Fracture reduction
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Osteoporosis international, ISSN 0937-941X vol. 13, suppl. 2, 2002
vii, S28 s. ; 30 cm
- MeSH
- fixace fraktury MeSH
- fraktury kostí MeSH
- osteoporóza komplikace MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- senioři MeSH
- Publikační typ
- abstrakty MeSH
- kongresy MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- vnitřní lékařství
- ortopedie
PURPOSE OF THE STUDY The characteristics, diagnosis, classification and treatment options of rare fractures of the sacrum known as suicidal jumper's fractures are presented based on six illustrative cases. MATERIAL AND METHODS Jumper's fractures of the sacrum are characterised by an H- or U-shaped fracture line in the upper sacrum, usually involving the S1-S2 region. Typically, the anterior segment of the pelvic ring is not injured. In most cases this injury is associated with polytrauma and it is imperative that the patients undergo thorough neurological examination including that for perineal sensitivity and anal tone. RESULTS Between 1998 and 2007, 109 patients were treated for AO/OTA type C pelvic injuries at the Department of Orthopaedics and Traumatology. A bilateral fracture of the sacrum with a typical fracture line, i.e., suicidal jumper's fracture, was recorded in six patients (5.5 %), which accounts for 1.2 % of the total number of the pelvic fractures treated. Five patients underwent surgery, one was treated conservatively. Neurological deficit was recorded in five of the six patients. Surgery resulted in bone union and overall improvement in five patients, the patient treated conservatively showed lasting neurological deficit with no progression; she developed pseudoarthrosis. DISCUSSION Transverse fracture of the sacrum, in the literature referred to as suicidal jumper's fracture, is a rare injury. In 1985 Roy-Camille introduced a classification system for sacral fractures. In the classification proposed by Denis et al., transalar, transforaminal and central fractures are distinguished, with transverse fractures being included. For making exact diagnosis, the AO/OTA classification is necessary. There is a wide range of neurological features associated with displaced sacral fractures. It includes motor and sensory deficit in L5 and S1 dermatomes and myotomes, dysfunction of the sphincters, perineal insensitivity and possibly also sexual dysfunction. Based on the Denis classification, zone I fractures are responsible for 5.9 %, zone II fractures for 28.4 % and zone III fractures for 56.7 % of the neurological deficits associated with sacral injuries. In patients with zone III fractures, urinary bladder innervation and sexual dysfunction are recorded in 76 %, and neurological deficit in 41 %, of which two-thirds are motor neuron lesions. Motor deficits are most often due to L5 and S1 root lesions; sensory deficits result from S2-S5 and L5 root lesions. External rotation and vertical displacement produce a traction mechanism, comminution and impaction of the massa lateralis result in nerve compression. Sacral fractures can be treated conservatively or surgically. Conservative therapy, bed rest, traction and gradual physical therapy are indicated in children and adolescents with non-displaced or slightly displaced sacral fractures, either without or with minimal neurological symptoms. Surgical treatment involving nerve decompression, open reduction of the fracture and subsequent fixation of the fragments is indicated in all displaced fractures. When nerve structures are affected, the injury-surgery interval should not exceed six hour. CONCLUSIONS Sacral fractures known as suicidal jumper's fractures are rare but very serious injuries difficult to diagnose. All injured patients should undergo a thorough neurological examination, including perineal sensitivity and anal tone. The treatment includes nerve decompression, fragment reduction and the restoration of sacral and pelvic stability necessary for neurological recovery, early rehabilitation and good clinical outcome.
- MeSH
- dopravní nehody MeSH
- dospělí MeSH
- fraktury páteře diagnóza etiologie chirurgie MeSH
- křížová kost zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- muži MeSH
- pokus o sebevraždu MeSH
- sportovní úrazy diagnóza chirurgie MeSH
- úrazy pádem MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
Autor uvádí definici osteoporózy a nástin šíře problému této civilizační choroby. Zabývá se rizikem zlomenin i problematikou mortality po prodělané zlomenině proximálního femuru, která je i přes adekvátní a rychlé chirurgické ošetření v prvním roce po zlomenině značně vysoká. V další části práce rozebírá mechanismus účinku antiresorpčních léčiv a způsob, jakým terapie těmito léčivy ovlivňuje kostní remodelační jednotky a jak následně působí na kortikální i trabekulární kost. Po obecné charakteristice bisfosfonátů soustřeďuje pozornost na dva základní typy působení bisfosfonátů na osteoklasty a na základní mechanismus působení na farnesyldifosfátsyntázu i vazebnou afinitu ke kosti. V další části práce jsou charakterizovány jednotlivé bisfosfonáty používané v terapii osteoporózy (alendronát, risedronát, ibandronát a zoledronát) včetně provedených klinických studií a účinnosti v redukci rizika zlomenin. V závěru se autor zabývá strategií léčby osteoporózy v duchu zásad Evidence Based Medicine a dotýká se i otázky farmakoekonomiky léčby.
Definition of osteoporosis is given and the scope of issues related to this noncommunicable disease is outlined. Attention is paid to fracture risk and mortality following proximal femoral fracture, which is rather high within the first postfracture year despite adequate and rapid surgical treatment. The mechanism of action of antiresorptive drugs and their effects on bone remodelling units and corti cal and trabecular bone are analyzed. General characteristics of bisphosphonates are presented. Then, focus is on two major types of their action on osteoclasts and effects on farnesyl diphosphate synthase and bone binding affinity. Different bisphosphonates (alendronate, risedronate, ibandronate and zoledronate) used in osteoporosis treatment are addressed, including clinical trials and efficacy in fracture risk reduction. In conclusion, osteoporosis treatment strategies in line with the principles of evidence-based medicine as well as their pharmacoeconomics are dealt with.
UNLABELLED: PURPOSE OF THE STUDY Although supracondylar humeral fractures represent a major part of the pediatric fractures, no classification system or radiological characteristics describes which supracondylar fractures require open reduction. We aim to evaluate the factors that lead us to perform open reduction during operation. MATERIAL AND METHODS We retrospectively evaluated 57 patients who underwent operation for type III supracondylar fracture, and divided them into two groups; those with open reduction and internal fixation, and those with closed reduction and percutaneous fixation. The two groups were compared based on age, gender, BMI by age, medial spike angle of the fracture, medial spike-skin distance and rotation angle between the fractured fragments. RESULTS Of all patients, 46 (81.71%) underwent closed reduction and percutaneous fixation (CRPF) and 11 (19.29%) were treated with open reduction and internal fixation (ORIF). BMI by age was remarkably higher in the ORIF group (p = 0.00). And medial spike angle was smaller in the ORIF group (p = 0.014). DISCUSSION Closed reduction and percutanous fixation is the main treatment of supracondylar humeral fractuers. Open reduction in supracondylar humeral fractures could be associate with complications and cosmetic lesions. Many studies indicates that obesity is high risk factor for complex fractures as well as preoperative and postoperative complications. A prominant medial spike could associate with muscle entrapment, and obliquity of the fracture line. It could be also an indirect finding of instablity of the fracture. CONCLUSION We suggest that a smaller medial spike angle and a higher BMI in children with Type III supracondylar humeral fractures may require open reduction, and it is unreasonable to avoid open reduction in cases where closed reduction is not achieved. KEY WORDS: supracondylar humerus, open reduction, obesity, medial spike angle.
- MeSH
- dítě MeSH
- fixace fraktury metody statistika a číselné údaje MeSH
- fraktury humeru diagnostické zobrazování chirurgie MeSH
- index tělesné hmotnosti MeSH
- kostní hřeby MeSH
- lidé MeSH
- otevřená repozice fraktury statistika a číselné údaje MeSH
- pooperační komplikace epidemiologie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- uzavřená repozice fraktury statistika a číselné údaje MeSH
- vnitřní fixace fraktury statistika a číselné údaje MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Zlomeniny proximálního femuru patří mezi velmi častá poranění, někdy se ale vyskytují také u pacientů po amputaci dolní končetiny. K umožnění časné vertikalizace se v současné době upřednostňuje operační řešení. Typ zvoleného výkonu záleží na typu zlomeniny. Postup u pacientů s amputací se liší technikou repozice. Máme několik možností repozice: molitanová extenze, extenze pomocí tahu za ruku používaná při artroskopii ramene, skeletální extenze, otočení boty extenčního stolu nebo manuální repozice. Porovnávali jsme možnost použití a výhody i nevýhody jednotlivých metod. Na našem pracovišti jsme s dobrými výsledky použili repozici pomocí skeletální trakce a repozici asistentem. Summary: Fractures of proximal femur appear very frequently and can be observed in patients with amputated limb too. Surgery to faster mobilization is preferred in these times. Type of chosen operation method depends on type of fracture. Difference between patients with and without amputation stays in technique of fracture reduction. There are several methods of reduction: skin traction, arm trap used for shoulder arthroscopy, skeletal traction, inverting the traction boot, manual reduction. We compared possibility of application, advantages and disadvantages of each method. Reposition of skeletal traction and reposition with assistant were tested in our hospital with satisfying results.
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- MeSH
- femur * chirurgie zranění MeSH
- fraktury kostí * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- manipulace ortopedická metody MeSH
- pahýl po amputaci * chirurgie MeSH
- senioři MeSH
- trakce MeSH
- uzavřená repozice fraktury metody MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
