Complex fracture

With an increased popularity of sport and active living worldwide, our study aims to explore the incidence and features of sports-related orbital fractures in Singapore. 1421 computer tomography (CT) imaging scans of the face and orbits done at the National University Hospital over a 24-month period from January 2013 and December 2014 were reviewed retrospectively for orbital fractures. We identified 483 orbital fractures of which sports injury was the fourth most common etiology (n = 65; 13.5%) after road traffic accident (n = 131; 27...

INTRODUCTION: Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients...

We report a 23-year-old woman admitted post cyclist versus heavy goods vehicle accident in December 2014. This was the second case the life-saving procedure, that is, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed on at the roadside. This advanced procedure was performed due to the extensive haemorrhage from this patient's complex pelvic fracture . As a result of REBOA, the patient consequently lost her left lower limb and underwent a variety of complex pelvic and lower limb surgeries...

Diabetes mellitus, both type 1 and type 2 (T2DM), is associated with decreased bone strength as well as increased fracture risk. Bone mineral density is decreased in type 1 diabetes but increased in T2DM, compared with controls. This suggests alterations in bone quality are a major player in the pathogenesis of fragility fractures in patients with diabetes. The link between diabetes and bone appears to be mediated by complex pathways, including the insulin-insulin growth factors system, accumulation of advanced glycation end-products in bone collagen, microangiopathy, and increased bone marrow fat content...

BACKGROUND: Pedicle screw fixation of the lumbar spine in children less than two years of age is particularly challenging, as successful cannulation of the small pedicle dimensions require a high level of precision and there are no implants specifically designed for the infantile spine. Image-guided navigation is commonly used in adult spinal surgery and may be particularly helpful for placement of spinal screws where the bony anatomy is small and/or anatomically complex as in the upper cervical area...

Fracture healing is a complex biological process involving many cellular and molecular events. During fracture healing, biochemical signals play a regulatory role in promoting the healing process. Although many experiments have been conducted to study fracture healing, not all of the mechanisms are clearly understood. Over the past years, a lot of mathematical models and computational simulations have been established to investigate the fracture healing process. These models offer a powerful tool to study the interplay between cell behaviour, mechanical stimuli and biochemical signals and help design new treatment strategies...

Surgical treatment of ultrasmall proximal pole scaphoid fractures poses a number of challenges. The fragment may be too small to fix with conventional headless screw fixation owing to the high risk of fragmentation upon insertion. However, excision of the fragment risks compromising the scapholunate ligament complex and also exposes the radioscaphoid joint to potential degenerative changes. Under these circumstances, we describe the use of bioabsorbable osteochondral fixation nails that allows stable low-profile fixation while minimizing the risk of fracturing the proximal pole...

PURPOSE: Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique. METHODS: This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months)...

BACKGROUND: Segond's fracture is a well-recognised radiological sign of an anterior cruciate ligament (ACL) tear. While previous studies evaluated the role of the anterolateral ligament (ALL) and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of Segond's fracture in an ACL deficient knee. The aim of this study was to evaluate the effect of a Segond's fracture on knee rotation stability as evaluated by a navigation system in an ACL deficient knee...

PURPOSE: This study aimed to evaluate the results of volar locking plate for treatment of type B distal radius fractures involving the lunate facet and compare them with those without involvement in lunate facet. METHOD: s: This was a retrospective study. A total of 93 patients with type B distal radius were treated by single volar locking plate between January 2014 and December 2015. Preoperative digital radiographs were used to initially diagnose and further classify this injury according to AO/OTA classification system...

Top-down ultraviolet photodissociation (UVPD) allows greater sequence coverage than any other currently available method, often fracturing the vast majority of peptide bonds in whole proteins. At the same time, UVPD can be used to dissociate noncovalent complexes assembled from multiple proteins without breaking any covalent bonds. Although the utility of these experiments is unquestioned, the mechanism underlying these seemingly contradictory results has been the subject of many discussions. Herein, some fundamental considerations of photochemistry are briefly summarized within the context of a proposed mechanism that rationalizes the experimental results obtained by UVPD...

INTRODUCTION: The purpose of this study was to evaluate outcomes after reverse shoulder arthroplasty for the treatment of complex three- and four-fragment proximal humeral fractures after mean follow-up time of 45 months and to compare our results with the results published by other authors. MATERIALS AND METHODS: Retrospectively we have analyzed 27 consecutive patients after total arthroplasty with less medialized reverse shoulder prosthesis used for the treatment of complex proximal humeral fracture...

High volume hydraulic fracturing (HVHF) of shale to stimulate the release of natural gas produces a large quantity of wastewater in the form of flowback fluids and produced water. These wastewaters are highly variable in their composition and contain a mixture of fracturing fluid additives, geogenic inorganic and organic substances, and transformation products. The qualitative and quantitative analyses of organic compounds identified in HVHF fluids, flowback fluids, and produced waters are reviewed here to communicate knowledge gaps that exist in the composition of HVHF wastewaters...

A subset of C2/C3 pilon fractures, open pilon injuries, metaphyseal bone comminution, and those involving substantial soft tissue or vascular injury may be nonreconstructable. Such injuries are at risk of progress to nonunion and failing open reduction internal fixation (ORIF). The risk of infection, malunion, and nonunion is relatively high with such injury patterns. In such cases, tibiotalar arthrodesis is performed after ORIF fails as a salvage procedure. Overall, the literature agrees that all pilon fractures will develop posttraumatic osteoarthritis, and these patients are ultimately treated with an arthrodesis or in narrow population with total ankle arthroplasty...

BACKGROUND: Most total elbow arthroplasty (TEA) designs aim to replicate anatomy and provide stability in the treatment of the degenerative elbow joint. Given the promising results that have been reported following the use of TEA for the treatment of complex fractures, the indications for this procedure are growing. The objective of the present study was to review the most recent literature on the results of the most commonly performed TEAs. METHODS: A comprehensive literature search was conducted...

With newer-generation ceramic components used in total hip arthroplasty, component fracture is a rare complication. However rare, when ceramic component fracture does occur, prompt identification and revision is necessary as delay can lead to dramatic failure with resultant metallosis as the extremely hard ceramic debris abrades remaining components. We present a case of a 70-year-old woman with ceramic liner fracture and an estimated 10-year delay in intervention with failure resulting in pelvic discontinuity and massive metallosis with associated cutaneous manifestation...

OBJECTIVES: Complex regional pain syndrome is a challenging condition including a broad spectrum of sensory, autonomic and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with CRPS following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS. METHODS: Using the Danish Patient Compensation Association's (DPCA) database we identified 647 patients claiming post-treatment CRPS, between 1992 and 2015...

BACKGROUND: The aim of this study was to assess proximal humeral fracture patterns using 3-dimensional computed tomography images and relate them to the normal osseous landmarks and soft-tissue attachments. METHODS: Forty-eight 3-dimensional computed tomography scans of proximal humeral fractures were retrospectively collected, and the fractures were transcribed onto proximal humeral templates. We analyzed the common location and orientation of the fracture lines, with a focus on fractures of the articular surface, tuberosities, metaphysis, and proximal diaphysis...

Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model...

PURPOSE OF REVIEW: The purpose of this paper is to review the distinct clinical and radiographic features that may lead to prompt diagnosis of rapidly progressive osteoarthritis (RPOA) and thus obviate unnecessary and costly diagnostic workup. RECENT FINDINGS: RPOA is uncommon but is more frequently seen in practice because of the aging population. RPOA is a destructive arthropathy that occurs most commonly in elderly women but can also be seen in patients that have sustained trauma...