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An impact of the endogenous intoxication on the treatment efficacy of the lower jaw fractures is not well-studied. Therefore, the aim of the present study was to examine the effect of endogenous intoxication on the dynamics of recovery from traumatic injuries of the lower jaw. Thirty-two patients with the open bilateral traumatic fracture of the lower jaw were enrolled in present study. All the patients were subjected for general blood analysis; the biochemical and hemostasis parameters and leukocyte intoxication index were also included. The patients were divided into the 3 experimental groups. Group 1 was composed of patients (26.3%) with low leukocyte intoxication index (< 1.0). The patients included into group 2 (47.4%) exhibited the index ranging from 1.0 to 1.4. For the patients included in group 3 (26.3%), this index exceeded 1.5. All the examinations were performed on day 1 after the injury and on day 5 after the reposition of fragments of the lower jaw. Thirteen patients were also examined for the macro- and microelement content and ratios in the oral fluid. We observed that due to the adverse effects of endogenous intoxication, the patient may develop the opposite reactions, including the restoration to normal values or development of sensitization of the body and tissue necrobiosis. We also found that significant changes in leukocyte intoxication index during the recovery period in all experimental groups. For example, in group 1, the leukocyte intoxication index decreased up to 0.88 ± 0.05 (p < 0.001), whereas in group 2, this index decreased up to 1.27 ± 0.04 (p < 0.001). Group 3 demonstrated a substantial decreased of this index, e.g., 2.0 ± 0.22 (p < 0.05). The precise molecular mechanisms of this phenomenon are unknown and remain to be further elucidated. We showed here for the first time that endogenous intoxication during the traumatic injuries of the lower jaw might trigger the development of sensitization or necrobiosis of the surrounding tissues, which has a significant impact on duration of the treatment and recovery period.

Fractures in the pediatric population are less common than in adults. Facial fractures represent only 4%-5% of total trauma in infants. Osteogenesis imperfecta is a group of genetic disorders where multiple fractures can occur even in early years of life. Long-term treatment with bisphosphonates is currently used in these children in order to increase bone strength and to alleviate symptoms. This paper reports a rare case of a traumatic fracture of the mandible in a 4-year-old child with osteogenesis imperfecta type I. This is an unusual complication in children, even in this group of patients. Open reduction and rigid fixation are not often described as the best treatment. As there are controversies about the subject, a literature review and discussion are presented.

Background Traumatic fractures are common in sub-Saharan Africa, a region with a shortfall of orthopaedic surgeons, and can result in morbidity if not appropriately managed. WhatsApp is an encrypted smartphone application and ubiquitous in sub-Saharan Africa. The objective of this study was to assess the use of WhatsApp as a mobile health platform to support fracture management by non-orthopaedic doctors in Cape Town, South Africa. Study Design A WhatsApp orthopaedic referral group was created between non-orthopaedic doctors from community health clinics and the orthopaedic team from a first-level hospital to manage traumatic fractures. Non-orthopaedic doctors posted cases on the orthopaedic referral group and the orthopaedic team provided advice. Traumatic fracture data from January 1 to June 30, 2018 were analyzed and outcomes included response time, management advice, and treatment by facility level. Results Seventy-two non-orthopaedic doctors posted 731 cases of traumatic fractures to the 5-member orthopaedic team. Six hundred and sixty-one (90%) cases were responded to within 1 hour. Three hundred and fifty-four (48%) patients were treated successfully by non-orthopaedic doctors at community health clinics, 288 (39%) were treated by the orthopaedic team at the first-level hospital, and 89 (12%) were referred directly to an orthopaedic subspecialist at a third-level hospital. Conclusions The WhatsApp orthopaedic referral group provided a free telementoring platform for non-orthopaedic doctors to successfully manage traumatic fracture cases at community health clinics. This type of mobile health platform can be applicable to other resource-limited settings if disease burden is high and specialists are scarce.

Pedicle fractures are among the least common; those involving bilateral pedicle fractures are rare. To our knowledge, there are no previous reports of bilateral multi-level pedicle fractures in the lumbar spine secondary to trauma concerning adolescents. We report a 14-year-old male with bilateral multi-level traumatic pedicle fractures (BMTPF) of lumbar spine (LS) three and five (L3, L5) and spondylolisthesis of L3 on L4 (classified Meyerding grade II). Posterior lumbar instrumentation from L1 to S1 was performed. Postoperative recovery was uneventful. The aims of the study were to provide the first documentation of this pattern of injury in adolescents LS secondary to trauma and to review literature. The patient’s parents were informed that non-identifying information from the case would be submitted for publication, and they provided consent.

Paediatric orbital trauma is uncommon, but it can be associated with significant morbidity. Traumatic pseudomeningocele is an infrequent complication of orbital trauma; it occurs due to an extradural collection of cerebrospinal fluid (CSF) that develops after a dural tear. Herein, we report a case of a seven-month-old male child who presented with eye swelling and suspicion of orbital cellulitis, along with a history of a road traffic accident. He was later diagnosed with traumatic orbital pseudomeningocele and underwent a left frontal craniotomy and duroplasty along with repair of medial orbital pseudomeningocele. Postoperatively, the child remained stable and resolution of proptosis was observed.

We report the case of a fracture healing after Ra in an 83-year-old wheelchair-bound man with prostate castration-resistant adenocarcinoma treated due to uncontrollable pain from widespread bone metastases. The patient fractured both right tibia and fibula 15 days prior to the first Ra cycle. After the first cycle, there was complete remission of his metastatic bone pain; after the second cycle, he began walking with support, which helped improve fracture healing; and after the third cycle, he presented complete mobility. Posttreatment images showed consolidated fractures. By improving metastatic bone pain with Ra, consolidation of the insufficiency fracture was possible.

Purpose Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. Methods This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. Results The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. Conclusions We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.

We present a rare case of a 10-cm right subclavian artery pseudoaneurysm, with slow growth over 4 years after a traumatic fracture of the right clavicle. The patient had multiple prior endovascular attempts of embolization and stenting at other hospitals; despite this the pseudoaneurysm continued to grow and caused mass effect and neurologic symptoms. We present our open approach for the repair and a review of literature.

Central venous catheters play a pivotal role in the perioperative support of critically ill patients. They are used for administration of fluids, vasopressors, blood products, and various medications; however, their use may be associated with serious complications, such as catheter fracture and embolization. While most data on catheter fracture embolization consist of isolated case reports, only a few studies have examined patients with central venous catheter embolism. We report a traumatic inadvertent transection of central venous catheter that migrated through a donor transplanted liver and was found to be lodged in the recipient’s right ventricle. The catheter was retrieved under fluoroscopy using a trilobed snare device.

We report a case of a temporal bone pneumatocele with full-thickness erosion of the cranium associated with aggressive nose blowing. This condition presented 9 years after traumatic fracture of the temporal bone. There are 17 reported cases of mastoid sinus hyperpneumatisation in the literature. Eleven of the 17 are associated with Valsalva manoeuvres or elevated middle ear pressure. However, no other cases of full-thickness erosion at the site of a former fracture have been reported. We propose that the fracture, in combination with elevated mastoid sinus pressure from aggressive nose blowing, led to escape and trapping of pressurised air in the epidural and subcutaneous spaces, which resulted in bone erosion.

Traumatic deformities affect the appearance and function of lower limbs. Different type, location, and severity correspond to different manifestations. Some patients suffer from delay in treatment or improper treatment at the first time. Traumatic and infection sequelae of lower extremity are divided into the following categories: 1. Malunion after traumatic fracture 2. Bone and joint deformity caused by scar contracture 3. Bone and joint deformity caused by ischemic muscle contracture after vascular injury 4. Bone and joint deformity caused by muscle imbalance as incomplete central or peripheral nerve damage 5. Joint deformity caused by early closure of the epiphysis resulting from trauma or infection 6. Joint deformity caused by septic arthritis 7. Complex lower limb deformities caused by severe complex injuries, and so on

ObjectiveTo explore the risk factors of perioperative deep vein thrombosis (DVT) in patients with traumatic fracture after orthopaedic surgery and their potential diagnostic values in clinical.DesignRetrospective cohort study.SettingClinical Laboratory of Honghui Hospital, Xi’an JiaoTong University College of Medicine, Xi’an, Shaanxi, China.Materials and methodsA retrospective cohort study was conducted with surgically treated fracture patients in Honghui Hospital from 1 May 2016 to 31 February 2017.χ2test, independent sample t test and regression analysis were applied to examine the correlation between perioperative DVT and the factors of preoperative time, fracture sites, D-dimer value and chronic diseases (hypertension, diabetes and coronary disease).Results462 patients were enrolled for analysis. The preoperative time of patients with DVT was significantly longer than that of non-DVT patients (7.14±5.51 vs 5.45±3.75) (Pχ2test showed the significant differences in the rate of DVT among patients with different fracture sites (PConclusionsFracture site was correlated to the incidence of DVT; prolonged preoperative time and increased D-dimer value were independent risk factors for DVT in patients with lower extremity traumatic fractures.

Post-traumatic meningioma is a matter of controversy with many reported cases of cranial post-traumatic meningioma and rare cases for such pathology in human spine. The author reports a 61-year-old woman who had post-traumatic spinal meningioma at the site of old traumatic fracture for 26 year after her initial trauma. The patient treated successfully with microsurgical resection and posterior fusion with improvement of here recent weakness. The author reviews the literatures for similar cases as well as reviews the controversies regarding the development of post-traumatic meningiomas.

The treatment of pathologic fractures should be the final stage of a concise pathway including diagnostics, imaging, and survival prediction. If the treatment of a pathologic fracture is rushed, this can lead to severe and needless complications. Several important pitfalls should be avoided: The cause of a pathologic fracture or the origin of a solitary lesion should be known. Without a final diagnosis, a new solitary lesion should always be regarded as primary tumour. One should be cautious of a spontaneous fracture or of a fracture after minimal trauma, since there can be an underlying pathology. It is important to realise that a pathologic fracture does not heal like a traumatic fracture. This must be considered when deciding on the treatment strategy. Pain is not a firm prognostic factor for the risk of an impending fracture. More than one lesion can be present in a bone, so complete imaging is essential. The treatment strategy should depend in great part on the expected survival. The aim of the treatment should be to give the patient a stable limb in a single operation. The extent of the surgery and the implant should thus be in balance with the expected survival, preventing overtreatment and unnecessary complications.

Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.

Neglected fracture neck of femur is a challenging condition to treat. Preservation of the head of femur is desirable in young patients. Various options include osteosynthesis, osteotomy combined with or without vascular or non-vascular bone grafting. We have done a prospective case series on neglected fracture neck of femur in young adults treated by osteosynthesis with nonvascularized fibula grafting.This study included traumatic fracture neck of the femur delayed more than 3 weeks in young adults 15-60-year-old . We achieved a satisfactory outcome with HHS of more than 70 in 81.25% of our patients. There was a nonunion rate of 6.25% and AVN rate of 12.5%. This study shows that nonvascular fibula grafting is a viable option for the treatment of neglected fracture neck of femur in young patients. It is technically less demanding with results comparable to other more complicated procedures.

Fat embolism syndrome is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is most commonly associated with fractures of long bones and the pelvis. Patients usually present with signs and symptoms of multiorgan dysfunction, particularly involving the triad of lungs, brain, and skin. A combination of clinical criteria and MRI brain will enable early and accurate diagnosis of FES. Prevention, early diagnosis, and adequate symptomatic treatment are the mainstay of management. We present a case who became drowsy, after a few hours of a traumatic fracture and developed pulmonary insufficiency, cutaneous petechiae. MRI findings were consistent with cerebral fat embolism. Treatment included intensive care, artificial respiration, and symptomatic therapy. The patient had recovered completely. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14370 Bangladesh Crit Care J March 2013; 1: 49-52

In deze casus wordt de succesvolle behandeling beschreven van een traumatische mid-diafysaire femurfractuur met behulp van een type I “tie-in-fixator” bij een kookaburra. Een vijf maanden oude, in gevangenschap gehouden kookaburra (Dacelo novaeguineae) werd aangeboden met trauma ten gevolge van interspecies-agressie. Op basis van klinisch en radiografisch onderzoek werd de aanwezigheid van een gesloten, multipele, dwarse tot spiraalvormige, mid-diafysaire femurfractuur vastgesteld. Na reductie van de fractuur werd stabilisatie bekomen door het toepassen van een type I tie-in-fixator bestaande uit een combinatie van een intramedullaire (IM) pin en een externe skeletale fixator. Postoperatieve radiografische opnamen bevestigden een optimale reductie van de fractuur en een correcte plaatsing van het osteosynthesemateriaal. Postoperatief trad er een vlotte recovery op en werden er onmiddellijk een goede steunname en normale belasting van de aangetaste poot waargenomen. Hoewel de externe fixatie een week later door de vogel verwijderd werd, bleek er nog steeds goede stabilisatie aanwezig te zijn en bleef de functionaliteit van de aangetaste poot behouden. Twee weken postoperatief bevestigden controleradiografieën fractuurheling die gekarakteriseerd werd door lichte callusvorming en een startende overbrugging van de cortices. Op basis van de klinische en radiografische bevindingen werd besloten om de IM-pin op dat ogenblik te verwijderen. Tijdens een opvolgingsperiode van drie maanden vertoonde de kookaburra volledig herstel.

An instrument set for application in patients requiring a correction treatment and/or a temporary fixation of the cervical spine is described. The halo is combined with a cast or a brace employing the 8 mm Hoffmann External Fixator system supplemented by three additional, newly designed parts. Applications of the instrument set in the treatment of traumatic fracture, fibrous dysplasia and ankylosing spondylitis are described.

SummaryTraumatic patellar fracture in cats mainly occurred in male neutered cats with an average age of four years, six months and a mean weight of 4.8 kg. Patellar fractures were concurrent with long bone fractures and cruciate ligament rupture or occurred after gunshot. The patella luxated medially or laterally in four cats. Fracture fragments were usually small, either from the proximal pole (base) or distal pole (apex) or longitudinal fragments. Treatment was by fragment excision when the fragment was small or by reconstruction with pins and wires when fractures were comminuted. The outcome in six cats was reported as ′good′ to ′normal′ and three cats were ′improving′ or had ′mild′ intermittent lameness at the last follow up.

A traumatic pedicle fracture in association with pre-existing bilateral spondylolysis and anterolisthesis has never been described. A 27-year-old male professional football player presented with acute gluteal pain caused by a traumatic fracture of the left pedicle L5 missed on plain radiographs, but seen on CT-scan and confirmed on bone scintigraphy. Instability caused by this fracture in association with pre-existing bilateral spondylolysis and grade I-anterolisthesis required immobilization of the lumbar spine. Since no neurological deficit was observed, it was decided not to operate but to treat the patient with analgesics and with a lumbar orthosis which would provide unilateral hip fixation in extension during walking. We report here on the difficulties of diagnosis and on the successful treatment by means of immobilization in a lumbar orthosis. A rehabilitation program with specific sports-related exercises was devised.

Our objective in this study was to evaluate whether measurement of quantitative uptake of 99mTc-methylene diphosphate (MDP) and 99mTc-hexamethylpropyleneamine oxime (HMPAO) white blood cells (WBCs) is useful in detecting osteomyelitis in peripheral bony lesions. Methods: Twenty-four patients (12 men and 12 women; age range, 25–72 y) were referred for imaging because of clinically suspected osteomyelitis. They had a traumatic fracture (n = 10), knee prosthesis (n = 5), hip prosthesis (n = 2), diabetic foot (n = 4), or chronic osteomyelitis (n = 3). Three-phase bone scanning and 99mTc-HMPAO WBC studies were performed on all patients within the same week. Regions of interest were drawn over the abnormal bony sites and the contralateral normal sites, and the abnormal-to-normal uptake ratios (A/N ratios) were obtained for both studies. Results: All patients had abnormal findings on 3-phase bone scanning, whereas 17 (71%) had abnormal findings on 99mTc-HMPAO WBC studies, of which 15 were confirmed to be true-positive. In those 15 patients, the mean A/N ratios for 99mTc-MDP and 99mTc-HMPAO WBC were 3.0 ± 1.6 (range, 1.3–6.2) and 1.8 ± 0.3 (range, 1.4–2.2), respectively. In the other 9 patients, whose scan results were clinically confirmed to be true-negative, the mean A/N ratios for 99mTc-MDP and 99mTc-HMPAO WBC were 2.1 ± 1.2 and 1.2 ± 0.2, respectively. In the group with a 99mTc-MDP A/N ratio greater than 2 (n = 15), 87% (13/15) had a high 99mTc-HMPAO WBC A/N ratio (>1.5), including 2 that were false-positive. In the remaining 2 patients, one with chronic osteomyelitis and the other with a recent hip prosthesis, 99mTc-HMPAO WBC ratios were normal. In the group with a bone A/N ratio of less than 2 (n = 9), only 4 patients (44%) were true-positive for acute osteomyelitis. Conclusion:99mTc-MDP bone scanning alone, with an A/N ratio of more than 2, is useful in detecting osteomyelitis in violated bone except in the case of a recent hip prosthesis or chronic osteomyelitis.

Background: Prospective clinical outcome measures in a large cohort of patients with thoracolumbar spinal injuries have not been reported to date. Objective: To evaluate the outcomes of traumatic pathologic or nonpathologic thoracolumbar spine injuries treated with a percutaneous posterior internal fixation using the CD Horizon® Sextant™ Rod Insertion System (Medtronic® Sofamor Danek). Patients and Method: We performed a prospective clinical study evaluating a novel method of internal fixation of traumatic thoracolumbar spinal injuries. Over a 2-year period from August 2003 to July 2005, a total of 156 patients with thoracolumbar spinal injuries were treated with percutaneous posterior internal fixation using the CD Horizon® Sextant™ Rod Insertion System (Medtronic® Sofamor Danek). Indications for surgery included (1) AO Type A and Type B spinal fractures, (2) the presence of polytrauma, or (3) a pathologic traumatic fracture in the setting of osteoporosis or metastatic disease with or without prior anter...

The differential diagnosis of a fractured clavicle includes acute traumatic fracture, stress fracture, pathologic fracture secondary to radiation exposure, neoplasm, infection, or metabolic bone disease, and fracture-like conditions such as infection and bony dysplasias. An appropriate workup should identify most of these underlying conditions. We report a case of concurrent bilateral nontraumatic fractures of the clavicle occurring in a healthy young man in the absence of repetitive trauma. Workup revealed no underlying explanation for the fractures. To our knowledge, this has not been reported. Our case suggests the differential diagnosis of a fractured clavicle should be expanded to include idiopathic nontraumatic fractures.

We report a case of traumatic fracture subluxation of the hip joint. An acetabular lip fracture, chondrolysis of the articular cartilage and hip subluxation, rendered this injury a disabling injury and difficult to treat. A sector of the head of the femur collapsed, few months after injury and the developed osteoarthritis. The patient was treated using surface total hip replacement with a very satisfactory out come.

We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine.

Bilateral femoral neck fractures are rare in the pediatric age group, and only a few cases have been reported following major trauma in children. A 9-year old girl presented with bilateral femoral neck fractures following a motor vehicle accident. The patient was managed with early operative fixation of the fractures with a successful outcome. This case highlights the importance of awareness of the occurrence of bilateral femoral neck fractures in the polytrauma patients. This case is presented due to its rarity.

Enchondromas are benign cartilage forming tumors most commonly involving the marrow cavity of the long bones. Ollier disease is one of the subtypes of Enchondromatosis associated with lesions in the center of the bone. Most commonly presenting in 2nd and 3rd decade of life. Radiological evidence is adequate for the diagnosis. Exact etiology is unknown with increasing genetic predilection. Regular follow up with conservative management remains the mainstay of treatment.

Key Clinical Message Traumatic fracture of the malleus handle without tympanic membrane perforation is a rare incidence. Diagnosis of conductive hearing loss can only be confirmed with manipulation of the ossicles under sedation as computerized tomography is not informative. We present a 39-year-old lady with Q-tip injury when she get sudden phone call.

We report a case of traumatic humeral neck fracture occurring in a patient with osteopoikilosis after a motorcycle accident. The radiograph revealed the fracture but also multiple bone lesions. A few years before, the patient had been operated for a maldiagnosed chondrosarcoma of the humeral head. Osteopoikilosis is a rare benign hereditary bone disease, whose mode of inheritance is autosomal dominant. It is usually asymptomatic and discovered incidentally on radiograph that shows the presence of multiple osteoblastic lesions. It can mimic other bone pathologies, in particular osteoblastic metastases. Osteopoikilosis is a diagnosis that should be kept in mind to avoid misdiagnosis, particularly with regard to cancer metastasis. This disorder does not require any treatment and complications are rare. However, there may be associated anomalies that require follow-up.

症例は76歳の農婦.数年来, 腰痛を訴え骨粗鬆症と診断され, その後, 生じた貧血は消化管出血由来とされ, いずれも治療中, 転倒し肋骨骨折を来たし入院.検査で高度の貧血及び腎機能障害と著明な高蛋白血症を認め, 免疫電気泳動で, 血清中にIgG型のM蛋白, 尿中にκ型のベンスジョーンズ蛋白を検出した.骨は外傷性肋骨骨折のほか骨溶解性病変を呈した.これらの症候と検査成績から多発性骨髄腫 (以下MM) と確診した.高度の貧血に輸血を行い, 当初エンドキサン, 次いでプレドニンを投与し, γグロブリンは半減したが腎不全が進行し死亡した.自験例は確診に先立つかなり前からMMの手掛かりとなる骨痛, 貧血が存在し, 前者を骨粗鬆症, 後者を消化管出血由来と判断した為早期診断が遅れた.著明な貧血と腰, 背, 胸部の疼痛を呈する疾患を見た場合, 多発性骨髄腫等の悪性腫瘍も考慮し対応することが肝要と反省させられた.

We report traumatic disruption of a ringed polytetrafluorethylene (PTFE) axillofemoral bypass (AFB) graft due to a fall. We also review the literature of previously reported blunt traumatic PTFE graft disruptions. A 75-year-old man with previous bilateral AFB grafting presented with a painful left chest wall mass after a fall from standing height. Chest computed tomography (CT) revealed a large chest wall hematoma. The patient underwent evacuation of the hematoma, resection of the fractured graft, and placement of an interposition PTFE graft. Two prior case reports have documented the midportion PTFE graft disruption from blunt trauma. Our case report demonstrates the potential for disruption of the midportion of ringed PTFE AFB grafts with direct blunt trauma. The diagnosis was confirmed by CT scan and the graft was successfully repaired with an interposition graft.

We describe two cases of avascular necrosis after traumatic fracture of the femoral neck. The size and signal intensity of the necrotic areas changed on follow-up magnetic resonance images. Magnetic resonance imaging is suitable for showing resolvable changes that radiographic study cannot demonstrate during the clinical course.

Stress fractures occur due to repetitive forces on the bones and develop over time. The etiology differs from a traumatic fracture and therefore stress fractures are more an overload injury. Stress fractures of the foot and ankle are frequently seen in athletes and can be a potentially career ending injury for these high demanding sportsmen. Some locations are considered as high-risk stress fractures due to slow healing and high rates of non-unions. This article discusses the most common sites for stress fractures of the foot and ankle, the risks and evidence on best treatment options.

Objective-To study comparisons of diagnosis for occult fractures with nuclear magnetic resonance imaging and computerized tomography. Methods-Seventy six cases of patients with bone fracture including 45 males and 31 females were recruited in this study. And the data of X-ray, nuclear magnetic resonance Imaging (MRI) and computerized tomography (CT) were collected. Results-CT examination revealed 61 cases of patients with occult fractures and the accuracy rate was 80.26 %. MRI examination revealed 70 cases of patients with occult fractures and the accuracy rate of diagnosis was 92.11 %. There was no statistically significant difference between two methods in accuracy rates of fractures around the knee and recessive traumatic fracture (P > 0.05). For vertebral fractures and recessive bone fracture, the diagnosis rate of CT were 72.22 and 73.68 %, respectively the diagnosis rate of MRI were 91.67 and 94.74 %, respectively, there was statistically significant difference(P < 0.05). Conclusion-While both computerized tomography and MRI can easily detect the bone fractures that are not recognized from X-ray film and whose clinical signs and symptoms are not clear, MRI can easily detect the occult fractures that are not shown by x-ray film and computerized tomography imaging and it can clarify many types of injuries and thus has high value and clinical applications.

Patient with C5 traumatic fracture treated by vertebral drawing and prosthesis positioning fixed by transvertebral screws at C4–C6.

Patient with C2 traumatic fracture treated at first with collar and then by anterior stabilization through trans odontoid screw.

Complete traumatic fracture-dislocation of the lumbar spine is a rare spinal injury often leading to death. Surgical intervention is an effective treatment modality to decrease mortality. Our patient was a 16 year old boy who had a collision caused by fall from a construction material lifter. He was referred to our hospital with waist trauma. Later, the patient underwent posterior surgical decompression during which vertebral column restoration by long segment fixation was performed. After surgery there were no significant changes in the patient condition.

An acute traumatic fracture can be present with high level of 18F-FDG uptake. Nevertheless, FDG-PET/CT is useful in differentiating some rare benign form of bone disease.

Objective To present a case of a traumatic fracture of a polymethyl methacrylate (PMMA) patient-specific implant (PSI) for cranioplasty. Methods A 14-year-old boy with a history of right decompressive hemicraniectomy and reconstructive cranioplasty with a PMMA PSI presented after an unhelmeted bicycle accident with somnolence, confusion, seizures, left hemiparesis, and an obviously deformed cranium. Results Computed tomography scan showed a comminuted, depressed fracture of the implant and cerebral contusions. The implant was seen to be shattered, resulting in displaced, overriding fragments and significant damage to underlying brain. The patient remained neurologically stable. To minimize the number of operations, intervention was delayed while a polyetheretherketone PSI was fabricated. During surgery, it was noted that the fractured pieces of the implant had caused dural lacerations, and some pieces were embedded in brain parenchyma. The fractured PMMA was removed, and the new implant was placed. The patient remained hemiparetic and was later transferred to an inpatient rehabilitation facility. Conclusions PMMA PSIs are commonly used for large defects and generally have good outcomes with low rates of revision. The case report described involves a shattered PMMA PSI after a traumatic impact, which resulted in hemiparesis. The question arises if this type of complication can be easily avoided with the addition of titanium onlay to restrict displacement in the event of fracture. This onlay represents a minor change of technique that could prevent migration of fracture fragments.

The implantation of massive allografts is a reconstruction alternative after limb salvage for aggressive bone tumours. It is hoped that durable long-term results can be obtained with these biological reconstructions. Revitalization of the allografts is one of the most important factors with regard to durability. One massive proximal femoral osteoarticular allograft is described that was followed up for 22 years. Twenty-one years after the implantation, a traumatic fracture in the middle of the allograft occurred, and formation of massive callus showed that revitalization even in the central parts of massive allografts is sufficient for fracture healing. This is why it may be justified to expect long-lasting results.

Tibial plateau fracture (fracture of proximal end of tibia) is one of the most common traumatic fracture of the knee joint.

Intra-articular injections of the elbow can be performed in the treatment of a variety of pathological conditions.

The role of magnetic resonance imaging (MRI) has recently been enhanced in the diagnosis of thoracolumbar fractures due to its ability to examine soft tissue injury.We conducted a prospective study to analyze the usefulness of MRI in fracture diagnosis and its influence on treatment decision making. Thirty-three patients were enrolled after suffering an acute traumatic thoracolumbar fracture. Osteoporotic or pathologic fractures were excluded. Fractures were initially classified using X-ray and CT scan following the AO classification. Afterward, a selective MRI protocol was performed with T1 and T2-weighted FS/STIR sequences. Subsequently, fractures were classified according to the TLICS system and reclassified following the AO system. Analysis was performed before and after MRI, focusing on: diagnostic changes, occult fractures and differences in treatment decision making.Thirty patients (15 males, 15 females) with an average age of 39.9 years were studied. Forty-one fractures were initially diagnosed using plain X-rays and CT scans, while MRI diagnosed 50 fractures and 9 vertebral contusions. MRI modified our diagnosis in 40% of our patients (discovering 18 occult injuries), the classification of fracture pattern in 24% of the fractures (mostly upgrading type A to type B patterns) and the therapeutic management in 16% of our patients.MRI seems to be a useful tool in the evaluation of thoracolumbar acute fractures, as it allows a better visualization of the posterior complex integrity and of the levels involved, offering additional information compared to traditional diagnostic tools.

Tibial plateau fracture: mathematical model to correlate agent force trauma The upper tibial extremity is in the midlle of inferior limb and coresponds aproximately to the upper quarter of the shank. Diafizo metafizar quarter segment of the upper tibia assure the conection between massive epifizar in four angles and triangular diaphysis section. In all cases, will be trying to mention trauma mechanism to allow such research orientation and direction demands resulting from this fracture topographies, where the chorus flows associated ligament injuries. Research ligament injuries should be charged with two kinds of etiologies: ligament injuries induced fractures or ligament injuries induced mechanism. As a general rule, ligament injuries induced fracture alters a lesser extent than the prognosis of ligament injuries induced even by mechanism This paper proposes an power matching agent against the traumatic fracture type and it produces cross ligaments through creation of a mathematical model to answer two of the above questions:-Ligament injuries are caused by fractures or does this happen? -Ligament injury may be stage-based mechanism?

Eighteen cases of traumatic fracture dislocation were managed surgically using a technique which involved an anterior cervical approach followed by discectomy, bone graft, and insertion of a metal plate. The patients were mobilized early to prevent the usual complications of bedsores, deep vein thrombosis, pulmonary embolism, chest infection, and contractures. After more than two years of follow-up, no patient has had problems with local infection, screw loosening, neurological deterioration, dysphagia, or persistence of laryngeal nerve paresis. The benefits of this technique, already endorsed by some authors, include reduced morbidity and hospitalization as well as decreased demand on the staff, particularly as required by quadriplegic patients.

The safety and treatment possibilities of balloon kyphoplasty have rapidly led to the use of this technique in traumatic vertebral fractures. Initially balloon kyphoplasty was used in osteoporotic patients who sustained a fall and a subsequent traumatic fracture; however, the general rules of balloon kyphoplasty also apply in trauma cases and the guidelines shown above remain valid. Although we now have a safe and effective method of restoring vertebral height and reducing the fracture, the injectable bone substance is still an issue, especially in trauma. In general there is consensus that polymethylmethacrylate (PMMA) is safer in the elderly, as it is not resorbed or remodeled, but in young patients consensus has not yet been found on whether the use of PMMA in traumatic fracture is safe. During the past five years resorbable calcium phosphate cements (CPC) have therefore gained in popularity. In this chapter we summarize knowledge of the use of balloon kyphoplasty with resorbable CPC in traumatic fractures in young patients.

SummaryIn the dog, the pelvis is frequently injured following motor vehicle accidents (1). Injuries to the lower urinary and intestinal tracts may accompany pelvic fractures in man (2, 3, 4, 5) and the dog (1, 6, 7). This paper describes an unsual case of bladder retroflexion and herniation through a tear, into the rectum of a dog, following traumatic fracture of the pelvis. The successful management and repair is outlined and a biomechanical sequence leading to the abnormal bladder position is proposed.An unusual case of bladder retroflexion and herniation through a tear, into the rectum of a dog, following traumatic fracture of the pelvis is described. Repair was accomplished by manipulation of the bladder into its normal position through a coeliotomy incision and suturing of the rectal tear after prolapsing the rectum through the anus. The proposed biomechanical sequence leading to this injury is tearing by the inwardly rotated, fractured left hemipelvis as well as or alternatively, shearing forces along lines of excessive tension.