computer games (OR = 2.35; 95%CI: 1.7-3.24, p < 0.001), and attending extra classes (OR = 1.82; 95%CI: 1.2-2.7, p = 0.007) were risk factors for having a upper limb fracture. Risk factors for upper limb fractures following adjusted for confounders were siblings in the family (aOR = 11.62, 95% CI: 6.95-41.29, p = 0.03) and attend extra classes after school hours (aOR = 2.51, 95%CI: 0.68-0.93, p = 0.04). Two significant effect modifications between being a Buddhist and low standard of living index (p < 0.001) and having one sibling in the family and attend extra classes after school hours (p = 0.01) were observed.
CONCLUSIONS
Modifiable risk factors in relation to lifestyle factors and socioeconomic position were important determinants of upper limb fracture risk in adolescents. Many fractures can be prevented by strengthening awareness programmes in the community.
Topics: Adolescent; Case-Control Studies; Fractures, Bone; Humans; Risk Factors; Sri Lanka; Upper Extremity
PubMed: 36162991
DOI: 10.1186/s12889-022-14154-0 -
The Veterinary Clinics of North... Mar 1996Metacarpal and metatarsal fractures are usually amenable to external coaptation using a short or full limb polyurethane resinimpregnated knitted fiberglass fabric cast.... (Review)
Review
Metacarpal and metatarsal fractures are usually amenable to external coaptation using a short or full limb polyurethane resinimpregnated knitted fiberglass fabric cast. The prognosis for long-term pain-free survival is excellent for closed fractures and fair to good for open fractures managed in the manner. Surviving animals generally are not lame and do not demonstrate significant limb deformity or limb shortening and generally become completely productive. Even considering the narrow profit margin involved when treating cattle with serious injuries, this method of fracture management is usually economically and technically feasible.
Topics: Animals; Animals, Newborn; Cattle; External Fixators; Female; Fractures, Bone; Metacarpus; Metatarsus; Radiography
PubMed: 8705802
DOI: 10.1016/s0749-0720(15)30443-6 -
BMC Geriatrics Feb 2016Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can... (Randomized Controlled Trial)
Randomized Controlled Trial
Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial.
BACKGROUND
Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability and falls in older people following fall-related lower limb or pelvic fracture. Cost-effectiveness of the intervention will also be investigated.
METHODS/DESIGN
A randomised controlled trial with concealed allocation, assessor blinding for physical performance tests and intention-to-treat analysis will be conducted. Three hundred and fifty people aged 60 years and over with a fall-related lower limb or pelvic fracture, who are living at home or in a low care residential aged care facility and have completed active rehabilitation, will be recruited. Participants will be randomised to receive a 12-month intervention or usual care. The intervention group will receive ten home visits from a physiotherapist to prescribe an individualised exercise program with motivational interviewing, plus fall prevention education through individualised advice from the physiotherapist or attendance at the group based "Stepping On" program (seven two-hour group sessions). Participants will be followed for a 12-month period. Primary outcome measures will be mobility-related disability and falls. Secondary outcomes will include measures of balance and mobility, falls risk, physical activity, walking aid use, frailty, pain, nutrition, falls efficacy, mood, positive and negative affect, quality of life, assistance required, hospital readmission, and health-system and community-service contact.
DISCUSSION
This study will determine the effect and cost-effectiveness of this exercise self management intervention on mobility-related disability and falls in older people who have recently sustained a fall-related lower limb or pelvic fracture. The results will have implications for the design and implementation of interventions for older people with fall related lower limb fractures. The findings of this study will be disseminated in peer-reviewed journals and through professional and scientific conferences.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry: ACTRN12610000805077.
Topics: Accidental Falls; Aged; Aged, 80 and over; Australia; Disease Management; Exercise Therapy; Female; Fractures, Bone; Humans; Lower Extremity; Male; Middle Aged; Mobility Limitation; New Zealand; Quality of Life; Self Care; Single-Blind Method
PubMed: 26838998
DOI: 10.1186/s12877-016-0206-5 -
The Journal of Spinal Cord Medicine Jan 2022The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the...
CONTEXT/OBJECTIVE
The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the most common fracture location in SCI/D. Physical therapists (PTs) and occupational therapists (OTs) play an important role in rehabilitating LE fractures in Veterans with SCI/D. This paper describes their role in assisting persons with SCI/D and LE fractures to return to previous function and levels of participation.
DESIGN
Cross-sectional semi-structured interviews were conducted by telephone. Setting: VA SCI centers.
PARTICIPANTS
Purposive sample of therapists (PTs and OTs) experienced in LE fracture rehabilitation in SCI/D Interventions: NA.
OUTCOME MEASURES
Coding of responses used a data-driven thematic and deductive approach, dictated by a semi-structured interview guide addressing the entire treatment process.
RESULTS
Participants strongly advocated for early PT/OT involvement in post-fracture rehabilitation in order to recommend braces and devices to minimize skin breakdown, and needs for patient equipment, skills training and/or caregiver assistance resulting from post-fracture mobility changes. Seating specialists should be involved in post-fracture seating assessments in wheelchair users to address changes in alignment, deformities, limb length discrepancies and/or seating posture during and following fracture management.
CONCLUSION
PTs and OTs are critical in rehabilitating LE fractures in persons with SCI/D and LE fractures, bringing expertise in patient function, ambulatory status, transfer strategies, mobility equipment, spasticity, lifestyle, and home and caregiver support. Involving them early in the rehabilitation process, along with orthopedic surgeons, physiatrists and other SCI clinicians can address the multiple and often unique issues that occur in managing fractures in this population.
Topics: Cross-Sectional Studies; Fractures, Bone; Humans; Lower Extremity; Occupational Therapists; Spinal Cord Diseases; Spinal Cord Injuries; Veterans
PubMed: 33705274
DOI: 10.1080/10790268.2021.1890680