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https://www.readbyqxmd.com/read/29781820/management-of-pediatric-femoral-neck-fracture
#1
Joseph T Patterson, Jennifer Tangtiphaiboontana, Nirav K Pandya
In the pediatric population, femoral neck fracture is a relatively uncommon injury with a high complication rate, despite appropriate diagnosis and management. The anatomy and blood supply of the proximal femur in the skeletally immature patient differs from that in the adult patient. Generally, these fractures result from high-energy trauma and are categorized using the Delbet classification system. This system both guides management and aids the clinician in determining the risk of osteonecrosis after these fractures...
May 16, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29776736/trabecular-bone-score-at-the-distal-femur-and-proximal-tibia-in-individuals-with-spinal-cord-injury
#2
Stacey Lobos, Anne Cooke, Gillian Simonett, Chester Ho, Steven K Boyd, W Brent Edwards
Rapid declines in bone mineral density (BMD) at the knee after spinal cord injury (SCI) are associated with an increased risk of fracture. Evaluation of bone quality using the trabecular bone score (TBS) may provide a complimentary measure to BMD assessment to examine bone health and fracture risk after SCI. The purpose of this study was to assess bone mineral density (BMD) and trabecular bone score (TBS) at the knee in individuals with and without SCI. Nine individuals with complete SCI (mean time since SCI 2...
April 24, 2018: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/29776439/concurrence-of-symmetrical-peripheral-gangrene-and-venous-limb-gangrene-following-polytrauma-a-case-report
#3
Jih Huei Tan, Yuzaidi Mohamad, Chor Lip Henry Tan, Mahazir Kassim, Theodore E Warkentin
BACKGROUND: Symmetrical peripheral gangrene is characterized as acral (distal extremity) ischemic limb injury affecting two or more extremities, without large vessel obstruction, typically in a symmetrical fashion. Risk factors include hypotension, disseminated intravascular coagulation, and acute ischemic hepatitis ("shock liver"). In contrast, venous limb gangrene is characterized by acral ischemic injury occurring in a limb with deep vein thrombosis. Both symmetrical peripheral gangrene and venous limb gangrene present as acral limb ischemic necrosis despite presence of arterial pulses...
May 19, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29768025/the-post-injury-inflammatory-state-and-the-bone-marrow-response-to-anemia
#4
Tyler J Loftus, Juan C Mira, Elizabeth S Miller, Kolenkode B Kannan, Jessica M Plazas, Daniel Delitto, Julie A Stortz, Jennifer E Hagen, Hari K Parvataneni, Kalia K Sadasivan, Scott C Brakenridge, Frederick A Moore, Lyle L Moldawer, Philip A Efron, Alicia M Mohr
RATIONALE: The pathophysiology of persistent injury-associated anemia is incompletely understood, and human data are sparse. OBJECTIVE: To translate pre-clinical findings by characterizing injury-associated anemia among critically ill trauma patients. This study compared elective hip repair patients with an acute stress response to severely injured trauma patients with a prolonged stress response and evaluated the bone marrow response to anemia. METHODS: A translational prospective observational cohort study comparing severely injured, blunt trauma patients who had operative fixation of a hip or femur fracture (n=17) with elective hip repair patients (n=22) and healthy donors (n=8)...
May 16, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29746363/lower-extremity-fractures-in-hospitalized-pediatric-patients-following-road-traffic-accidents
#5
Shay Tenenbaum, Jason T Bariteau, Ofir Chechik, Adi Givon, Kobi Peleg, Ran Thein
Lower extremity fractures (LEFs) caused by road traffic accidents (RTAs) can result in significant morbidity and account for a substantial part of nonfatal injuries requiring hospitalization. This study investigated the epidemiology of RTA-associated LEFs in the pediatric population. Based on the National Trauma Registry, data of 28,924 RTA hospitalized pediatric patients were reviewed. Data were analyzed according to LEF mechanism of injury, age distribution, fracture types, associated injuries, surgical treatment, and their interrelations...
May 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29738398/revenue-for-initial-orthopaedic-trauma-care-effects-of-patient-and-injury-characteristics
#6
Christopher D Flanagan, Alexander S Rascoe, David M Wang, Heather Vallier
OBJECTIVE: To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management DESIGN:: Retrospective SETTING:: Level 1 trauma center PARTICIPANTS:: 440 consecutive adult trauma patients INTERVENTION:: fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures MAIN OUTCOME MEASUREMENT:: Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care RESULTS:: Patient were predominantly male (74...
May 3, 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29698292/does-the-watson-jones-or-modified-smith-petersen-approach-provide-superior-exposure-for-femoral-neck-fracture-fixation
#7
Paul M Lichstein, John P Kleimeyer, Michael Githens, John S Vorhies, Michael J Gardner, Michael Bellino, Julius Bishop
BACKGROUND: A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. QUESTIONS/PURPOSES: (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? METHODS: Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches...
April 24, 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29681707/pediatric-proximal-femur-fractures
#8
REVIEW
Brian L Dial, Robert K Lark
Pediatric proximal femur fractures are rare injuries resulting from high-energy trauma. The Delbet classification is used when describing these injuries, and associates fracture type to the development of avascular necrosis. Historically, casting was utilized in the treatment of these injuries, but high complication rates following this approach have changed the treatment modality to early and anatomic fixation. Complications associated with these injuries including avascular necrosis, non-union, coxa-vara, and premature physeal fusion...
June 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29680494/femur-loading-in-feet-first-fall-experiments-using-an-anthropomorphic-test-device
#9
Angela Thompson, Gina Bertocci, Craig Smalley
BACKGROUND: Femur fractures are a common orthopedic injury in young children. Falls account for a large portion of accidental femur fractures in young children, but there is also a high prevalence of femur fractures in child abuse, with falls often provided as false histories. Objective information regarding fracture potential in short distance fall scenarios may aid in assessing whether a child's injuries are the result of abuse or an accidental fall. Knowledge of femur loading is the first step towards understanding likelihood of fracture in a fall...
March 31, 2018: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/29658534/the-influence-of-osteoporotic-bone-structures-of-the-pelvic-hip-complex-on-stress-distribution-under-impact-load
#10
Katarzyna Arkusz, Tomasz Klekiel, Niezgoda Niezgoda, Romuald Będziński
PURPOSE: The aim of this study was to determine the effect of bone mineral density (BMD) on the stress distribution in pelvic-hip complex (PHC) model which included bone structures and soft tissues. Bone mass changes in osteoporosis and osteopenia were considered in this analysis. In addition, the relations between force direction and stress distribution causing PHC fractures were determined. METHODS: This paper presents the development and validation of a detailed 3D finite element model with high anatomical fidelity of the PHC and BMD changes in trabecular and cortical bones, modelled based on CT scans...
2018: Acta of Bioengineering and Biomechanics
https://www.readbyqxmd.com/read/29655780/dietary-flavonoid-kaempferol-inhibits-glucocorticoid-induced-bone-loss-by-promoting-osteoblast-survival
#11
Sulekha Adhikary, Dharmendra Choudhary, Naseer Ahmad, Anirudha Karvande, Avinash Kumar, Venkatesh Teja Banala, Prabhat Ranjan Mishra, Ritu Trivedi
OBJECTIVE: Kaempferol, a dietary flavonoid found in fruits and vegetables, has been reported to reverse osteopenic condition in ovariectomized rats. Because kaempferol is endowed with osteogenic activity, the aim of this study was to determine whether it has a beneficial effect on glucocorticoid (GC)-induced bone loss. METHODS: Adult female rats were divided into four groups as control (vehicle; distilled water), methylprednisolone (MP; 5 mg•kg•d, subcutaneously), MP + kaempferol (5 mg•kg•d, oral), and MP + human parathyroid 1-34 (30 µg/kg, 5 times/wk, subcutaneously) and treated for 4 wk...
February 13, 2018: Nutrition
https://www.readbyqxmd.com/read/29650034/complex-fracture-orthopedic-rehabilitation-comfort-real-time-visual-biofeedback-on-weight-bearing-versus-standard-training-methods-in-the-treatment-of-proximal-femur-fractures-in-the-elderly-study-protocol-for-a-multicenter-randomized-controlled-trial
#12
Marco Raaben, Syaiful Redzwan, Robin Augustine, Taco Johan Blokhuis
BACKGROUND: Proximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly...
April 12, 2018: Trials
https://www.readbyqxmd.com/read/29644317/a-rare-case-of-hoffa-fracture-combined-with-lateral-patellar-dislocation
#13
Martin C Jordan, Leonie A Bittrich, Kai Fehske, Rainer H Meffert, Hendrik Jansen
The coronal unicondylar fracture of the distal femur (AO 33-B3) is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure...
June 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29605113/disuse-osteopenia-following-leg-fracture-in-postmenopausal-women-implications-for-hip-fracture-risk-and-fracture-liaison-services
#14
S J Hopkins, A D Toms, M Brown, A Appleboam, K M Knapp
INTRODUCTION: Disuse osteopenia is a known consequence of reduced weight-bearing and has been demonstrated at the hip following leg injury but has not been specifically studied in postmenopausal women. METHOD: Bilateral DXA (GE Lunar Prodigy) bone mineral density (BMD) measurements were taken at the neck of femur (NOF), total hip region (TH) and lumbar spine in postmenopausal female groups comprising controls (N = 43), new leg fractures (#<3wks) (N = 9), and participants who had sustained a leg fracture more than one year previously (#>1yr) (N = 24)...
May 2018: Radiography
https://www.readbyqxmd.com/read/29593715/comparative-analysis-of-the-regulatory-t-cells-dynamics-in-peripheral-blood-in-human-and-porcine-polytrauma
#15
Rafael Serve, Ramona Sturm, Lukas Schimunek, Philipp Störmann, David Heftrig, Michel P J Teuben, Elsie Oppermann, Klemens Horst, Roman Pfeifer, Tim P Simon, Yannik Kalbas, Hans-Christoph Pape, Frank Hildebrand, Ingo Marzi, Borna Relja
Background: Severely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg) play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP) and compared those to either healthy volunteers (HV) or data from porcine polytrauma...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29584493/numerical-investigation-of-driver-lower-extremity-injuries-in-finite-element-frontal-crash-reconstruction
#16
Xin Ye, James P Gaewsky, Logan E Miller, Derek A Jones, Mireille E Kelley, Jeffrey D Suhey, Bharath Koya, Ashley A Weaver, Joel D Stitzel
OBJECTIVE: Lower extremity injuries are the most frequent Abbreviated Injury Scale (AIS) 2 injury for drivers in frontal crashes. The objective was to reconstruct 11 real-world motor vehicle crashes (2 with AIS 2+ distal lower extremity injury and 9 without lower extremity injury) and to analyze the vehicle parameters and driver attributes that affect injury risk. METHODS: Eleven frontal crashes were reconstructed with a finite element simplified vehicle model (SVM) using a semi-automated optimization method...
February 28, 2018: Traffic Injury Prevention
https://www.readbyqxmd.com/read/29584491/active-muscle-response-contributes-to-increased-injury-risk-of-lower-extremity-in-occupant-knee-airbag-interaction
#17
Bingbing Nie, Deepak Sathyanarayan, Xin Ye, Jeff R Crandall, Matthew B Panzer
OBJECTIVE: Recent field data analysis has demonstrated that knee airbags (KABs) can reduce occupant femur and pelvis injuries but may be insufficient to decrease leg injuries in motor vehicle crashes. An enhanced understanding of the associated injury mechanisms requires accurate assessment of physiological-based occupant parameters, some of which are difficult or impossible to obtain from experiments. This study sought to explore how active muscle response can influence the injury risk of lower extremities during KAB deployment using computational biomechanical analysis...
February 28, 2018: Traffic Injury Prevention
https://www.readbyqxmd.com/read/29584479/injury-risk-functions-based-on-population-based-finite-element-model-responses-application-to-femurs-under-dynamic-three-point-bending
#18
Gwansik Park, Jason Forman, Taewung Kim, Matthew B Panzer, Jeff R Crandall
OBJECTIVE: The goal of this study was to explore a framework for developing injury risk functions (IRFs) in a bottom-up approach based on responses of parametrically variable finite element (FE) models representing exemplar populations. METHODS: First, a parametric femur modeling tool was developed and validated using a subject-specific (SS)-FE modeling approach. Second, principal component analysis and regression were used to identify parametric geometric descriptors of the human femur and the distribution of those factors for 3 target occupant sizes (5th, 50th, and 95th percentile males)...
February 28, 2018: Traffic Injury Prevention
https://www.readbyqxmd.com/read/29578106/two-team-management-of-vascular-injuries-concomitant-with-osteo-articular-injuries-in-36-patients-over-six-years
#19
B Leclerc, E Boyer, G Menu, G Leclerc, P Sergent, E Ducroux, L Salomon Du Mont, P Garbuio, S Rinckenbach, L Obert
BACKGROUND: Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice...
March 22, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29572365/a-rare-presentation-of-haematuria-hip-prosthesis-in-the-bladder
#20
Yih Chyn Phan, Nnaemeka Eli, Praveen Pillai, Jonathan O'Dair
An 80-year-old woman presented to our department with visible haematuria and stage II acute kidney injury (AKI). She had stage IIB cervical cancer, for which she received chemotherapy and external beam radiotherapy in 2003. Four years later, she had a left dynamic hip screw for an extracapsular neck of femur fracture following a fall. In 2010, she underwent a right total hip replacement owing to osteoarthritis, and it was subsequently revised in 2012 owing to a right acetabular component failure. In this admission, her AKI improved with intravenous fluid administration and her haematuria settled following catheterisation with a three-way catheter and bladder irrigation with saline...
March 22, 2018: BMJ Case Reports
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