Fracture Patterns
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2021 ◽  
Vol 2 (3) ◽  
pp. 12-18
Author(s):  
Gregory W. Kunis ◽  
Joshua A. Berko ◽  
Jeffrey C. Shogan ◽  
Joshua B. Sharan ◽  
Derek Jones

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern. Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle. Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carlos Hernández-Pascual ◽  
José Ángel Santos-Sánchez ◽  
Juan Manuel García-González ◽  
Carlos Fernando Silva-Viamonte ◽  
Carmen Pablos-Hernández ◽  
...  

Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.


2021 ◽  
Vol 14 (5) ◽  
pp. 689-692
Author(s):  
Ashwini B Prasad ◽  
Deepak Raisingani ◽  
Prachi Mital ◽  
Harshit Srivastava ◽  
Namita Somani ◽  
...  

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francesco Parisio ◽  
Keita Yoshioka ◽  
Kiyotoshi Sakaguchi ◽  
Ryota Goto ◽  
Takahiro Miura ◽  
...  

AbstractDeveloping high-enthalpy geothermal systems requires a sufficiently permeable formation to extract energy through fluid circulation. Injection experiments above water’s critical point have shown that fluid flow can generate a network of highly conductive tensile cracks. However, what remains unclear is the role played by fluid and solid rheology on the formation of a dense crack network. The decrease of fluid viscosity with temperature and the thermally activated visco-plasticity in rock are expected to change the deformation mechanisms and could prevent the formation of fractures. To isolate the solid rheological effects from the fluid ones and the associated poromechanics, we devise a hydro-fracture experimental program in a non-porous material, polymethyl methacrylate (PMMA). In the brittle regime, we observe rotating cracks and complex fracture patterns if a non-uniform stress distribution is introduced in the samples. We observe an increase of ductility with temperature, hampering the propagation of hydraulic fractures close to the glass transition temperature of PMMA, which acts as a limit for brittle fracture propagation. Above the glass transition temperature, acoustic emission energy drops of several orders of magnitude. Our findings provide a helpful guidance for future studies of hydro-fracturing of supercritical geothermal systems.


Author(s):  
Corey Brown ◽  
Brian A. Kelly ◽  
Kirsten Brouillet ◽  
Scott J. Luhmann

Purpose Determine the frequency of compartment syndrome of the leg after displaced, operatively treated modified Ogden I to III tibial tubercle fractures (TTFxs), evaluate the preoperative assessment and use of advanced imaging, and need for prophylactic fasciotomies. Methods Retrospective analysis of operatively treated, displaced modified Ogden I to III TTFxs, at our level 1 paediatric trauma centre between 2007 and 2019. Modified Ogden Type IV and V fracture patterns were excluded. Fracture patterns were determined by plain radiographs. Results There were 49 modified Ogden I to III TTFxs in 48 patients. None had signs nor symptoms of vascular compromise, compartment syndromes or impending compartment syndromes preoperatively. In all, 13 of the 49 fractures underwent anterior compartment fasciotomy at surgery; eight of the 13 had traumatic fascial disruptions, which were extended surgically. All incisions were primarily closed. There were no instances of postoperative compartment syndromes, growth arrest, leg-length discrepancy or recurvatum deformity postoperatively. All patients achieved radiographic union and achieved full range of movement. Conclusion The potentially devastating complications of compartment syndrome or vascular compromise following TTFx did not occur in this consecutive series of patients over 12 years. The presence of an intact posterior proximal tibial physis and posterior metaphyseal cortex (Modified Ogden TTFx Type I to III) may mitigate the occurrence of vascular injury and compartment syndrome. Plain radiographs appear appropriate as the primary method of imaging TTFxs, with use of advanced imaging as the clinical scenario dictates. Routine, prophylactic fasciotomies do not appear necessary in Ogden I to III TTFxs, but should be performed for signs and symptoms of compartment syndrome. Level of evidence Level IV


Author(s):  
Patrick Pflüger ◽  
Eftychios Bolierakis ◽  
Markus Wurm ◽  
Klemens Horst ◽  
Frank Hildebrand ◽  
...  

Abstract Purpose Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. Methods A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. Results A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. Conclusion Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.


Author(s):  
Alvin K. Shieh ◽  
Augustine M. Saiz Jr ◽  
Kelsey S. Hideshima ◽  
Brian M. Haus ◽  
Holly B. Leshikar

Introduction Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology. Methods A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation. Results There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold. Conclusion This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability. Level of evidence IV


2021 ◽  
Author(s):  
Bryan Tan ◽  
Jingwen Ng ◽  
Wei Xiang Ng ◽  
Wei Yuan ◽  
Ernest Beng Kee Kwek

Abstract Introduction. Olecranon fractures are a common fracture of the upper extremity. The primary aim was to investigate the evolution of olecranon fractures and fixation method over a period of 12 years. The secondary aim was to compare complication rates of Tension Band Wiring (TBW) and Plate Fixation (PF). Materials and Methods Retrospective Study for all patients with surgically treated olecranon fractures from 1 January 2005 to 31 December 2016 from a tertiary trauma center. Records review for demographic, injury characteristics, radiographic classification and configuration, implant choices and complications. Results grouped into three 4-year intervals, analyzed comparatively to establish significant trends over 12 years. Results 262 patients were identified. Demographically, increasing mean age (48.7 to 58.9 years old, p-value 0.004) and higher ASA scores (7.1% ASA 3 to 21.0% ASA 3 p-value 0.001). Later fractures were more oblique (fracture angle 86.1 to 100.0 degrees, p-value 0.001) and comminuted (Schatzker D type 10.4–30.0%, p-value 0.025, single fracture line 94.0–66.0%, p-value 0.001). Implant choice, sharp increase in PF compared to TBW (PF 16.0% to PF 80.2%, p-value 0.001). Complication-wise, TBW had higher rates of symptomatic implant, implant and bony failures and implant removal. Conclusion Demographic and fracture characteristic trends suggest that olecranon fractures are exhibiting fragility fracture characteristics (older age, higher ASA scores, more unstable, oblique and comminuted olecranon fractures). Having a high index of suspicion would alert surgeons to consider use of advanced imaging, utilize appropriate fixation techniques and manage the underlying osteoporosis for secondary fracture prevention. Despite this, trends suggest a potential overutilization of PF particularly for stable fracture patterns and the necessary precaution should be exercised.


2021 ◽  
Vol 1 ◽  
pp. 61-62
Author(s):  
Filip Loeckle

Abstract. The stochastic generation of discrete fracture networks (DFN) is a method for modelling fracture patterns used to assess the in situ fragmentation in a volume of rock. The DFN modelling approach is based on the assumption that the natural fragmentation of rocks is a function of the length and connectivity of the fractures within the considered volume of rock. Thus, in order to generate a site-specific DFN, the primary geometric properties of the fracture surfaces within the rock volume (especially orientation, size and fracture intensity as well as the local spatial variability) must be defined as distribution functions (Elmo et al., 2014). The required base statistics are usually obtained from fracture analysis on boreholes, exposed rock surfaces or (to a limited extent) 3D seismics (e.g. Bisdom et al., 2014; Bemis et al., 2014). We adopted a terrestrial close-range photogrammetry approach to capture several outcrops and analyse fracture traces on the exposed rock surfaces, the chosen workflow is based around the use of free and open-source software. Images were acquired from several quarries in the Weschnitzpluton, a granodioritic to quartz monzodioritic pluton in the Bergstrasse Odenwald (e.g. Altherr et al., 1999) using a consumer-grade Nikon D5300 DSLR with fixed focal length instead of a drone or Lidar-system for legal reasons, partially tree-lined outcrops and cost efficiency. Since point clouds obtained from photogrammetry are inherently dimensionless, we used a spherical target with compass and bubble level for scale and proper spatial orientation (Froideval et al., 2019). The exact geolocation is not particularly important for the task, so the use of GPS, total station or georeferenced ground control points is not necessary. Dense point clouds were computed using the open source SfM photogrammetry suite Meshroom (AliceVision, 2021), which can be used for manual or semi-automatic detection of fracture surfaces and their orientation (Schnabel et al., 2007) and to generate orthorectified images of the rock surface to trace fracture lengths and nodes in a GIS (Nyberg et al., 2018). Our investigations proved terrestrial photogrammetry to be a valuable and easily accessible tool in the documentation of natural fracture patterns and a robust base for the generation of DFN networks.


2021 ◽  
Author(s):  
Claudio Rojas ◽  
ERNESTO EWERTZ ◽  
Jose Miguel Hormazabal

Abstract Background: Type I lateral compression pelvic fractures (LC-I) have historically been treated conservatively. Inferior outcomes in a distinctive subset of these injuries has been reported, therefore their management has shifted towards surgery. Revisiting historical series of LC-I allows us to determine whether non-operative management of these unstable patterns result in poorer outcomes. The objective was to evaluate the differences in the rehabilitation progress, fracture consolidation and displacement in non-operatively treated LC-I fractures that would be considered unstable using today´s AO criteria.Methods: We conducted a retrospective review of conservatively treated LC-I injuries in a single level I trauma center, between June 2010 and June 2014. Patients were distributed in Stable (Group A) and unstable (Group B) groups according to 2018 AO classification. Time to walk independently (TWI), time to return to work (TRW), fracture consolidation and displacement were analyzed. Results: 34 patients, mean aged 45.5 ±14.5 years, were included. Mean TWI in groups A and B were 71.2 ±31.9 and 105.9 ±50.9 days (p=0.027). Mean TRW was 106 ±51.3 and 157 ±84 days in Groups A and B respectively (p=0.038). A difference in mean TWI and TRW of 34.7 and 51.3 days between groups was observed. No significant differences in fracture consolidation or displacement were observed.Conclusion: Unstable fractures presented significantly longer TWI and TRW. The revised AO classification contributes in the identification of fracture patterns that correlate with prolonged rehabilitation in which additional treatment strategies might be considered.


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