			Home About us Contact

Limb Fractures (limb + fractures)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Paracetamol versus ibuprofen: A randomized controlled trial of outpatient analgesia efficacy for paediatric acute limb fractures

EMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009
Michael Shepherd
Abstract Paediatric limb fracture is a common injury that presents frequently to the ED. The primary objective of the present study was to determine whether ibuprofen provides better analgesia than paracetamol for paediatric patients discharged with acute limb fractures. A prospective, randomized controlled study was conducted in a children's ED. Children aged 5,14 years with an acute limb fracture were randomized to be prescribed paracetamol 15 mg/kg/dose every 4 h or ibuprofen 10 mg/kg/dose every 8 h. Objective (child-reported) pain scores using the ,Faces' pain scale were measured over a 48 h period. Child-reported pain did not differ significantly between the paracetamol and ibuprofen groups (mean pain score paracetamol 2.8 [95% CI 2.4,3.4]vs 2.7 [95% CI 2.1,3.3], P= 0.73). Parent-reported sleep quality did not differ between the two groups (P= 0.78). Child-reported pain score decreased over the 48 h of measurement (P < 0.0001). There were no significant differences in side-effects detected between the two groups. The present study shows that in the outpatient paediatric population, ibuprofen does not provide better analgesia than paracetamol. Pain from an acute fracture can be managed by regular simple oral analgesia and immobilization. [source]

Bisphosphonate-Induced Osteopetrosis: Novel Bone Modeling Defects, Metaphyseal Osteopenia, and Osteosclerosis Fractures After Drug Exposure Ceases,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2008
Michael P Whyte
Abstract In 2003, we reported on a 12-yr-old boy who had developed osteopetrosis (OPT) while receiving pamidronate (PMD) for idiopathic bone pain and enigmatic elevation in circulating bone alkaline phosphatase. Now 17 yr of age, he was re-evaluated 6.5 yr after PMD exposure stopped. Our patient described less bone pain but further limb fractures. His growth plates were fused, yet hyperphosphatasemia persisted. Radiographs documented interval fractures of a metacarpal, an osteosclerotic distal radius, and a dense diaphyseal segment of an ulna where a "chalkstick" break remained incompletely healed after 2 yr. There was new L4 spondylolysis, and previous L5 spondylolysis had caused spondylolisthesis. Modeling disturbances of OPT persisted, but partial recovery was shown by metaphyseal surfaces with a unique concave shape. Metaphyseal osteosclerosis had remodeled imperfectly to become focal areas of dense, diaphyseal bone. Newer metaphyseal bone was unexpectedly osteopenic, especially in his distal femurs where cortices were thin and a paucity of trabeculae was documented by CT. Femoral necks had become short and wide with an abnormal contour. A "bone-within-bone" configuration was now present throughout his skeleton. In vertebrae, endplates were thin, and trabecular osteopenia was present central and peripheral to the bands of osteosclerosis. BMD Z-scores assessed by DXA had decreased into the normal range in his spine, hip, and whole body. Iliac crest biopsy showed active bone formation, with much less accumulated primary spongiosa than during the PMD infusions. Osteoclasts that had been dysmorphic, round cells without polarization and off of bone surfaces were now unremarkable in number, location, and appearance. In conclusion, bisphosphonate toxicity during childhood can impair skeletal modeling and remodeling with structural changes that evolve and carry into adult life. [source]

Hormonal and Biochemical Parameters and Osteoporotic Fractures in Elderly Men

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2000
Dr. Jacqueline R. Center
Abstract Low testosterone has been associated with hip fracture in men in some studies. However, data on other hormonal parameters and fracture outcome in men is minimal. This study examined the association between free testosterone (free T) estradiol (E2), sex hormone-binding globulin (SHBG), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and fracture in 437 elderly community-dwelling men. Age, height, weight, quadriceps strength, femoral neck bone mineral density (FN BMD), and fracture data (1989,1997) also were obtained. Fractures were classified as major (hip, pelvis, proximal tibia, multiple rib, vertebral, and proximal humerus) or minor (remaining distal upper and lower limb fractures). Fifty-four subjects had a fracture (24 major and 30 minor). There was no association between minor fractures and any hormonal parameter. Risk of major fracture was increased 2-fold for each SD increase in age, decrease in weight and height, and increase in SHBG, and risk of major fracture was increased 3-fold for each SD decrease in quadriceps strength, FN BMD, and 25(OH)D (univariate logistic regression). Independent predictors of major fracture were FN BMD, 2.7 (1.5,4.7; odds ratio [OR]) and 95% confidence interval [CI]); 25(OH)D, 2.8 (1.5,5.3); and SHBG, 1.7 (1.2,2.4). An abnormal value for three factors resulted in a 30-fold increase in risk but only affected 2% of the population. It is not immediately apparent how 25(OH)D and SHBG, largely independently of BMD, may contribute to fracture risk. They may be markers for biological age or health status not measured by methods that are more traditional and as such may be useful in identifying those at high risk of fracture. [source]

Fijian seasonal scourge of mango tree falls

ANZ JOURNAL OF SURGERY, Issue 12 2009
Anuj Gupta
Abstract Background:, Mango tree falls are a frequent presentation at any health facility in the South Pacific. This study aims to identify (i) the number of admissions because of falls from mango trees; (ii) epidemiology; (iii) seasonal trend; (iv) injury profile; and (v) hospital care provided. Methods:, Retrospective case review on all mango tree falls related injuries resulting in admissions at the Lautoka Hospital, Fiji during a 1-year period (2007). Patient records were analysed to identify specific injury patterns such as upper/lower limb fractures, spinal cord injury and head injury, caused by mango tree falls. Results:, Thirty-nine cases were identified. Eighty-two percent (n= 32) of the falls occurred in the mango season (June,November). Seventy-two percent (n= 28) of the patients were males and 28% (n= 11) were females. Seventy-six percent were aged 5,13 and only 21% were adults. Also, 77% (n= 30) of the patients were ethnic Fijians and 23% (n= 9) were Fijian-Indians. Sixty-four percent (n= 25) had closed fractures and 17% (n= 7) had open fractures. Fifty-six percent (n= 22) of the fractures were of the fore arm. There were two cases of spinal cord injury, four cases of head injury, one ICU admission and one death. Average hospital stay was 7.56 days. Conclusion:, All these injuries were recreational and the majority in the urban setting. They were all avoidable. [source]

Coconut palm-related injuries in the pacific islands

ANZ JOURNAL OF SURGERY, Issue 1 2001
J. S. Mulford
Introduction: Coconut palms are an integral part of life in the Solomon Islands, given the widespread dependence of subsistence agriculture. Injuries related to the coconut palm are thus inevitable. Hospital records from the Central Referral Hospital were reviewed to identify (i) how commonly the coconut palm is implicated in injuries referred to the surgery department; (ii) which patients are being injured; and (iii) the type of injuries sustained. Methods: The present study reviews all patients referred to the Department of Surgery and Orthopaedics between January 1994 and December 1999 who had a coconut palm-related injury. This was possible due to the trauma epidemiology form, which records the patient details, cause of injury, fracture details and other injury information. Results: A total of 3.4% of all injuries presenting to the surgical department was related to the coconut palm. Eighty-five patients fell from the coconut palm, 16 patients had a coconut fruit fall on them, three patients had a coconut palm fall on them and one patient kicked a coconut palm. The majority of patients who were injured by falling from a coconut palm were young (aged 6,25 years). Eleven of the 16 patients struck by falling fruit were under 25 years of age. The majority of injuries sustained were fractures. Patients falling from coconut palms sustained mainly upper limb fractures (60.1% of all fractures) or spinal fractures (16.3%). Patients injured by falling fruit sustained skull or upper limb fractures. All skull fractures occurred in patients under the age of 10 years. Conclusion: This is the largest review of coconut palm-related injuries. It highlights some epidemiological facts that raise considerations for preventative health measures in the Solomon Islands. Parents and young children must be warned of the dangers of playing beneath coconut trees. Boy and girls should be warned of the dangers of collecting fruit. With an increasing amount of schooling becoming available the Solomon Islands is an ideal place to direct an education programme about the dangers of coconut palms as well as many other primary health issues. Because subsistence farming plays a crucial role in the life of most Solomon Islanders, injuries that result in loss of function are crippling both to the patient and the village. Any preventative measure to reduce the rates of injury will be important. [source]