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ZusammenfassungMittelhand- und Phalangenfrakturen sind in der Summe die zweithäufigsten Frakturen der oberen Extremität. Die korrekte Therapie und Nachbehandlung sind essenziell für die Wiederherstellung der Funktion der verletzten Hand. Das bessere Verständnis von Anatomie und Biomechanik der Mittelhand und Phalangen sowie die Entwicklung moderner Implantate erlauben gute Ergebnisse bei der operativen Versorgung, wenn auch die konservative Therapie einen großen Stellenwert hat.

Humeral fractures account for 5% to 8% of all fractures, whereas proximal humerus fractures represent the seventh most frequent fractures in adults...

Case We report an 18-year-old patient with a clinical phenotype consistent with severe osteogenesis imperfecta (OI) with frequent fractures, short stature, shortening and bowing of extremities, and unusual radiographic features of severe fibrous dysplasia, including lytic lesions and a "ground-glass" appearance. Genetic testing for the patient was notable for a c.119C>T (p.Ser40Leu) variant in exon 1 of IFITM5 and a c.676C>A (Pro226Thr) variant in exon 5 of CREB3L1. Conclusion This unusual skeletal presentation was in the setting of a rare IFITM5 mutation and represents a unique case of severe OI.

Background Osteogenesis imperfecta, fibrous dysplasia/McCune-Albright syndrome and X-linked hypophosphatemia are three rare musculoskeletal diseases characterised by bone deformities, frequent fractures and pain. Little high-quality research exists on appropriate treatment and long-term management of these conditions in adults. This is further worsened by limited research funding in rare diseases and a general mismatch between the existing research priorities and those of the patients. This partnership adopted the James Lind Alliance approach to identify the top 10 research priorities for rare musculoskeletal diseases in adults through joint patient, carer and healthcare professional collaboration. Results The initial survey for question collection recruited 198 respondents, submitting a total of 988 questions. 77% of the respondents were patients with a rare musculoskeletal disease. Following out-of-scope question exclusion, repeating query grouping and scientific literature check for answers, 39 questions on treatment and long-term management remained. In the second public survey, 220 respondents, of whom 85% were patients with a rare musculoskeletal disease, their carers, relatives or friends, prioritised these uncertainties, which allowed selection of the top 25. In the last stage, patients, carers and healthcare professionals gathered for a priority setting workshop to reach a consensus on the final top 10 research priorities. These focus on the uncertainties surrounding appropriate treatment and holistic long-term disease management, highlighting several aspects indirect to abnormal bone metabolism, such as extra-skeletal symptoms, psychological care of both patients and their families and disease course through ageing. Conclusions This James Lind Alliance priority setting partnership is the first to investigate rare bone diseases. The priorities identified here were developed jointly by patients, carers and healthcare professionals. We encourage researchers, funding bodies and other stakeholders to use these priorities in guiding future research for those affected by rare musculoskeletal disorders.

Osteopetrosis (OP) is a rare hereditary sclerosing bone dysplasia characterised by generalised hard and brittle bone secondary to defective osteoclastic function. Osteopetrotic bone is brittle, thus these subjects are prone to frequent fractures, particularly of the long bones. Due to defective osteoclastic function, remodeling is also defective in OP. This report is a case of humeral fracture in a 9 years old girl who was followed seven years. The fracture had remodeled totally similar to healthy bone at the final follow-up. Conservative treatment should be kept in mind in the management of fractures in children with OP, and fractures within acceptable angulations and/or translations should be treated conservatively without hesitation.

Zygomatico-maxillary fractures are the most frequent fractures of the middle face. Their functional and aesthetic repercussions pose a great challenge to the practitioner. Their management is a challenge, which raises an altercation between the authors, between orthopedic and surgical indications, and the different surgical approaches. We report a retrospective workup study of 262 cases of zygomaticomaxillary fractures, in 4 years, managed in our department to evaluate and compare the different postoperative results of these fractures treated by orthopedic reduction and/or by osteosynthesis.

Some children with cerebral palsy (CP) have frequent fractures due to low bone mineral density and receive treatment with pamidronate, an intravenous bisphosphonate. Our review evaluates the outcome of pamidronate treatment in these children.A retrospective chart review was performed, and 32 patients (14 girls and 18 boys) with CP Gross Motor Function Classification System level III (2 patients), IV (3 patients), and V (27 patients) treated with 5 courses of pamidronate for low mineral density were identified. Patients with a minimum of 2 years of follow-up were included in the study. Data collection was a review of the demographics and pretreatment, peritreatment, and posttreatment fracture history.The mean age at treatment was 11.6 years (range, 2.9 to 19.6 y). There were 102 fractures (mean duration 2.5 y) pretreatment and 28 fractures posttreatment. With an average follow-up of 6.4 years, posttreatment rate of fracture decreased to 0.10 fractures per year from the pretreatment rate of 2.4 fractures per year (P0.001). The femur was the most common bone fractured both pretreatment (54%) and posttreatment (61%); the major site was the distal third of the femur. There were 11 fractures during the course of pamidronate treatment at a rate of 0.33 fractures per year. Only 11 patients (34%) sustained fracture posttreatment. No correlation with fracture pattern or occurrence was found with patient age, number of pretreatment fractures, or sex. Most fractures were caused by low-energy injuries, and most were managed nonoperatively.In patients with CP and disuse osteoporosis, the most common fracture sustained involved the distal femur via low-velocity injury, and most fractures were treated nonoperatively. Although the fracture pattern and the treatment remained unchanged, reoccurring fractures in these children can be effectively treated medically to interrupt the fracturing tendency.

Fractures of the distal radius are the most frequent fractures encounted by orthopaedic trauma surgeons accounting for 17.5% of all adult fractures. Although closed reduction with cast immobilization remains a reliable standard method of treatment for stable extra articular fractures and minimally displaced articular injuries, similar management for unstable articular disruption is prone for failure. The aim of our study was to evaluates the functional outcome of open reduction and plate fixation in the treatment of fracture distal end radius. This is a prospective study in which eighty (80) consecutives cases of fracture of distal radius, aged 18-70 years are taken into account. Patient were operated by volar distal radius locking plate and functional outcome assessed by demerit-point system of Gartland and Werley score. Final functional outcome in our study, 60 patients (75%) had excellent result, 13 had (16%) had good results, 5 patient (6%) had fair and 2(3%) had poor results. To conclude plate osteosynthesis is an excellent method in the treatment of distal radius fracture and functional outcome.

Objective: To analyze the epidemiology and characteristics of patients with calcaneus fractures. Methods: This is a retrospective revision of patients with calcaneus fractures hospitalized in the Institute of Orthopedics and Traumatology of this institution between 2006 and 2010. Data such as age, gender, laterality, trauma mechanism, type of fracture, associated injuries, compound fractures, and time from injury to surgery were analyzed. Results: The analysis of 52 patients showed that men were more commonly affected than women, at a ratio of 5.5:1. Bilateral fractures were observed in ten cases, resulting in a total of 62 calcaneus fractures. A fall from a height was the most frequent trauma mechanism (75%), followed by motorcycle accidents (11.5%) and automobile accidents (9.6%). The most frequent fractures were intra-articular, with 47 cases. Compound fractures were observed in 15 patients (28.9%). Non-surgical management was adopted for 11 patients while 41 patients underwent surgery. The mean time between trauma and the definitive treatment was 7.8 days (range: 0-21 days), and 58.5% of cases were treated within seven days. Conclusion: Patients with calcaneus fractures, most commonly young men, were admitted to a high complexity care hospital, victims of a fall from a height with associated injuries. The great severity of these fractures is characterized by the high prevalence of bilateral (19.2%) and compound fractures (28.9%) in this population group. RESUMO Objetivo: Analisar a epidemiologia e as características das lesões e dos pacientes com fraturas do calcâneo. Métodos: Revisão retrospectiva dos pacientes com fraturas do calcâneo internados de 2006 a 2010, no Instituto de Ortopedia e Traumatologia dessa instituição. Foram analisados parâmetros como idade, gênero, lateralidade, mecanismo de trauma, tipo de fratura, lesões associadas, exposição e tempo decorrido até o tratamento cirúrgico. Resultados: Foram encontrados 52 pacientes com fratura do calcâneo, dez casos bilaterais (19,2%), total de 62 calcâneos fraturados, com predomínio do gênero masculino, na relação 5,5:1. A média de idade foi de 36,8 anos. O mecanismo de trauma mais frequente foi a queda de altura (75,0% dos casos), seguido por acidentes de motocicleta (11,5%) e acidentes de automóvel (9,6%). Fraturas intra-articulares foram mais frequentes, com 47 casos. Quinze pacientes apresentaram fraturas expostas (28,9%). Dos 52 pacientes com fratura do calcâneo, 11 foram tratados conservadoramente e 41, cirurgicamente. O tempo médio entre o trauma e o tratamento cirúrgico definitivo foi de 7,8 dias, variou de 0 a 21 dias, com a maioria dentro dos primeiros sete dias (58,5%). Conclusão: Pacientes com fraturas do calcâneo atendidos em um hospital voltado para o atendimento de alta complexidade foram na maioria jovens, do sexo masculino, que sofreram queda de altura e com algum tipo de lesão associada. Os índices elevados de bilateralidade (19,2%) e de exposição da fratura (28,9%) caracterizam a maior gravidade dessas fraturas nesse grupo populacional.

Fractures of the distal forearm have an incidence of 37 out of 10,000 females and 9 out of 100,000 males and are among the most frequent fractures of the adult population above the age of 35 years. In younger adults below the age of 39 years, high-energy trauma is more frequent, leading to a higher percentage of additional carpal ligamentous injuries. In this chapter reduction and fixation techniques of distal radius fractures will be discussed.

Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.

Purpose Osteogenesis imperfecta (OI) is a chronic, genetic condition frequently described as “brittle bones.” This condition is expressed by low bone density and characterized by frequent fractures with and without trauma. Additional symptoms include pain, altered growth, and challenges with mobility. This experience has a great impact on the daily life of the child diagnosed with OI and their family. With the introduction of bisphosphonate therapy children diagnosed with OI experienced an increase in bone density that included a change in symptoms and improvement in daily functioning. The purpose of this study was to describe the lived experience of children receiving bisphosphonate therapy for osteogenesis imperfecta (OI) and their mothers. Design and Methods A phenomenological study was conducted using interviews with a purposive sample of six children diagnosed with OI and their six mothers (N = 12). Children ranged in age from 6 to 18 years. The Giorgi (2009) methodology was used to discover the meaning of living day to day since initiating the bisphosphonate infusion therapy. Results Four themes emerged from the synthesis of the meaning units that reflected the experience that bisphosphonate therapy had on daily life with OI. These four themes explicitly described the phenomena being studied and included living daily life in stride; normalcy is living with uncertainty; renewal with infusions; and making choices and living with the consequences. Practice Implications Nurses must take an active role in developing and promoting family-centered interventions for transition and support.

Background: Osteogenesis imperfecta (OI) is a rare congenital genetic osteodystrophy, which has a prevalence of 1:20,000. OI is caused by the mutation of the COL1A1/COL1A2 genes, leading to a deficit of quality and/or quantity in the synthesis of procollagen-α type 1. Seven different forms of diverse clinical entity have been classified by Sillence and Glorieux, although, recently, up to 11 forms characterized by different genetic mutations have been recognized. Patients with OI suffer from extreme bone fragility and osteoporosis, which often predisposes them to frequent fractures. This paper presents the case of a child with OI type IV who, at birth, was also diagnosed with a severe clubfoot (congenital talipes equinovarus) grade III. Patient's mother also suffers from OI type IV. Methods: The treatment was started by placing femoro-podalic corrective casts, according to the Ponseti method, but some unexpected problems occurred during this treatment. When the patient was 3 months of age, we decided to correct the clubfoot before the time limit planned, performing a bilateral posteromedial surgical release. Results: Three weeks after surgery the casts were removed and replaced with bilateral Spica cast-like braces. On the 6th postoperative week, the patient began wearing Bebax corrective shoes, after 1 year ambidextrous orthopedic shoes. Now, he is 2 years old and has started to walk properly without any orthesis. Conclusion: In the presence of an orthopedic pathology associated with OI, it is recommended to manage the patient according to the underlying pathology, always considering the bone fragility associated with OI. The final surgical treatment to correct the clubfoot can be done earlier, if necessary. In our opinion, this uncommon association between OI and clubfoot is non-syndromic. This means that the two congenital diseases are not necessarily included in a singular uncommon genetic syndrome, but the clubfoot was caused by multifactorial causes, especially by both the mother's bisphosphonate drug therapy and the amniocentesis performed during her pregnancy to drain polyhydramnios. In our analysis, those environmental factors could have interacted with an already altered genetic substratum, contributing to develop this rare combination of congenital disorders.

Osteoporosis and osteomalacia are, to date, among the most common metabolic diseases in the world. Lately, an association between metabolic bone diseases and chronic liver disease has been increasingly reported, inducing many authors to create a new nosographic entity known as 'hepatic osteodystrophy.' The importance of such a condition is further increased by the morbidity of these two diseases, which greatly reduce the quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this reason, early identification of high-risk patients should be routinely performed by measuring bone mass density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: from hypogonadism to use of corticosteroid drugs, from genetic factors to interferon therapy. To date, few studies have been conducted, and all with a small number of patients to establish definitive conclusions about the possible treatment, but some evidence is beginning to emerge about the safety and efficacy of bisphosphonates.

To have knowledge of the physiological closure of a particular physeal plate is necessary to understand fractures close to the end of growth (transitional fractures). Most frequent fractures involve the distal radius in adolescents. However, there are no systematic investigations on the topic of growth plate closure concerning the distal radius plate, so far. Twenty-two healthy female volunteers underwent MRI investigations of their left wrist. Absolute width, percentage and localization of the physeal part, closed at the time of investigation were recorded. Sequential MRI scans were performed. In this series T1-weighted sequences were most useful to distinguish open and closed parts of the physis. Total area was 291-469 mm(2) (average, 399 mm(2) ). It did positively correlate with body height (P < 0.01), but not with weight (P = 0.241) or BMI (P = 0.394). Physeal closure took place at 15-18 years. There was no significant correlation between menarche and closure (P = 0.091). Bony bridging of the growth plate begins centroradial and ends with a small limbus dorsoradial. Sequential scans showed that there are only a few months from beginning to end of physeal closure. Physiological closure of the distal radius growth plate takes place in late adolescence, varying individually. There seems to be no influence of the menarche in female individuals. The process happens within a very short time of less than a year. This may be one rationale for the fact, that transitional fractures of the distal radius are rare.

Osteoporosis is a very common disease, which affects aged elderly people. Fractures are the main clinical manifestation of osteoporosis, being the more frequent fractures, vertebral fractures, distal forearm fractures and proximal femur fractures. The main objective in the treatment of osteoporosis is to avoid or to reduce new fractures. To obtain this, an integral approach should be done, including non-pharmacological measures, as a well balanced diet, the practising of regular exercise, avoiding or suppressing toxic habits (excess of alcohol and tobacco), and when indicated, patients should take a drug. There are several drugs available whose reduce the risk of fracture, all of them evaluated under the "Evidence-Based Medicine" criteria. Not all the drugs reduce the risk of all fracture. Thus, there are drugs that reduce only the risk of vertebral fractures, drugs that reduce the risk of non-vertebral fractures and finally, drugs that reduce the risk of hip fracture. All the studies performed on osteoporosis, the drugs have been always prescribed together with a supplement of calcium and Vitamin D. So, the correct prescription of a treatment for osteoporosis should include general measurements, the chosen drug and a supplement of calcium and Vitamin D.

Bruxism is a much-discussed clinical issue in dentistry. Although bruxism is not a life-threatening disorder, it can influence the quality of human life, especially through dental problems, such as tooth wear, frequent fractures of dental restorations and pain in the oro-facial region. Therefore, various clinical methods have been devised to assess bruxism over the last 70 years. This paper reviews the assessment of bruxism, provides information on various assessment methods which are available in clinical situations and discusses their effectiveness and usefulness. Currently, there is no definitive method for assessing bruxism clinically that has reasonable diagnostic and technical validity, affects therapeutic decisions and is cost effective. One future direction is to refine questionnaire items and clinical examination because they are the easiest to apply in everyday practice. Another possible direction is to establish a method that can measure actual bruxism activity directly using a device that can be applied to patients routinely. More clinical studies should examine the clinical impact of bruxism on oral structures, treatment success and the factors influencing the decision-making process in dental treatment.

We report a sibship of three sisters and two brothers who showed osteoporosis of variable severity; the propositus has incapacitating deformities following numerous fractures. Four of the sibs, including three with frequent fractures, were blind from infancy ("pseudogliomatous blindness"). In addition, two were mentally retarded. The osteoporosis-pseudoglioma syndrome is inherited as an autosomal recessive trait; similar reports from the literature support this assumption.

AIM The purpose of this study was to compare cemented anatomic stems with cemented straight stems regarding cement mantle and stem orientation in the medullary canal. METHODS In a cadaver study, 10 anatomic SP II stems and 10 MEM straight stems were implanted in paired human femora using a standardised modern cementing technique. In one group the femoral canal was prepared using conventional broaches, in the other group diamond hollow-cutters were used. Standardised horizontal cuts were made and evaluated regarding stem orientation and cement mantle using digitised image analysis. RESULTS All SP II stems in the "diamond group" showed good stem centralisation without cement mantle defects. In the "broach group" all diaphyseal cancellous bone had been removed and only 3/5 stems were well orientated. No reproducible stem centralisation was achieved with the straight stems. All stems showed an oblique orientation from antero-proximally to postero-distally with direct stem to bone contact. The variation from the optimal stem alignment along the canal axis showed a mean deviation of 3.1 mm in the anatomic stem group and 10 mm in the straight stem group. The canal preparation using broaches showed frequent fractures of the cancellous bone and debris interposition despite the use of jet-lavage. Most of the cancellous bone in the diaphysis had been destroyed. CONCLUSIONS Anatomic stems show a better stem centralisation and a more even cement mantle than straight MEM stems. The use of high volume straight stems carries a significant risk of producing cement mantle defects. Diamond instruments are less traumatic than broaches for femoral canal preservation and help to preserve diaphyseal cancellous bone, which improves stem self-centralisation.

Background A clinical report of a patient complaining of frequent fractures of her maxillary complete denture opposing dentulous mandibular arch is presented. Materials and Methods The patient was rehabilitated with a maxillary complete denture using modified functionally generated path technique to achieve harmonious occlusion between the complete denture and the natural dentition. Discussion Using the patient's own denture to record the functionally generated path made the technique much easier and also saved valuable chair-side time. Occlusal balancing in the trial denture bases gave us the flexibility to move the teeth slightly, or grind them in order to balance the occlusion. Summary and Conclusion Our modification of the functionally generated path technique resulted in successful rehabilitation of the patient without any fracture of the prosthesis in the 2-year follow-up, and has saved valuable chair-side time and laboratory effort.

Frequent fractures following trivial trauma or during normal daily activities occur in a group of conditions where the bones are brittle. The most common of these conditions is osteogenesis imperfecta (Plotkin 2004). Various types of osteogenesis imperfecta have been described; the severity, the frequency of fractures, and other clinical features vary in each of the types (Sillence et al. 1979; Sillence 1988; Glorieux et al. 2000).

The introduction of nickel-titanium (NiTi) as material for endodontic instruments about 15 years ago opened many new perspectives. Many dentists and scientists see a benefit in using NiFi files. Initial problems such as frequent fractures and the uncertainty of the best way to use them have been solved. Other challenges such as enhancing the cutting ability or optimizing the speed, torque, and fatigue are currently being addressed. Some clinicians are skeptical because they see this approach as too mechanical. Nevertheless, the combination of anatomic, biologic, and pathophysiologic knowledge with the use of NiTi instruments is a large step forward in optimizing the quality of root canal treatment worldwide.

This retrospective study determined the frequency of orthopedic diseases in horses. It was possible to establish 141 specific orthopedic diagnoses in 1955 horses with lameness. In 14.58 % horses, multiple pathologic orthopedic changes were determined. In 61.84 % cases, the pathologic changes were present on the thoracic limb, 28,86 % on the pelvic limb and other parts of the oganism (neck, spine, muscles) in 9.29 % cases. Pathologic changes on the tendons, ligaments, tendon sheats, bursae and muscles were determined in 31.51 % cases. Diseases of the hoof were present in 25.82 % cases. According to our investigation the most frequent orthopedic diseases are: podarthritis (acute, chronic, septic) (5.04 %), navicular disease (4.69 %), tendinitis m. flexor digitalis superfacialis (4.51 %), kissing spine syndrom (4.30 %) periarthritis et osteoarthrosis tarsi (3.30 %), distal metacarpal/metatarzophalengeal tendovaginitis (3.30 %) and high suspensory ligament desmitis (3.12 %). Most frequent fractures were diagnosed on the metacarpal/metatarsal bone II and IV (2.56 %). Osteochondrossis dissecans was most frequently determined in the tarsocrural (1.26 %) and the metacarpophalengeal joint (1.56 %).

Femoral neck fractures are frequent fractures of the elderly. They can be treated by the use of dynamic hip screws, lag screws, bipolar hemi-protheses or total hip replacement. The results are markedly influenced by the timing of the operation and the choice of the implant. Using the Garden classification of femoral neck fracture we demonstrate a different therapeutic approach according to Garden stadium I-IV.

A group of experienced riders who qualified for the German riding badge 9.5 years ago answered a questionnaire pertaining to injuries during jumping, dressage and cross-country riding, as well as handling the horse. During riding 69% of the persons had had 187 injuries and while handling the horse 52% had had 124 injuries. Fractures and contusions were the most-frequent injuries; most riding injuries were located in the upper extremities and shoulder while handling mainly in the hands and feet. The number of injuries was comparable in jumping, dressage or cross-country riding. The time engaged in jumping was about one-third of the other types of riding, but the injuries were more severe. While handling the horse the number of injuries relative to the time spent during the activity were higher but less complicated. No change in safety precautions had been implemented by 67% of the persons injured. The injury rate for equestrians is relatively low both in handling the horse and during riding. The frequent fractures and contusions may be reduced by following the required safety regulations. Language: de

Osteogenesis imperfecta (OI) is a heritable disorder of variable phenotype that is characterised by bone fragility and frequent fractures, with deformities and short stature in more severe cases.We sought to review the response to treatment in a cohort of adult patients with OI.Charts of 16 patients with OI attending a metabolic bone disease clinic were reviewed, particularly with respect to the response to treatment using bisphosphonates and recombinant human parathyroid hormone (rhPTH). The response to treatment was assessed by monitoring bone mineral density (BMD) and bone turnover markers (BTMs).In response to bisphosphonate therapy, median (range) BMD increased at the spine by 15.1(6.9-43.7) %. In response to rhPTH in 2 cases, spinal BMD increased by 40.3 and 27.2 %.OI is debilitating disorder, but the course of the disease may be altered by treatment that increases BMD such as bisphosphonates and rhPTH. Both serial BMD and BTM aid in assessing response to intervention. Further study is needed with regard to fracture prevention.

The osteoporosis-pseudoglioma syndrome (MIM 259770) is a rare autosomal recessive disorder in which bone fragility and frequent fractures are associated with serious ocular changes. The skeletal manifestations resemble those of osteogenesis imperfecta while hyperplasia of the vitreous, eye and corneal opacities often mimics the appearance of intraocular glioma. This disorder was previously reported in a South African family of Indian stock as 'the ocular form of osteogenesis imperfecta'. Terminological discussion followed and it was suggested that these individuals had osteoporosis-pseudoglioma syndrome. This article describes and depicts the manifestations of the disorder and discusses the nosology.

Resumen: La osteogénesis imperfecta (OI) es una enfermedad causada por un defecto genético en la síntesis cuali y cuantitativa del colágeno tipo I.Presenta una gran variabilidad clínica, caracterizándose por fragilidad ósea, cuyo resultado es un hueso vulnerable ante fuerzas externas e internas, condicionando la aparición de fracturas frecuentes ante traumatismos mínimos o inexistentes.Desde el punto de vista terapéutico, el objetivo va dirigido a mejorar la capacidad funcional del niño o adulto afectado, adoptando aquellas estrategias compensatorias que optimicen su independencia. En este sentido, el empleo de diferentes ortesis y productos de apoyo se antojan importantes en los hitos a alcanzar.Se han revisado en diferentes bases de datos, de los últimos 25 años, las principales aportaciones ortésicas a esta patología, así como la evolución de los diferentes dispositivos empleados. Abstract: Osteogenesis imperfecta (OI) is a disease caused by a genetic defect in the qualitative and quantitative synthesis of type I collagen.There is a wide variation in its clinical signs, characterized by bone fragility, resulting in a bone vulnerable to external and internal forces, determining the occurrence of frequent fractures with minimal or no trauma.The therapeutic objective is directed to improve the functional capacity of the child or adult concerned, adopting those compensatory strategies to optimise their independence. In this sense, the use of different orthoses and assistive technology are important for achieving these objectives.We reviewed the main contributions to this orthotic disease and the evolution of the different devices used in different databases over the last 25 years.

Until recently, medical management of osteogenesis imperfecta, a genetic disorder of reduced bone mass and frequent fractures, was elusive, and treatment was focused on maximizing mobility and function. The introduction of bisphosphonates for the treatment of osteogenesis imperfecta 14 years ago changed this paradigm. Cyclic intravenous pamidronate therapy leads to an increase in bone density and a decrease in fracture rate in patients with osteogenesis imperfecta. Pamidronate therapy has a positive impact on functional parameters including improved energy, decreased bone pain, and increased ambulation. Histomorphometric studies have shown that the reduced osteoclast activity results in gains in cortical thickness and trabecular bone volume. Potential negative effects may include prolonged time to heal after osteotomies and a decrease in the rate of bone remodeling. Overall, it seems clear that the benefits of pamidronate therapy outweigh its potential risks in moderate-to-severe osteogenesis imperfecta, and pamidronate therapy has become the standard of care for patients with this condition. Questions remain regarding when treatment should be stopped and the need for pamidronate therapy in patients with mild osteogenesis imperfecta.

We conducted a clinical and statistical analysis on 421 cases of maxillo-facial fractures at the clinic of the Oral Surgery Department of Ryukyus University Hospital during the ten years period from October 1973 to September 1983.1) Out of the 421 cases annalyzed, 201 cases (47.7%) were inpatients and 220 cases (52.3%) were outpatients.2) One hundred and twenty-three cases (29.3%) were found in the twenties age group, 122 cases (29.0%) in the teen age group, 328 cases were male patients and 93 cases were female patients. The ratio of the male to the female was 3.5 to 1.3) There were 159 cases (37.3%) caused by traffic accidents, 100 cases (23.8%) by fist blows, and 47 cases (11.2%) by overturning.4) Ninety-nine cases (23.5%) of all patients visited our hospital within 24 hours, 152 cases (36.1%) within three days, and so on. The fresh fractures injuried within two weeks were 373 cases (88.6%). The remaining cases were old fractures.5) One hundred and eighteen cases (28. 0%) were refered to us from private dental clinics, 97 cases (23.8%) from prefectual hospital, and so on.6) Of all the facial fractures, 291 cases (69. 1%) were found in mandible, 94 cases (22.3%) in maxilla (including the middle third facial region), 63 cases (8.5%) in the combined mandible and maxilla. The fractures of the bodies of the mandible, the maxilla and the middle third facial region were 325 cases (77.1%). The fracture of the alveolar process of the mandible and maxilla were 96 cases (22.3%). Regarding the fractures of the bodies, 249 cases were found in the mandible, 52 cases in the maxilla (including the middle third facial region), 26 cases in the combined mandible and maxilla.7) In the region of the mandible, most frequent fractures were found in the region of the molar and the angle, second were in the incisal region and third were in the region of the condylar process. According to the Le-Fort classification (including unilateral fractures) there were 21 cases of Le-Fort III, 9 cases of Le-Fort II. Unilateral fracture of the zygoma was seen in 38 cases.8) One hundred and eighty cases (65. 5%) of the mandibular fractures were result of direct force, and most of the fractures of the maxilla from direct force.9) The complications of 1, 148 cases were observed in our cases in the area of associated injuries, 294 cases were found in the oral mucosa, 217 cases in the teeth, 266 cases in the facial skin, and so on. There were 169 cases of unconciousness, and 65 cases with fractures other than facial.

1. In a series of seventy-one patients with wringer injuries of the hand three basic types of lesion were observed: a) denuding of part of or the entire hand, usually accompanied by avulsion of the distal phalanges; b) small lacerated wounds with wide detachment of surrounding skin and frequent fractures; c) multiple cut injuries of digits or the entire hand with skin avulsions. 2. Treatment was guided by the following principles: a) improvement of blood supply in regions of impaired nourishment; b) stable primary fixation of bones with Kirschner wires; c) primary wound closure through free skin grafting with maximal utilisation of available flaps. 3. Surgical technique as applied in various typical cases is outlined.

The syndrome of brittle bones, blue scleras, relaxed ligaments and deafness is an interesting hereditary condition which to the otologist is of particular interest because of the nature of the hearing impairment and its similarity to the deafness accompanying otosclerosis. Patients afflicted with this set of symptoms are usually first seen in the orthopedic service, because of frequent and multiple fractures, and the condition is promptly recognized by the blue scleras of the patients themselves and by the histories of frequent fractures both among the patients and among other members of the family. Reports in the literature regarding brittle bones and blue scleras have been numerous, but the associated deafness was reported first by van der Hoeve and de Kleyn 1 and later by Bronson. 2 These writers brought forth the interesting observation that persons with this syndrome have a tendency to become deaf in the third or fourth decade of life.

ResumenLas fracturas del componente craneofacial aumentan su frecuencia y severidad día con día en las salas de urgencias. Las disrupciones de la mandíbula pueden clasificarse de acuerdo a su localización anatómica, siendo más frecuentes las del ángulo (36.3%) y el cuerpo (21.2%) y poco comunes las de apófisis coronoides (0.25%).1 Las fracturas de coronoides, condilares y de arco cigomático, pueden enmascarar un fractura de cavidad glenoidea, ya que clínicamente existe restricción de la motricidad mandibular. Presentamos el caso de un paciente de 38 años, con fracturas de complejo cigomaticomaxilar, apófisis coronoides y cavidad glenoidea derecho.AbstractEmergency rooms have seen a gradual increase of patients afflicted by craniofacial fractures. Mandible fractures can be classified according to their anatomical location. The most frequent fractures are angle fractures (36.3%) and body of the mandible fractures (21.2%). Coronoid process fractures are uncommon (0.25%).1 Zygomatic arch, condylar or coronoid process fractures can mask a fracture of the glenoid fossa, since, clinically, there is restriction of mandibular movements. The case here presented is that of a 38 year patient afflicted with fractures of the maxillary-zygomatic complex, coronoid process as well as right glenoid fossa.

Two teen-age XY brothers with mental retardation, short stature, obesity, genital abnormalities, and contractures of their hands are described. They have generalized osteoporosis and a history of frequent fractures. Their endocrinologic evaluation was normal except for mild glucose intolerance and delayed, but normal puberty. Although these brothers are similar to individuals with Prader-Willi syndrome, their unusual hand contractures, clinically significant osteoporosis, and lack of hypotonia indicate that they represent a different entity.

Scanning electron microscopy of bone collagen of three patients with osteogenesis imperfecta congenita demonstrates the failure of thin collagen fibers to aggregate extracellularly into the distinct and separately discernible large collagen fiber bundles of normal bone. These organizational alterations may in part explain the changes in physical properties which result in the frequent fractures characterizing this disease.

I present to you a new appliance to be used as a retentive apparatus in fracture of the clavicle. Let me modestly state among my first assertions that the appliance probably is not the most valuable contribution that has been made to surgery in the past few years, but its efficiency, neatness, rapidity of application, comfort to the patient, and small cost to the surgeon, commends it in my judgment, formed after using it several years, as superior to any dressing generally known to the profession. In my remarks I shall premise that a fracture of the clavicle has occurred, has been properly diagnosed, properly reduced, and that we seek the most perfect apparatus for retention. This paper then will not be an essay upon one of the most frequent fractures of the body, it will not be a treatise upon the clavicle or scapula, or their muscular attachments. I

This paper deals with determination of the failures causes of supporting tubes in a 350 MW fossil fuel power plant. Due to frequent fractures of supporting pipes occurring always at the same location and the ensuing reduction of the plant availability as well as substation financial losses, there was an urgent need to resolve the problem [K. Takahashi, M. Yokouchi, S.K. Lee, K. Ando, J. Am. Ceram. Soc., 86-12, 2003]-[3]. This work describes the test results and the conclusions drawn from the results.

The patients on whom these studies were made were admitted to the Children's Hospital at about the same time, and as they presented difficult but not uncommon clinical problems, it was decided to make as complete an investigation as possible of their mineral metabolism. The study did not bring out anything of definite assistance in the handling of the cases, but gave some interesting observations. These are reported in detail, because complete studies on the mineral metabolism of children are rare, and it seems desirable to have them on record. REPORT OF CASES Case1.—Osteopsathyrosis.1 History.—M. F., a girl of 11 years, was admitted for study in November 1931, because of frequent fractures from slight cause and marked increasing scoliosis, for which she was receiving orthopedic treatment from one of the members of the staff. The family history was irrelevant, and there had been nothing of note