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Fracture Treatment (fracture + treatment)
Selected AbstractsThe management of mandibular body fractures in young childrenDENTAL TRAUMATOLOGY, Issue 6 2009Dror Aizenbud Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored. [source] Adverse Outcomes of Osteoporotic Fractures in the General Population,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2003L Joseph Melton III MD Abstract Osteoporotic fractures exact a terrible toll on the population with respect to morbidity and cost, and to a lesser extent mortality, which will increase dramatically with the growing elderly population. Attention has focused on the 12-20% excess deaths after hip fracture, but most are caused by underlying medical conditions unrelated to osteoporosis. More important is fracture-related morbidity. An estimated 10% of patients are disabled by hip fracture, and 19% require institutionalization, accounting for almost 140,000 nursing home admissions annually in this country. Distal forearm and vertebral fractures less commonly result in nursing home placement, but about 10% of postmenopausal women have vertebral deformities that cause chronic pain, and a substantial minority have poor function after forearm fracture. These fractures interfere greatly with the activities of daily living, and all of them can have a substantial negative impact on quality of life. Annual expenditures for osteoporotic fracture care in the United States ($17.5 million in 2002 dollars) are dominated by hip fracture treatment, but vertebral fractures, distal forearm fractures, and importantly, the other fractures related to osteoporosis contribute one-third of the total. Although all fracture patients are at increased risk of future fractures, few of them are currently treated for osteoporosis, and only a subset (i.e., those with vertebral fractures) are considered candidates for many clinical trials. Eligibility criteria should be expanded and fracture end-points generalized to acknowledge the overall burden of osteoporotic fractures. [source] Tibio-femoral loading during human gait and stair climbingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2004William R. Taylor Abstract Surgical intervention of the knee joint routinely endeavors to recreate a physiologically normal joint loading environment. The loading conditions resulting from osteotomies, fracture treatment, ligament replacements, and arthroplasties of the knee are considered to have an impact on the long term clinical outcome; however, knowledge regarding in vivo loading conditions is limited. Using a previously validated musculoskeletal lower limb model, we predicted the tibio-femoral joint contact forces that occur in the human knee during the common daily activities of walking and stair climbing. The average resultant peak force during walking was 3.1 times body weight (BW) across four total hip arthroplasty patients. Inter-individual variations proved larger than the variation of forces for each patient repeating the same task. Forces through the knee were considerably larger during stair climbing than during walking: the average resultant peak force during stair climbing was 5.4 BW although peaks of up to 6.2 BW were calculated for one particular patient. Average anteroposterior peak shear components of 0.6 BW were determined during walking and 1.3 BW during stair climbing. These results confirm both the joint contact forces reported in the literature and the importance of muscular activity in creating high forces across the joint. The magnitudes of these forces, specifically in shear, have implications for all forms of surgical intervention in the knee. The data demonstrate that high contact and shear forces are generated during weight bearing combined with knee flexion angles greater than approximately 15°. Clinically, the conditions that produce these larger contact forces should be avoided during post-operative rehabilitation. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Biomechanical evaluation of healing in a non-critical defect in a large animal model of osteoporosisJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2003C. A. Lill Abstract Current methods for fracture treatment in osteoporosis are not always sufficient. To develop new fixation strategies (both mechanical and biological) requires pre-clinical testing utilizing appropriate models. The aim of this study was to apply a recently developed sheep model of osteoporosis to the study of healing in a non-critical long bone defect. A standardized transverse mid-shaft tibial osteotomy (with a fracture gap of 3 mm) was performed in seven osteoporotic and seven normal sheep and stabilized with a special external fixator for 8 weeks. The fixator was used for weekly in vivo bending stiffness measurements. Ex vivo bending stiffness and torsional stiffness of the callus zone were also determined. Callus area, callus density, and osteoporosis status were determined at 0, 4, and 8 weeks using peripheral quantitative computed tomography. The increase of in vivo bending stiffness of the callus was delayed approximately 2 weeks in osteoporotic animals. A significant difference (33%) in torsional stiffness was found between the osteotomized and contralateral intact tibia in osteoporotic animals, but no significant difference occurred in normal sheep (2%). In osteoporotic animals, ex vivo bending stiffness was reduced 21% (p = 0.05). Bending stiffness was correlated with callus density (r = 0.76, r = 0.53); torsional stiffness was correlated with callus area (r = 0.60) and to a lesser extent with callus density (r = 0.53). This study demonstrated a delay of fracture healing in osteoporotic sheep tibiae with respect to callus formation, mineralization, and mechanical properties. © 2003 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. 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