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  • 1
    ISSN: 1432-1084
    Keywords: Bone mineral measurements ; Biomechanical bone properties ; Measurement reproducibilities ; Measurement agreements
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to assess the agreement between different femoral bone mineral measures and their agreement with some biomechanical parameters. By means of quantitative CT (QCT) and dual X-ray absorptiometry (DXA), measurements were made in different locations of 33 pairs of human femur specimens. There was a principal distinction between bone density as measured by QCT and bone mass as measured by QCT and DXA. Bone mass measured by QCT and the bone mineral content (BMC) measured by DXA are true mass parameters. However, bone mineral density (BMD) as measured by DXA agreed substantially better with the mass measures than with the densities. The mass measures, including the BMD, had good agreements with each other, with a common reference parameter and with the biomechanical parameters. The QCT densities had, on the average, poor agreements with each other, with the other bone mineral measures (including the MBDs), and with the mechanical parameters. The gender differences were less for the QCT densities than for the mass parameters, whereas in this regard the BMDs were intermediate. All measures had approximately similar reproducibilities. Although all mass measures, including the BMDs, seemed to agree with a general structural property of the femur, the bone densities seemed to have local variations, probably to adapt the calcium distribution and bone geometry to local biomechanical requirements. We suggest that BMD should be denoted “mass per projected area” to avoid any misconceptions concerning the nature of this parameter.
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  • 2
    ISSN: 1432-0932
    Keywords: Thoracolumbar spine ; Unstable lesion ; Transpedicular fixation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seventy-eight patients were treated with closed reduction and transpedicular fixation for 82 spine fractures. The fractures were localised in the lower third of the spine and were all, according to the Denis classification, considered unstable. Eighteen patients had neurological deficiencies. One patient with a fracture in T11 was completely paraplegic, four patients had a cauda equina syndrome while the rest had radicular symptoms only. Primary reconstruction of the vertebral height and the physiological curves of the spine was satisfactorily obtained. An improvement in the neurological symptoms was observed in all patients with fractures distal to the spinal cord, while the patient with the dislocated fracture of T11 remained completely paraplegic during the follow-up. The complication rate of the transpedicular fixation method used reported by other authors could not be confirmed in our material. Iatrogenic neurological damage was not observed. A partial loss in the correction of the traumatic kyphosis was observed after removal of the implant in 11 patients.
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  • 3
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Flexion-distraction injuries of the spine are reported after traffic accidents in individuals wearing only lap seatbelts. We examine here this type of injury in one child and two adolescents who all were seated in the rear seat of cars involved in traffic accidents. All of the children were wearing regular three-point safety belts not adjusted to children. They were all treated surgically. Two of the patients had no neurological impairment, while one patient suffered persistent complete paraplegia. In two patients intra-abdominal lesions required surgery. Flexion-distraction injuries in individuals with an immature skeleton, wearing standard three-point safety belts, have not been reported in the literature. The pathomechanism of the lesion in the lower spine may well involve damage to the intestines, particularly at the junction between the mobile intra-abdominal and the fixed retroperitoneal part of the gut. Reduction and stable fixation preserve the anatomy of the lower spine, while unstable fixation methods do not secure reduction sufficiently to allow early mobilisation.
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  • 4
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract With a soft-tissue plasty, stability could be obtained in 17 of 22 patients with unstable hips after total hip arthroplasty. While in 16 of 18 patients with a posterior instability stability was achieved, only 1 of 3 patients with a unstable hip for dislocation in all directions was successfully treated. No stability could be achieved in one patient with a hip which dislocated anteriorly. The method described should only be used for posterior recurrent dislocations after total hip arthroplasty.
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  • 5
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During the past few years we have monitored tissue pressure in patients treated with intramedullary nailing of tibial shaft fractures. A value of 30 mmHg has been used as the threshold for fasciotomy. The purpose of this study was to evaluate this practice. Sixty-three patients were included in the series. Forty-three fractures were closed, 18 grade I (Gustilo) and two grade II. Tissue pressure measurements were performed in 43 patients. Eighteen legs were treated with decompressive fasciotomy, three on clinical findings alone, and 15 after measurement of a pressure higher than 30 mmHg. This gives a fasciotomy rate of 29%. At follow-up two patients were dead. All fractures were healed, and there were no major complications such as deep infection, extensive muscle necrosis, paresis or short-foot syndrome. Three fasciotomized patients had significantly reduced muscle strength compared with the contralateral leg.
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  • 6
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To analyze the mechanical properties of cortical and cancellous bone in the femur and relate them to bone mineral, we retrieved 14 pairs of femurs from elderly subjects at autopsy. Bone mineral was measured by quantitative single-energy computed tomography. Significant associations were found between two types of cortical bone mechanical tests, three-point bending and pull-out of screw, one performed on the right and the other on the left femur. Similarly, pairwise associations were found between the mechanical tests of cancellous bone, punch and cube compression, one performed on the right and the other on the left femur. Also, all mechanical tests correlated with bone mineral as determined by quantitative single-energy computed tomography. In general, bone mass measures correlated better with bone strength than did bone density measures. However, the cortical and cancellous bone mechanical properties were not interrelated, which suggests a separate regulation of the strength of these two types of bone. Bone mineral may not only have importance for the occurrence of fractures; it should be considered as an important factor in the fixation of fragile bone.
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  • 7
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The charts of 118 consecutive ankle fractures were reviewed. The patients’ age, sex, energy of trauma, hospital stay, need for traction therapy, syndesmosis fixation and soft-tissue problems were related to the various types of fractures according to the AO classification. An interobserver check study revealed an agreement of 0.61 (kappa), which is considered good. The age of the patients with A-fractures was 33 years (SD ± 13), B-fractures 56 years (SD ± 18), and C-fractures 48 years (SD ± 16). The age differences within these groups were highly significant (P 〈 0.005). The highest average ages were found in the patients with B2 and B3 type fractures, 57 and 61 years, respectively. Women were significantly older than men (P 〈 0.0001), and 61% of the patients were women. Perioperative problems, such as wound margin necrosis and infections, were significantly related to fracture types B2 and B3. Preoperative traction therapy was necessary in the least stable fractures, of which all but one C1 fracture were B2/3 type fractures. The energy of trauma was not related to perioperative problems. The period of hospitalisation was significantly longer in the patients with B2/B3 type fractures (P 〈 0.001). Judging by the significantly higher incidence of perioperative complications, longer hospital stay, and predominance of instability and skin damage in the AO B2 and B3 type fractures, these fractures may benefit from more attentive and urgent care.
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