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Axial loading of the lower leg during impact events can cause significant fractures of the tibia. The magnitude of lower leg axial loading that occurs during short-duration high-impulse events, such as anti-vehicular landmine blasts, can lead to life-altering injuries. These events achieve higher forces over shorter durations than car crashes, the current standard used for protective measures. In order to determine appropriate injury limits for the lower limb, a testing apparatus has been designed that can simulate these types of events for testing of anthropomorphic test device (ATD) lower legs as well as cadaveric specimens. Moreover, the design allows for the velocity at which the specimen is struck to be varied independently of the force applied, thus allowing independent investigation into the effect of momentum or energy on fracture strength. Test specimens are supported on a low-friction bearing system, and receive the controlled impulse from a projectile of variable mass that is accelerated using pneumatics. The apparatus includes velocity sensors, a six-degree-of-freedom load cell, and an accelerometer to completely quantify the loading event. The apparatus' performance was validated against an ATD lower leg. It was able to create impulse events with forces from 0.5 kN to 17.0 kN, and projectile speeds of 2.3-13.9 m/s. Various momenta could be achieved at a constant force level by varying the mass of the projectile, with a maximum difference of 65%, whereas kinetic energy was inherently linked to the impact force. This apparatus will be useful in future studies for determining the appropriateness of currently used injury limits for the lower limb to high-impulse events, as well as for quantifying the relationship between cadaveric fracture response and ATD measurements. This device can also be readily applied to other bones of the body, to create realistic fracture patterns for known injury mechanisms. [DOI: 10.1115/1.4000084] Keywords: impulse loading, test apparatus, lower limb, anthropomorphic test device, injury

The study aims to evaluate the efficacy of denosumab in preventing and reducing fractures among postmenopausal women with osteoporosis. The results indicate that denosumab showed positive results in reducing the risk of vertebral, novertebral and hip fractures among women.

The relationship between the high-trauma nonspine fractures and low bone mineral density (BMD) in older women and men is studied. The results demonstrate the presence of a linear relationship between the two.

ABSTRACT Background Data from previous studies are inconsistent, and it is therefore uncertain whether, to what extent, and at what level leisure physical activity influences the risk of osteoporotic fractures [...]

Background: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse? Methods: We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review. Findings: Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel. Conclusion: Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question. Keywords: Cardiopulmonary resuscitation; Rib fractures; Children

Byline: Fredrik Borgstrom (1,2), Niklas Zethraeus (3), Olof Johnell (4), Lars Lidgren (5), Sari Ponzer (6), Olle Svensson (7), Peter Abdon (8), Ewald Ornstein (9), Karl Lunsjo (10), Karl Goran Thorngren (5), Ingemar Sernbo (4), Clas Rehnberg (1), Bengt Jonsson (3) Keywords: Costs; Fracture; Osteoporosis; Quality of life Abstract: This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (a!), at a!14,221, a!12,544 and a!2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/a!]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at a!0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived. Author Affiliation: (1) Medical Management Centre, Karolinska Institutet, Stockholm, Sweden (2) Stockholm Health Economics, Klarabergsgatan 33 3tr, 111 21, Stockholm, Sweden (3) Stockholm School of Economics, Stockholm, Sweden (4) Department of Orthopaedics, Malmo General Hospital, Malmo, Sweden (5) Department of Orthopaedics, Lund University, Lund, Sweden (6) Department of Orthopaedics, Stockholm Soder Hospital, Karolinska Institutet, Stockholm, Sweden (7) Division of Orthopedics, Umea University Hospital, Umea, Sweden (8) Department of Orthopedics, Ystad Hospital, Ystad, Sweden (9) Department of Orthopedics, Hassleholm-Kristianstad Hospitals, Hassleholm, Sweden (10) Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden Article History: Registration Date: 20/09/2005 Received Date: 27/06/2005 Accepted Date: 19/09/2005 Online Date: 09/11/2005

A study is conducted to determine if women who undergo pelvic irradiation for pelvic malignancies have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation. Conclusions suggest that pelvic irradiation substantially increases the risk of pelvic fractures in older women.