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International Journal of Molecular... Dec 2021There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in... (Review)
Review
There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.
Topics: Body Mass Index; Body Weight; Fractures, Bone; Humans; Obesity; Risk Factors
PubMed: 34948466
DOI: 10.3390/ijms222413662 -
Orthopaedics & Traumatology, Surgery &... Feb 2021Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and... (Review)
Review
Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and ligament lesions, with high more-or-less long-term risk of residual instability, stiffness, pain and osteoarthritis. During the last 20 years, pathologic, biomechanical and clinical knowledge has greatly progressed. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. Finally, we propose a simple algorithm to guide repair.
Topics: Elbow; Elbow Joint; Fracture Fixation, Internal; Humans; Joint Dislocations; Radius Fractures; Range of Motion, Articular; Treatment Outcome; Ulna Fractures
PubMed: 33333276
DOI: 10.1016/j.otsr.2020.102784 -
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 -
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 -
Journal of Sport and Health Science May 2023Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls.
METHODS
Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies.
RESULTS
The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5-30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion, and hip adduction in the TSF group.
CONCLUSION
Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.
Topics: Humans; Fractures, Stress; Biomechanical Phenomena; Retrospective Studies; Prospective Studies; Foot; Cumulative Trauma Disorders
PubMed: 36481573
DOI: 10.1016/j.jshs.2022.12.002 -
Minerva Anestesiologica Jul 2019Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with... (Review)
Review
Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. Ultrasound imaging techniques display a plethora of advantages that have pervaded regional anesthesia practice. In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed.
Topics: Acute Pain; Analgesia; Anesthesia, Conduction; Brachial Plexus; Compartment Syndromes; Emergency Medical Services; Fractures, Bone; Humans; Lower Extremity; Nerve Block; Pain Management; Pain, Postoperative; Patient Positioning; Peripheral Nerve Injuries; Peripheral Nerves; Ultrasonography, Interventional; Upper Extremity
PubMed: 30735016
DOI: 10.23736/S0375-9393.19.13145-8 -
Ugeskrift For Laeger Jan 2023Diaphyseal forearm fractures in children are common and knowledge of both ordinary and rare variations of these are important to deliver the best treatment as presented... (Review)
Review
Diaphyseal forearm fractures in children are common and knowledge of both ordinary and rare variations of these are important to deliver the best treatment as presented in this review. Closed reduction and cast immobilisation are effective and well-documented treatments for most fractures. Fractures which cannot be sufficiently treated in a cast are stabilised with elastic stable intramedullary nailing which is an effective treatment with a low complication rate. The focus in reduction is to correct alignment, displacement, and rotation to restore normal function of the forearm.
Topics: Child; Humans; Forearm; Ulna Fractures; Radius Fractures; Bone Nails; Treatment Outcome
PubMed: 36760151
DOI: No ID Found -
British Journal of Hospital Medicine... Sep 2022The forearm is the most common site of fracture in children. At the time of initial assessment, a thorough examination and neurovascular assessment of the limb is... (Review)
Review
The forearm is the most common site of fracture in children. At the time of initial assessment, a thorough examination and neurovascular assessment of the limb is necessary. X-rays allow evaluation of the fracture location and type, in addition to the degree of displacement. With the help of intranasal opiates, manipulation of fracture fragments can be performed in the emergency department. Immobilisation in plaster is the gold standard treatment for paediatric forearm fractures where the degree of displacement is within acceptable parameters. Manipulation and casting should be followed by orthogonal radiographs and a repeated neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge and the child should be reviewed in fracture clinic within a week of the injury. This article reviews the British Orthopaedic Association Standards for Trauma and Orthopaedics for the early management of paediatric forearm fractures that do not require operative management.
Topics: Child; Forearm; Forearm Injuries; Humans; Opiate Alkaloids; Radiography; Radius Fractures
PubMed: 36193916
DOI: 10.12968/hmed.2021.0564 -
Ugeskrift For Laeger Feb 2024Beak fractures represent a rare subtype of calcaneal fractures with potential risk of soft tissue complications due to compromised local perfusion. Early diagnosis and...
Beak fractures represent a rare subtype of calcaneal fractures with potential risk of soft tissue complications due to compromised local perfusion. Early diagnosis and timely intervention are crucial to prevent necrosis, infection, and soft tissue defects. This case report describes a 71-year-old male with a beak fracture and delayed intervention with reoccurring soft tissue defects. Given the rarity of the condition, atypical presentation and need for urgent intervention, this emphasizes the importance of awareness of beak fractures of the calcaneus.
Topics: Animals; Male; Humans; Aged; Calcaneus; Beak; Lower Extremity; Ankle Injuries; Knee Injuries; Fractures, Bone
PubMed: 38445338
DOI: 10.61409/V10230635 -
Ugeskrift For Laeger Jan 2023Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review... (Review)
Review
Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review describes a broad range of techniques for treatment ranging from immobilization in a cast to open reduction and fixation with K-wires, screws, or flexible intramedullary nails. Premature growth arrest is relatively common following the physeal fractures in proximal or distal tibia. We recommend early consultation with a tertiary care centre for guidance and planning of the best treatment.
Topics: Humans; Child; Leg; Bone Nails; Tibial Fractures; Lower Extremity; Growth Plate
PubMed: 36760152
DOI: No ID Found