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Takahashi, Toshihide, Tomoya Takada, Takeshi Narushima, Atsuro Tsukada, Eiichi Ishikawa, and Akira Matsumura. "Correlation Between Bone Density and Lumbar Compression Fractures." Gerontology and Geriatric Medicine 6 (January 2020): 233372142091477. http://dx.doi.org/10.1177/2333721420914771.
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Objectives: Bone densitometry is widely used to evaluate osteoporosis; however, it is pointed out that bone density may be high in the case of fractures, deformities, and osteosclerotic changes. The present study evaluated bone density measured at our hospital and evaluated its correlation with the presence or absence of lumbar spine fractures. Methods: Bone density of the lumbar spine and femur was measured in 185 patients from July 2017 to June 2019 at our hospital, and the presence or absence of a lumbar spine compression fracture was evaluated on the basis of the image. Information regarding age, sex, lumbar bone density, presence or absence of lumbar fracture, number of lumbar fractures, and grade of lumbar fracture was also statistically evaluated. Results: Analysis was performed for 185 patients (20 males and 165 females, average age 76.9 ± 7.5 years). The bone density was 0.830 ± 0.229 of compression fractured bodies (number of vertebral bodies were 132) and 0.765 ± 0.178 g/cm3 of noncompression fractured bodies (number of vertebral bodies was 608). Discussion: The presence of lumbar fractures significantly increases bone density. For diagnosing osteoporosis, both bone density and the possibility of lumbar spine fractures must be considered.
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Hübner, André Rafael, Ivana Flores Luthi, Charles Leonardo Israel, Marcelo Ribeiro, Álvaro Diego Heredia Suarez, Ivanio Tagliari, and Leandro de Freitas Spinelli. "SPLIT-TYPE FRACTURES OF THE SPINE: A NEW MINIMALLY INVASIVE PERCUTANEOUS TECHNIQUE." Coluna/Columna 20, no. 1 (March 2021): 55–59. http://dx.doi.org/10.1590/s1808-185120212001235878.
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ABSTRACT Objective: This research presents a biomechanical analysis performed in the lumbar spine of a porcine animal model, considering a minimally invasive technique for the treatment of split fractures. Methods: Porcine spines were used to perform compression tests, considering three different approaches. Three groups were defined in order to verify and validate the proposed technique: a control group (1); spines with split fractures (2); and a treatment group (3). For the first group (control), spines were axially compressed until any kind of fracture occurred, in order to verify the strength of the structure. In the second group, split fractures were created to obtain the mechanical failure pattern of the model. In the third group, the split fractures were submitted to the proposed treatment, to verify the resistance achieved. The three groups were compared by means of axial compression tests. Statistical analysis was performed by ANOVA. Results: The control group (intact spine) and the treated split fracture group presented similar results (p>0.05), differing from the results for the untreated split fracture group (p<0.05). Conclusions: The tests performed in order to determine the behavior and strength of the lumbar spine when subjected to axial compression provided positive data for the development of a minimally invasive technique capable of restoring split fractures of the spine. Level of evidence III; Experimental research.
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Yaman, Onur, Mehmet Zileli, Salim Şentürk, Kemal Paksoy, and Salman Sharif. "Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations." Neurospine 18, no. 4 (December 31, 2021): 681–92. http://dx.doi.org/10.14245/ns.2142340.170.
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Thoracolumbar fractures change the biomechanics of the spine. Load distribution causes kyphosis by the time. Treatment of posttraumatic kyphosis is still controversial. We reviewed the literature between 2010 and 2020 using a search with keywords “thoracolumbar fracture and kyphosis.” We removed osteoporotic fractures, ankylosing spondylitis fractures, non-English language papers, case reports, and low-quality case series. Up-to-date information on posttraumatic kyphosis management was reviewed to reach an agreement in a consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The first meeting was conducted in Peshawar in December 2019 with WFNS Spine Committee members’ presence and participation. The second meeting was a virtual meeting via the internet on June 12, 2020. We utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized 42 papers on posttraumatic kyphosis. Surgical treatment of thoracolumbar kyphosis due to unstable burst fractures can be done via a posterior only approach. Less blood loss and reduced surgery time are the main advantages of posterior surgery. Kyphosis angle for surgical decision and fusion levels are controversial. However, global sagittal balance should be taken into consideration for the segment that has to be included. Adding an intermediate screw at the fractured level strengthens the construct.
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Oberkircher, Ludwig, Maya Schmuck, Martin Bergmann, Philipp Lechler, Steffen Ruchholtz, and Antonio Krüger. "Creating reproducible thoracolumbar burst fractures in human specimens: an in vitro experiment." Journal of Neurosurgery: Spine 24, no. 4 (April 2016): 580–85. http://dx.doi.org/10.3171/2015.6.spine15176.
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OBJECT The treatment of traumatic burst fractures unaccompanied by neurological impairment remains controversial and ranges from conservative management to 360° fusion. Because of the heterogeneity of fracture types, classification systems, and treatment options, comparative biomechanical studies might help to improve our knowledge. The aim of the current study was to create a standardized fracture model to investigate burst fractures in a multisegmental setting. METHODS A total of 28 thoracolumbar fresh-frozen human cadaveric spines were used. The spines were dissected into segments (T11–L3). The T-11 and L-3 vertebral bodies were embedded in Technovit 3040 (cold-curing resin for surface testing and impressions). To simulate high energy, a metallic drop tower was designed. Stress risers were used to ensure comparable fractures. CT scans were acquired before and after fracture. All fractures were classified using the AO/OTA classification. RESULTS The preparation and embedding of the spine segments worked well. No repositioning or second embedding of the specimen, even after fracture, was required. It was possible to create single burst fractures at the L-1 level in all 28 spine segments. Among the 28 fractures there were 16 incomplete burst fractures (Type A3.1), 8 burst-split fractures (Type A3.2), and 4 complete burst fractures (Type A3.3). The differences before and after fracture for stiffness and for anterior, posterior, and central heights were all significant (p < 0.05). CONCLUSIONS The ability to create reproducible burst fractures of a single vertebral body in a thoracolumbar spine segment may serve as a basis for future biomechanical studies that will provide better understanding of mechanical properties or fixation techniques.
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Yagi, Mitsuru, Shunsuke Sato, Atsushi Miyake, and Takashi Asazuma. "Traumatic Death due to Simultaneous Double Spine Fractures in Patient with Ankylosing Spondylitis." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/590935.
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The aim of this study is to report the rare occurrence of simultaneous double spine fractures in a patient with progressive ankylosing spondylitis (AS). An 82-year-old male with established AS had low-energy falls. He had sustained simultaneous double spine fractures and died. Plain radiographs of the cervical spine were unremarkable in detecting a cervical spine fracture in a patient with AS and a spinal cord injury following a fall. CT scan showed a displaced fracture at the C6/C7 with American Spinal Injury Association-A spinal cord injury and displaced fracture at L1. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fracture and dislocation that were facilitated by spinal rigidity from AS. This case report illustrates the importance of obtaining a detailed medical history and thorough imaging study when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of entire spine CT scan in the evaluation of the mechanism, further spine fractures, and manner of death. Despite the occurrence of spine fracture in AS patients, simultaneous double or multiple spine fractures are extremely rare and can be missed. Care should be taken for the further spine fracture in the entire spine in patient with AS.
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Wasnich, R. D., J. W. Davis, and P. D. Ross. "Spine fracture risk is predicted by non-spine fractures." Osteoporosis International 4, no. 1 (January 1994): 1–5. http://dx.doi.org/10.1007/bf02352253.
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AuYong, Nicholas, and Joseph Piatt. "Jefferson fractures of the immature spine." Journal of Neurosurgery: Pediatrics 3, no. 1 (January 2009): 15–19. http://dx.doi.org/10.3171/2008.10.peds08243.
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Jefferson fractures of the immature spine have received little attention in the study of pediatric spinal trauma. Fractures through synchondroses are a possibility in the immature spine, in addition to fractures through osseous portions of the vertebral ring, and they create opportunities for misinterpretation of diagnostic imaging. The authors describe 3 examples of Jefferson fractures in young children. All 3 cases featured fractures through an anterior synchondrosis in association with persistence of the posterior synchondrosis or a fracture of the posterior arch. The possibility of a Jefferson fracture should be considered for any child presenting with neck pain, cervical muscle spasm, or torticollis following a head injury, despite a seemingly normal cervical spine study. Jefferson fractures in young children are probably much more common than previously recognized.
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Handa, Yuji, Minoru Hayashi, Hirokazu Kawano, Hidenori Kobayashi, and Satoshi Hirose. "Vertebral Artery Thrombosis Accompanied by Burst Fracture of the Lower Cervical Spine: Case Report." Neurosurgery 17, no. 6 (December 1, 1985): 955–57. http://dx.doi.org/10.1227/00006123-198512000-00015.
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Abstract A case of thrombosis of the vertebral artery and an associated bursting fracture of the lower cervical spine is reported. Computed tomography revealed both the location and the spreading of the fractures of the injured spine. We recognized that the vertebral artery thrombosis was caused by an injury to the arterial wall within the fractured transverse foramen
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Charilaou, Johan, Roopam Dey, Marilize Burger, Sudesh Sivarasu, Ruan van Staden, and Stephen Roche. "Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures – A multi-observer study." SICOT-J 7 (2021): 36. http://dx.doi.org/10.1051/sicotj/2021028.
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Introduction: Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods: Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results: The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion: Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
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Ivanov, Stanislav V., Vladimir M. Kenis, Tatyana N. Prokopenko, Aleksandra S. Fedoseyeva, and Milana A. Ugurchieva. "Fractures of lower limbs in children with spina bifida." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 6, no. 3 (September 28, 2018): 25–31. http://dx.doi.org/10.17816/ptors6325-31.
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Background. Spina bifida is a serious defect in the development of the spine and spinal cord. It is accompanied by several orthopedic disorders of the spine and lower limbs, including fractures of long tubular bones. In spina bifida, osteoporosis plays an important role in the pathogenesis of motor disorders.
Aim. The objective was to determine the patterns of occurrence and the clinical and radiological features of fractures of the long tubular bones of the lower limbs in children with sequelae of spina bifida.
Materials and methods. From 2006 to 2017, 544 patients with spina bifida were examined and treated at the Turner Research Institute for Children’s Orthopedics. Clinical-neurological and radiographic methods were used. The neurosegmental level of spinal cord involvement was determined using the Sharrard classification, and the motor level was assessed according to the method proposed by Melbourne Medical University.
Results. The clinical picture of a fracture of a long tubular bone in a child with spina bifida has many characteristics. There was no abnormal mobility in the fracture site in 56% of cases, edema was absent in 88% of children, and pain in the fracture region was observed in only 19% of cases. The radiographic features of the atypical fracture of long tubular bones in children with sequelae of spina bifida included lack of a fracture line, presence of a hypertrophic periosteal reaction, and sclerosis areas at the fracture site.
Conclusion. The frequency and localization of fractures of the lower limbs in children with sequelae of spina bifida are determined according to the neurosegmental level. The clinical picture of fracture often differs from usual fractures by the absence of pain syndrome, edema in the fracture region, and displacement of bone fragments, which must be considered for diagnosis. The peculiarities of the clinical and radiological picture are associated with the presence of osteoporosis in this pathology due to a decrease in the motor activity level of the patients.
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Tarawneh, A. M., S. Taqvi, K. M. I. Salem, and O. Sahota. "20 Cervical Spine Fragility Fractures in Older People: 5-Year Experience At A Regional Spine Centre." Age and Ageing 49, Supplement_1 (February 2020): i1—i8. http://dx.doi.org/10.1093/ageing/afz183.20.
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Abstract Introduction Cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less, in the presence of degenerative spinal disease. Atlanto-axial complex and odontoid process injuries are the most frequent type of fractures and are potentially life threatening. Published in-hospital and 1-year mortality rates in older people are eightfold higher than in younger patients. The aim of this study was to identify the incidence and characteristics of cervical spine fractures in older people presenting to a regional spine centre. Methods Clinical records and radiographs were retrospectively reviewed using our institutional registry covering a 5-year period. Data included patient age, gender, mechanism of trauma, level of fracture, stability of the fracture, treatment modality, imaging modality, and mortality rates. Results A total of 209 patients above the age of 70 with cervical spine fractures were treated in our centre from 2015-2019. The mean age of the patients at the time of injury was (82.4 ±7.5) years with the majority (n=117; 56%) being females. One-hundred fifty-one patients (72.2%) experienced fractures in the atlanto-axial complex. Particularly, Dens fractures were the most commonly reported fracture (n=119; 56.9%). Most of the patients encountered stable cervical spine fractures (n=181; 86.6%) and these were managed by external immobilization with hard collar or halo vest. Mechanism of trauma was divided into two main categories, low energy and high energy. Low energy trauma was the most common cause that lead to cervical spine fractures (n=169; 80.9%), compared to high energy trauma (n=40; 19.1%). CT scan and X-ray were the main imaging modalities utilized to detect cervical spine fractures. Whereas, MRI was only utilized in (n=51; 24.4%). Overall mortality rate was (n=17; 8.1%) at 30 days. Out of which (n=1; 5.9%) was in a patient who was surgically treated while the remaining (n=16; 94.1%) were in those treated conservatively. Conclusions Cervical spine injuries in older people are clinically important. Low energy trauma particularly falls, were the main mechanism of cervical spine injury. Upper cervical spine injuries, mainly C2, is the most common cervical spine fracture and were most commonly detected using CT scan. External immobilization was our treatment of choice for most of the cervical spine injuries in the older people. These patients are very similar with respect to mean age, mechanism of injury and 30 days mortality rate as hip fracture patients.
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German, John W., Blaine L. Hart, and Edward C. Benzel. "Nonoperative Management of Vertical C2 Body Fractures." Neurosurgery 56, no. 3 (March 1, 2005): 516–21. http://dx.doi.org/10.1227/01.neu.0000153908.53579.e4.
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Abstract OBJECTIVE: To estimate the incidence and to describe the clinical results of the nonoperative management of vertical C2 body fractures. METHODS: An 8-year retrospective review of upper cervical spine injuries from the registry of a level I trauma center identified 21 patients with a vertical C2 body fracture. RESULTS: Sixteen coronally oriented Type 1 vertical C2 body fractures and 5 sagittally oriented Type 2 vertical C2 body fractures were identified. These fractures account for approximately 10% of the upper cervical spine fractures identified over this period of time. One elderly patient with a Type 1 fracture died as a result of pneumonia, and two patients with Type 2 fractures died from severe closed-head injuries. One patient had evidence of spinal cord injury. This was not related to the C2 body fracture but rather to a subaxial cervical spine injury. Of the surviving 18 patients, all were managed nonoperatively (with external orthoses) and showed evidence of fusion (union of fracture fragments) at the time of the last follow-up. CONCLUSION: Vertical C2 body fractures are not rare injuries and can account for up to 10% of upper cervical spine injuries. In general, vertical C2 body fractures are amenable to nonoperative treatment with external orthoses.
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S., Satheesh Kumar. "Incidence of flexion distraction injuries of thoraco lumbar spine." International Journal of Research in Medical Sciences 8, no. 2 (January 27, 2020): 480. http://dx.doi.org/10.18203/2320-6012.ijrms20200221.
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Background: Thoraco-lumbar spine fractures form majority of spine fractures and is an important cause of morbidity. However, comprehensive data regarding epidemiological pattern of trauma patients with spinal fractures are scarce. Many epidemiological reports about spinal fractures focus on osteoporosis as an etiologic factor. But in Indian population more important etiological factors are road traffic accidents and falls from height. Studies concerning only operatively treated patients with spinal fractures show selective and biased data that might be useful for capacity planning in hospitals or evaluating results of operative treatment, but not for epidemiological purposes. Methods: Among 86 consecutive patients with thoracic or lumbar fractures attending the out-patient department or Emergency department of Sree Gokulam Medical College, Trivandrum were enrolled in the study. All patients with fractures of the thoracic or lumbar spine were enrolled in this study.Results: Flexion distraction injuries are the second commonest unstable thoracolumbar spine injuries.Conclusions: This study is a prospective cohort study of the epidemiological aspects and pattern of injury and treatment in thoraco-lumbar spine fractures at a tertiary care referral center. A total of 86 patients were enrolled in the study. The most common fracture pattern seen in this study was compression fractures (24.4%) which are stable. This was followed by stable burst fractures (23.2%, unstable burst fractures (18.6%), translational injuries (fracture-dislocations) (16.3%), flexion-distraction injuries (13.9%) and chance fractures (3.5%).
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Katoh, Hiroyuki, Eijiro Okada, Toshitaka Yoshii, Tsuyoshi Yamada, Kei Watanabe, Keiichi Katsumi, Akihiko Hiyama, et al. "A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis—A Nationwide Multicenter Study." Journal of Clinical Medicine 9, no. 1 (January 12, 2020): 208. http://dx.doi.org/10.3390/jcm9010208.
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In diffuse idiopathic hyperostosis (DISH), the ankylosed spine becomes susceptible to spinal fractures and spinal cord injuries due to the long lever arms of the fractured segments that make the fracture extremely unstable. The aim of this retrospective multicenter study was to examine the differences in DISH-affected spine fractures according to fracture level. The data of 285 cases with fractures of DISH-ankylosed segments diagnosed through computed tomography (CT) imaging were studied and the characteristics of 84 cases with cervical fractures were compared to 201 cases with thoracolumbar fractures. Examination of the CT images revealed that cervical fracture cases were associated with ossification of the posterior longitudinal ligament and had fractures at the intervertebral disc level, while thoracolumbar fracture cases were associated with ankylosing of the posterior elements and had fractures at the vertebral body. Neurologically, cervical fracture cases had a higher ratio of spinal cord injury leading to higher mortality, while thoracolumbar fracture cases had lower rates of initial spinal cord injury. However, a subset of thoracolumbar fracture cases suffered from a delay in diagnosis that led to higher rates of delayed neurological deterioration. Some of these thoracolumbar fracture cases had no apparent injury episode but experienced severe neurological deterioration. The information provided by this study will hopefully aid in the education of patients with DISH and raise the awareness of clinicians to potential pitfalls in the assessment of DISH trauma patients.
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Nishida, Norihiro, Junji Ohgi, Fei Jiang, Saki Ito, Yasuaki Imajo, Hidenori Suzuki, Masahiro Funaba, Daisuke Nakashima, Takashi Sakai, and Xian Chen. "Finite Element Method Analysis of Compression Fractures on Whole-Spine Models Including the Rib Cage." Computational and Mathematical Methods in Medicine 2019 (May 5, 2019): 1–10. http://dx.doi.org/10.1155/2019/8348631.
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Spinal compression fractures commonly occur at the thoracolumbar junction. We have previously constructed a 3-dimensional whole-spine model from medical images by using the finite element method (FEM) and then used this model to develop a compression fracture model. However, these models lacked the rib cage. No previous study has used whole-spine models including the rib cage constructed from medical images to analyze compression fractures. Therefore, in this study, we added the rib cage to whole-spine models. We constructed the models, including a normal spine model without the rib cage, a whole-spine model with the rib cage, and whole-spine models with compression fractures, using FEM analysis. Then, we simulated a person falling on the buttocks to perform stress analysis on the models and to examine to what extent the rib cage affects the analysis of compression fractures. The results showed that the intensity of strain and the vertebral body with minimum principle strain differed between the spine model including the rib cage and that excluding the rib cage. The strain on the spine model excluding the rib cage had approximately twice the intensity of the strain on the spine model including the rib cage. Therefore, the rib cage contributed to the stability of the thoracic spine, thus preventing deformation of the upper thoracic spine. However, the presence of the rib cage increased the strain around the site of compression fracture, thus increasing the possibilities of a refracture and fractures of adjacent vertebral bodies. Our study suggests that the analysis using spine models including the rib cage should be considered in future investigations of disorders of the spine and internal fracture fixation. The development of improved models may contribute to the improvement of prognosis and treatment of individual patients with disorders of the spine.
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Bourne, James Thomas, Alexander David Laing Baker, and Manoj Khatri. "A Combined Bony and Soft Tissue, Thoracic Chance Fracture: Late Displacement following Conservative Treatment." Case Reports in Orthopedics 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/6528673.
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We report the first case of a combined bony and soft tissue Chance fracture in the thoracic spine, with late presenting displacement following conservative management. Chance fractures are flexion-distraction injuries to the spine. They consist of disruption and longitudinal separation of the posterior elements of the vertebra, with the fracture extending through the pedicles and into the vertebral body. Both bony and soft tissue Chance fractures of the lumbar spine have been reported, as well as bony Chance fractures in the thoracic spine. This case suggests that this type of fracture is unstable and is an indication for operative management. It is also important to note that the displacement of the fracture occurred at more than eight weeks after injury, suggesting that instability may not present immediately.
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Wang, Marjorie C., Frank Pintar, Narayan Yoganandan, and Dennis J. Maiman. "The continued burden of spine fractures after motor vehicle crashes." Journal of Neurosurgery: Spine 10, no. 2 (February 2009): 86–92. http://dx.doi.org/10.3171/spi.2008.10.08279.
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Object Spine fractures are a significant cause of morbidity and mortality after motor vehicle crashes (MVCs). Public health interventions, such as the National Highway Traffic Safety Administration's Federal Motor Vehicle Safety Standards, have led to an increase in automobiles with air bags and the increased use of seat belts to lessen injuries sustained from MVCs. The purpose of this study was to evaluate secular trends in the occurrence of spine fractures associated with MVCs and evaluate the association between air bag and seat belt use with spine fractures. Methods Using the Crash Outcome Data Evaluation System, a database of the police reports of all MVCs in Wisconsin linked to hospital records, the authors studied the occurrence of spine fractures and seat belt and air bag use from 1994 to 2002. Demographic information and crash characteristics were obtained from the police reports. Injury characteristics were determined using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) hospital discharge codes. Results From 1994 to 2002, there were 29,860 hospital admissions associated with automobile or truck crashes. There were 20,276 drivers or front-seat passengers 16 years of age and older who were not missing ICD-9-CM discharge codes, seat belt or air bag data, and who had not been ejected from the vehicle. Of these, 2530 (12.5%) sustained a spine fracture. The occurrence of spine fractures increased over the study period, and the use of a seat belt plus air bag, and of air bags alone also increased during this period. However, the occurrence of severe spine fractures (Abbreviated Injury Scale Score ≥3) did not significantly increase over the study period. The use of both seat belt and air bag was associated with decreased odds of a spine fracture. Use of an air bag alone was associated with increased odds of a severe thoracic, but not cervical spine fracture. Conclusions Among drivers and front-seat passengers admitted to the hospital after MVCs, the occurrence of spine fractures increased from 1994 to 2002 despite concomitant increases in seat belt and air bag use. However, the occurrence of severe spine fractures did not increase over the study period. The use of both seat belt and air bag is protective against spine fractures. Although the overall increased occurrence of spine fractures may appear contrary to the increased use of seat belts and air bags in general, it is possible that improved imaging technology may be associated with an increase in the diagnosis of relatively minor fractures. However, given the significant protective effects of both seat belt and air bag use against spine fractures, resources should continue to be dedicated toward increasing their use to mitigate the effects of MVCs.
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Scheyerer, Max J., Stefan M. Zimmermann, Samy Bouaicha, Hans-Peter Simmen, Guido A. Wanner, and Clément M. L. Werner. "Location of Sternal Fractures as a Possible Marker for Associated Injuries." Emergency Medicine International 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/407589.
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Introduction. Sternal fractures often occur together with serious and life-threatening additional injuries. This retrospective study was designed to assess concomitant injuries and develop a correlation between fracture location and the severity of injury.Methods.All patients () diagnosed with a fracture of the sternum by means of a CT scan were analysed with respect to accident circumstances, fracture morphology and topography, associated injuries, and outcome.Results. Isolated sternal fractures occurred in 9%. In all other admissions, concomitant injuries were diagnosed: mainly rip fractures (64%), injury to the head (48%), the thoracic spine (38%), lumbar spine (27%), and cervical spine (22%). Predominant fracture location was the manubrium sterni. In these locations, the observed mean ISS was the highest. They were strongly associated with thoracic spine and other chest injuries. Furthermore, the incidence of head injuries was significantly higher. ICU admission was significantly higher in patients with manubrium sterni fractures.Conclusion. Sternal fractures are frequently associated with other injuries. It appears that the fracture location can provide important information regarding concomitant injuries. In particular, in fractures of manubrium sterni, the need for further detailed clinical and radiologic workup is necessary to detect the frequently associated injuries and reduce the increased mortality.
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Sharif, Salman, Yousuf Shaikh, Onur Yaman, and Mehmet Zileli. "Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations." Neurospine 18, no. 4 (December 31, 2021): 667–80. http://dx.doi.org/10.14245/ns.2142206.253.
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To formulate the specific guidelines for the recommendation of thoracolumbar fracture regarding surgical techniques and nonfusion surgery. WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meeting. For nonfusion surgery and thoracolumbar fracture, a systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020. The search was further refined by excluding the articles which were duplicate, not in English or were based on animal or cadaveric subjects. After thorough shortlisting, only 50 articles were selected for full review in this consensus meeting. To generate a consensus, the levels of agreement or disagreement on each item were voted independently in a blind fashion through a Likert-type scale from 1 to 5. The consensus was achieved when the sum for disagreement or agreement was ≥ 66%. Each consensus point was clearly defined with evidence strength, recommendation grade, and consensus level provided. A magnitude of prospective papers were analyzed to formulate consensus on various surgical techniques that can be employed to address different types of thoracolumbar fractures. Surgical treatment of thoracolumbar fractures can be a better option over the nonoperative approach, especially for those who cannot tolerate months in an orthosis or cast, such as those with multiple extremity injuries, skin lesions, obesity, and so forth. It generally allows early mobilization, less hospital stay, reduced pulmonary complications, and better correction of sagittal balance. Current available literature fails to demonstrate any statistically significant benefit of fusion surgery over nonfusion in thoracolumbar fractures.
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Hadley, Mark N., Curtis A. Dickman, Carol M. Browner, and Volker K. H. Sonntag. "Acute Traumatic Atlas Fractures: Management and Long Term Outcome." Neurosurgery 23, no. 1 (June 1, 1988): 31–35. http://dx.doi.org/10.1227/00006123-198807000-00007.
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ABSTRACT Fractures of the 1st cervical vertebra (C1) represent 7% of all acute cervical spine fractures. Isolated atlas fractures are most commonly bilateral or multiple fractures through the ring of C1. Frequently (44% of cases), the atlas will be fractured in combination with the axis. Treatment of isolated C1 fractures should be governed by the rules of Spence. The treatment of combination C1-C2 fractures is dictated by the type and severity of the C2 fracture. Experience with 57 cases of acute atlas fractures is reviewed. Nonoperative external immobilization was used in 53 patients (with 1 failure), and early surgical wiring and fusion were performed in 4 patients. The long term outcome from an atlas fracture is good (median follow-up, 40 months).
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Ellis, Henry B., Aaron J. Zynda, Aristides I. Cruz, Brant Sachleben, Catherine Sargent, Daniel W. Green, Drew E. Warnick, et al. "RELIABILITY IN RADIOGRAPHIC REVIEW OF TIBIAL SPINE FRACTURES IN A TIBIAL SPINE RESEARCH INTEREST GROUP." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0006. http://dx.doi.org/10.1177/2325967119s00069.
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BACKGROUND: Variability that exists amongst the radiographic measurement parameters associated with tibial spine fractures may have direct consequences when comparing, reporting, or treating these injuries. In developing data collection of tibial spine fractures amongst multiple centers, it is important to establish reliability in radiographic parameters. Therefore, we designed a study to validate the classification and a proposed cohort of measurements of tibial spine fractures amongst multiple institutions to assist with standardizing fracture classification and treatment decisions. METHODS: Radiographic assessment of de-identified acute tibial spine fractures was performed by members of the Pediatric Research in Sports Medicine (PRISM) Tibial Spine Research Interest Group. A descriptive Powerpoint presentation was provided to each reviewer demonstrating specific measurements and classification prior to review. Reviewers were also asked to provide treatment recommendations. DICOM files were provided to the surgeon through a web-based shared drive and reviewers were required to use the same imaging software. There were 40 patients included, determined through power analysis performed based on previous reliability studies and the number of participants. Assuming the intraclass correlation coefficient (ICC) will be .85 and 95% confidence interval to be 0.2, the sample size of 40 will achieve the desired 95% confidence. Data will be reviewed using both kappa and ICC reliability measures due to both categorical and continuous data points. RESULTS: A majority of radiographic measures demonstrated moderate ICC including posterior-proximal displacement (0.378), length and height of tibial spine fracture (0.466 and 0.535, respectively), and superior displacement of medial fragment (0.420). Good ICC was seen with superior displacement of the anterior tibial spine fragment (0.734). Poor correlation was seen with the measurements for anterior displacement, posterior sagittal displacement, and roof inclination angle. Classifying tibial spine fractures according to the historical Meyer & McKeever Classification demonstrated fair agreement (kappa = 0.347). 18 of 40 (45%) fracture patterns were classified by reviewers in three or more different classifications types while only 1 fracture pattern (Type 1) was agreed upon by all reviewers. A majority of reviewers recommended arthroscopic treatment with suture for more fracture patterns. However, there was fair agreement with the initial treatment regarding operative versus closed reduction (kappa = 0.328). CONCLUSION: Measurement of superior displacement of anterior tibial spine fracture on the lateral images is the only radiographic assessment with good correlation or agreement amongst a group of surgeons in a Tibial Spine Research Group. Classification of tibial spine fractures did not demonstrate acceptable agreement. Further studies and classification methodology is needed to standardize fracture patterns and thereby study outcomes based on pattern and treatment.
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Cabot, John H., Khang H. Dang, and Anil K. Dutta. "Free-Floating Scapular Spine: A Rare Shoulder Injury." Case Reports in Orthopedics 2019 (September 30, 2019): 1–4. http://dx.doi.org/10.1155/2019/1839375.
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A specific treatment protocol for managing scapular spine fractures does not currently exist. The purpose of our report is to describe this type of injury and detail our treatment management in order to better elucidate this rare pathology. We present a case of a 26-year-old female with an acute scapular spine and base fracture after a motor vehicle collision. Successful treatment of an acute free-floating scapular spine fracture was achieved with open reduction and internal fixation utilizing an elbow plate. Since scapular spine fractures are an unfortunate, rare injury, it may impose difficult challenges to the treating surgeon. With our case report, we hope to contribute to the overall knowledge of scapular spine fractures and offer our experience with a successful and appropriate treatment option in our patient.
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Akbarnia, Behrooz A. "PEDIATRIC SPINE FRACTURES." Orthopedic Clinics of North America 30, no. 3 (July 1999): 521–36. http://dx.doi.org/10.1016/s0030-5898(05)70103-6.
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Fourman, Mitchell S., Jeremy D. Shaw, Nicholas J. Vaudreuil, Malcolm E. Dombrowski, Rick A. Wawrose, Lorraine A. T. Boakye, Louis H. Alarcon, Joon Y. Lee, and William F. Donaldson. "Cervical Spine Fractures." SPINE 44, no. 23 (December 2019): 1661–67. http://dx.doi.org/10.1097/brs.0000000000003163.
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Meldon, Stephen W., and Laila N. Moettus. "Thoracolumbar Spine Fractures." Journal of Trauma: Injury, Infection, and Critical Care 39, no. 6 (December 1995): 1110–14. http://dx.doi.org/10.1097/00005373-199512000-00017.
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Kane, William. "Thoracolumbar Spine Fractures." Journal of Bone & Joint Surgery 75, no. 12 (December 1993): 1886. http://dx.doi.org/10.2106/00004623-199312000-00028.
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Hanley, Jr, Edward N., and Marjorie L. Eskay. "Thoracic Spine Fractures." Orthopedics 12, no. 5 (May 1, 1989): 689–96. http://dx.doi.org/10.3928/0147-7447-19890501-08.
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Kim, Young-Woo, Young-Seok Kim, Jae-Chel Byun, and Yong-Bok Park. "Thoracic Spine Fractures." Journal of the Korean Fracture Society 24, no. 2 (2011): 195. http://dx.doi.org/10.12671/jkfs.2011.24.2.195.
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Carreon, Leah Y., Steven D. Glassman, and Mitchell J. Campbell. "Pediatric Spine Fractures." Journal of Spinal Disorders & Techniques 17, no. 6 (December 2004): 477–82. http://dx.doi.org/10.1097/01.bsd.0000132290.50455.99.
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Vialle, Luiz Roberto, and Emiliano Vialle. "Thoracic spine fractures." Injury 36, no. 2 (July 2005): S65—S72. http://dx.doi.org/10.1016/j.injury.2005.06.016.
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Fröjd Révész, David, Andrea Norell, Anastasios Charalampidis, Peter Endler, and Paul Gerdhem. "Subaxial Spine Fractures." Spine 46, no. 17 (February 1, 2021): E926—E931. http://dx.doi.org/10.1097/brs.0000000000003979.
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Park, Hyung-Youl, Kee-Yong Ha, Ki-Won Kim, Kee-Won Rhyu, Young-Hoon Kim, Jun-Seok Lee, Sang-Il Kim, and Soo-Bin Park. "Unstable Bony Chance Fracture Successfully Treated With Teriparatide in Patient With Ankylosed Spine: A Case Report and Review of the Literature." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 2021): 215145932110390. http://dx.doi.org/10.1177/21514593211039024.
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Background: Ankylosed spines with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis (DISH) are prone to fractures due to osteoporosis and fracture instability from long lever arm. In such cases, surgical management is the main treatment option. Case presentation: We report a first case of successful treatment of unstable bony Chance fracture at thoracolumbar junction in DISH patient using teriparatide and review previous literature on ankylosed spine fractures treated with teriparatide. An 82-year-old male patient presented with back pain after falling from a 3 m height 3 months ago. Imaging studies showed L1 unstable flexion-distraction injury (bony Chance fracture) and intravertebral vacuum cleft in ankylosed spine due to DISH. Conservative treatment, teriparatide and orthosis, was determined as the most appropriate approach because the patient declined surgery and presented with tolerable mechanical back pain without any neurologic deficits. Solid bony union was successfully achieved without any complications after 1-year treatment. Conclusion: Although surgical management is strongly recommended for unstable fracture in ankylosed spine, non-surgical treatment including teriparatide and orthosis might be safer and effective options in bony Chance fracture without neurologic deficits and intractable mechanical pain.
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Varga, Péter Pál, István Béla Bors, and Áron Lazáry. "Orthopedic treatment of vertebral compression fractures in osteoporosis." Orvosi Hetilap 152, no. 33 (August 2011): 1328–36. http://dx.doi.org/10.1556/oh.2011.29178.
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Vertebral compression fracture is the most common type of fractures in osteoporosis increasing the mortality and morbidity of the systemic disease. Adequate treatment of the vertebral compression fractures is always in the focus of the national and international spine meetings and one of the most innovative fields in the spine care is the surgical therapy of the osteoporotic spine. Here, the authors summarize the orthopedic treatment options for vertebral compression fractures based on a literature review
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Tarawneh, Ahmad, Syed Taqvi, Khalid Salem, and Opinder Sahota. "Cervical spine fragility fractures in older people: 5-year experience at a regional spine centre." Age and Ageing 49, no. 6 (June 10, 2020): 1102–4. http://dx.doi.org/10.1093/ageing/afaa088.
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Abstract Background cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less. Atlanto-axial complex (AAC) and, particularly, odontoid process (OP) fractures are the most prevalent injuries. Objective to investigate the incidence and characteristics of cervical spine fractures in older patients presenting to a regional spine centre. Methods a retrospective review of the clinical records and imaging of all patients aged 70 years and over presenting to a regional spinal unit with a cervical injury over a 5-year period was performed. Patient demographics, mechanism of injury, level of fracture, stability of the fracture, treatment modality, imaging modality and mortality rates were collected and analysed. Results during the period between 2015 and 2019, a total of 209 patients aged 70 years and over were presented to the regional spine unit. The mean age at presentation was 82.4 (±7.5) years. Low-energy trauma was the commonest mechanism of injury (n = 169; 80.9%). MRI was undertaken in a quarter of the patients. One-hundred and fifty-one patients (72.2%) suffered an AAC Injury with OP fractures forming the majority of this group (n = 119; 78.8%). One-hundred and ninety-nine patients were treated conservatively, and the overall 30-day mortality rate was 8.1%. Conclusion cervical spine fractures are not uncommon amongst older people and are mostly the result of low-energy trauma and predominantly affect the axial cervical spine. The majority of these injuries are managed conservatively with an orthosis. The fractures nevertheless are a serious injury, with a high mortality rate at 30 days.
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Moon, MS, WT Choi, YW Moon, YS Kim, and JL Moon. "Stabilisation of Fractured Thoracic and Lumbar Spine with Cotrel-Dubousset Instrument." Journal of Orthopaedic Surgery 11, no. 1 (June 2003): 59–66. http://dx.doi.org/10.1177/230949900301100113.
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Objective. To evaluate the effectiveness of 2 different types of Cotrel-Dubousset instrument systems in stabilising thoracolumbar and lumbar spine fractures. Methods. Between January 1989 and December 1993, 45 fractures in 42 patients with unstable fracture or fracture dislocation of the thoracolumbar and lumbar spines were randomly assigned to 2 surgical treatments with Cotrel-Dubousset instrumentation—using either a long segment (Group 1) or a short segment (Group 2)—and short posterolateral fusion. Results. Consolidation of the fractured vertebral body and posterolateral fusion were achieved at a mean time of 4.5 months; fusion rates were 75% in Group 1 and 83% in Group 2. The average collapses of anterior vertebral body height in Group 1, in the immediate postoperative period and at the final follow-up, were 15% and 17%, respectively; and in Group 2, the figures were 16% and 24%, respectively. The correction of vertebral height and kyphosis at the last follow-up were lost more in Group 2 (5.7°) than in Group 1 (4.4°). There were neurological recoveries in 6 of the 9 cases of incomplete paraplegics, including complete recovery in 5, and one-Frankel grade increase in one. There were 15 instrument failures in 12 patients, including screw breakage in 3 Group 1 cases and 6 Group 2 cases. The plug dislodged in 3 Group 1 cases, and the hook dislodged in 3 Group 2 cases. In other words, instrument failures were more common in Group 2. Conclusion. Cotrel-Dubousset stabilisation of the fractured spine achieves fracture consolidation, but does not maintain the restored height and sagittal curve completely until fusion. The long rod and short fusion construct was more effective for all fracture types than was the short rod and fusion construct, although it leads to wider immobilisation of normal segments.
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Klesius, L., and K. Schroeder. "Effective Analgesia with Bilateral Erector Spinae Plane Catheters for a Patient with Traumatic Rib and Spine Fractures." Case Reports in Anesthesiology 2019 (April 8, 2019): 1–3. http://dx.doi.org/10.1155/2019/9159878.
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Pain management in trauma patients with acute rib and spine fractures presents a challenge for the anesthesiologist and achieving adequate analgesia is important in preventing pulmonary complications. Unfortunately, neuraxial techniques are often challenging or contraindicated due to spine fractures or coagulopathy. Erector spinae plane (ESP) blocks provide an alternative regional anesthetic technique to manage pain. We describe a case of bilateral ESP catheters placed intraoperatively after spinal instrumentation in a patient with bilateral rib and spine fractures sustained in a tractor rollover crash. Prior to surgery, the patient had inadequate pain control and poor respiratory function despite multimodal analgesia. With the addition of bilateral ESP catheters, the patient’s pain control improved and he was weaned from respiratory support. ESP blocks have been shown to provide effective analgesia in patients with rib fractures; however, the utilization of these blocks has not been described in patients with spine fractures undergoing spinal instrumentation. Thus, ESP blocks provide a simple alternative to providing surgical and trauma analgesia when neuraxial techniques are contraindicated. The success of bilateral ESP catheters in our patient indicates a further area for application of ESP blocks in patients undergoing spine surgery with acute traumatic spine fractures.
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Mistro Neto, Sylvio, Marcelo Italo Risso Neto, Guilherme Rebechi Zuiani, Roberto Rossanez, Gabriel Gomes Freitas de Castro, Ivan Guidolin Veiga, Wagner Pasqualini, et al. "PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES." Coluna/Columna 14, no. 4 (December 2015): 276–80. http://dx.doi.org/10.1590/s1808-185120151404152847.
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Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index), which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.
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Neubecker, Katherine, Beverley Adams-Huet, Irfan M. Farukhi, Rosinda C. Delapena, and Ugis Gruntmanis. "Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy." Journal of Osteoporosis 2011 (2011): 1–6. http://dx.doi.org/10.4061/2011/924595.
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Decrease of bone mineral density (BMD) and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT). We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX) tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualified for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine films increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not affect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD.
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Ma, Rui, Jie He, Biao Xu, Rugang Zhao, and Qiang Zhang. "Negative correlation between bone mineral density and subclinical fractures in patients with human immunodeficiency virus." Journal of International Medical Research 49, no. 2 (February 2021): 030006052098063. http://dx.doi.org/10.1177/0300060520980639.
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Background Although low bone mineral density (BMD) is associated with an increased risk of fracture, few studies have assessed fracture rates in patients with human immunodeficiency virus (HIV). Methods The occurrence of subclinical fractures in patients with HIV was assessed. Pearson’s chi-square test was used to analyze the relationship between subclinical fractures and related factors. Results Fifty patients with HIV were included, among whom 11 were diagnosed with subclinical fractures. These 11 patients had a mean body mass index of 24.127 ± 3.482 kg/m2, smoked a mean of 142.091 ± 3.482 cigarettes/month, drank a mean of 61.545 ± 13.026 mL/day of alcohol, had a mean CD4+ T cell count of 247.727 ± 181.679 cells/mm3, had a mean duration of acquired immunodeficiency syndrome (AIDS) of 4.27 ± 0.786 years, and had a mean BMD of the third lumbar spine of 0.810 ± 0.063 g/cm3. The AIDS duration and BMD of the third lumbar spine were significantly associated with subclinical fractures. The BMD of the third lumbar spine was negatively correlated with subclinical fractures. Conclusion A significant negative correlation was found between the BMD of the third lumbar spine and subclinical fractures.
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Sambrook, Philip N., and Piet Geusens. "The epidemiology of osteoporosis and fractures in ankylosing spondylitis." Therapeutic Advances in Musculoskeletal Disease 4, no. 4 (June 13, 2012): 287–92. http://dx.doi.org/10.1177/1759720x12441276.
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Bone is a target in many inflammatory rheumatic diseases. Inflammation leads to a wide range of changes in bone, and especially bone remodeling. In ankylosing spondylitis (AS) bone loss has been documented, but measuring bone density in the spine is hampered by new bone formation in syndesmophytes, periost and within the vertebrae. The risk of vertebral fractures is increased in AS. The diagnosis of vertebral fractures requires imaging and adequate evaluation of vertebral heights. In addition, in the ankysosed spine segments, additional imaging is often needed to diagnose spinal fractures at unusual locations (cervical spine) or in the posterior arch structures. Risk factors for vertebral fractures are helpful for case finding. Fracture prevention is indicated in high risk patients with AS, especially when they have already a vertebral fracture or in the presence of osteoporosis.
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Reinhold, Maximilian, Christian Knop, Christian Kneitz, and Alexander Disch. "Spine Fractures in Ankylosing Diseases: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)." Global Spine Journal 8, no. 2_suppl (September 2018): 56S—68S. http://dx.doi.org/10.1177/2192568217736268.
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Study Design: Review of literature and case series. Objectives: Update and review of current treatment concepts for spine fractures in patients with ankylosing spinal disorders. Methods: Case presentation and description of a diagnostic and therapeutic algorithm for unstable spinal injuries with an underlying ankylosing spinal disorder (ASD) of the cervical and thoracolumbar spine. Results: Nondisplaced fractures can be missed easily using conventional X-rays. Thus, computed tomography (CT) scans are recommended for all trauma patients with ASD. In doubt or presence of any neurologic involvement additional magnetic resonance imaging (MRI) scans should be obtained. Spine precautions should be maintained all times and until definitive treatment (<24 h). Nonoperative fracture treatment is not recommended given the mechanical instability of the most commonly seen fracture patterns (AOSpine B- and C-type, M2) in patients with ASD and inherent high risk of secondary neurologic deterioration. For patients with ankylosing spondylitis (AS) or diffuse idiopathic hyperostosis (DISH) sustaining cervical spine fractures, a combined anterior-posterior instrumentation for fracture fixation is recommended. Closed reduction and patient positioning can be challenging in presence of preexisting kyphotic deformities. In the thoracolumbar (TL) spine, a posterior instrumentation extending 2 to 3 levels above and below the fracture level is recommended to maintain adequate reduction and stability until fracture healing. Minimally invasive percutaneous pedicle screws and cement augmentation can help to minimize the surgical trauma and strengthen the construct stability in patients with diminished minor bone quality (osteopenia, osteoporosis). Conclusions: Current concepts, treatment options, and recommendations of the German Orthopedic Trauma Society–Spine Section for spinal fractures in the ankylosed spine have been outlined.
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Alos, Nathalie, Ronald M. Grant, Timothy Ramsay, Jacqueline Halton, Elizabeth A. Cummings, Paivi M. Miettunen, Sharon Abish, et al. "High Incidence of Vertebral Fractures in Children With Acute Lymphoblastic Leukemia 12 Months After the Initiation of Therapy." Journal of Clinical Oncology 30, no. 22 (August 1, 2012): 2760–67. http://dx.doi.org/10.1200/jco.2011.40.4830.
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Purpose Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. Patient and Methods We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semiquantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures. Results Of the 155 children, 25 (16%; 95% CI, 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen (52%) of the 25 children with incident vertebral fractures also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI, 2.3 to 23.1; P = .001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI, 1.2 to 2.7; P = .006). Conclusion Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features.
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Leslie, William D., Berengère Aubry-Rozier, Olivier Lamy, and Didier Hans. "TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk." Journal of Clinical Endocrinology & Metabolism 98, no. 2 (February 1, 2013): 602–9. http://dx.doi.org/10.1210/jc.2012-3118.
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Abstract Context: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. Objective: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. Design and Setting: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. Main Outcome Measures: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). Results: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30–2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10–1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24–1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. Conclusions: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.
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Zheng, Jiajia, Liang Tang, and Jingwen Hu. "A Numerical Investigation of Risk Factors Affecting Lumbar Spine Injuries Using a Detailed Lumbar Model." Applied Bionics and Biomechanics 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/8626102.
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Recent field data showed that lumbar spine fractures occurred more frequently in late model vehicles than early ones in frontal crashes. However, the lumbar spine designs of the current crash test dummies are not accurate in human anatomy and have not been validated against any human/cadaver impact responses. In addition, the lumbar spines of finite element (FE) human models, including GHBMC and THUMS, have never been validated previously against cadaver tests. Therefore, this study developed a detailed FE lumbar spine model and validated it against cadaveric tests. To investigate the mechanism of lumbar spine injury in frontal crashes, effects of changing the coefficient of friction (COF), impact velocity, cushion thickness and stiffness, and cushion angle on the risk of lumbar spine injuries were analyzed based on a Taguchi array of design of experiments. The results showed that impact velocity is the most important factor in determining the risk of lumbar spine fracture (P=0.009). After controlling the impact velocity, increases in the cushion thickness can effectively reduce the risk of lumbar spine fracture (P=0.039).
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Carlson, Bayard C., William A. Robinson, Nathan R. Wanderman, Arjun S. Sebastian, Ahmad Nassr, Brett A. Freedman, and Paul A. Anderson. "A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine." Geriatric Orthopaedic Surgery & Rehabilitation 10 (January 1, 2019): 215145931986159. http://dx.doi.org/10.1177/2151459319861591.
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Introduction: Osteopenia and osteoporosis are common conditions in the United States. The health consequences of low bone density can be dire, from poor surgical outcomes to increased mortality rates following a fracture. Significance: This article highlights the impact low bone density has on spine health in terms of vertebral fragility fractures and its adverse effects on elective spine surgery. It also reviews the clinical importance of bone health assessment and optimization. Results: Vertebral fractures are the most common fragility fractures with significant consequences related to patient morbidity and mortality. Additionally, a vertebral fracture is the best predictor of a subsequent fracture. These fractures constitute sentinel events in osteoporosis that require further evaluation and treatment of the patient’s underlying bone disease. In addition to fractures, osteopenia and osteoporosis have deleterious effects on elective spine surgery from screw pullout to fusion rates. Adequate evaluation and treatment of a patient’s underlying bone disease in these situations have been shown to improve patient outcomes. Conclusion: With an increased understanding of the prevalence of low bone mass and its consequences as well an understanding of how to identify these patients and appropriately intervene, spine surgeons can effectively decrease the rates of adverse health outcomes related to low bone mass.
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Kaniewska, Malwina, Johannes Maria de Beus, Frank Ahlhelm, Alexander Mameghani, Karim Eid, Rahel A. Kubik-Huch, and Suzanne E. Anderson. "Whole spine localizers of magnetic resonance imaging detect unexpected vertebral fractures." Acta Radiologica 60, no. 6 (August 24, 2018): 742–48. http://dx.doi.org/10.1177/0284185118796673.
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Background Whole spine localizers (WS-loc) of magnetic resonance imaging (MRI) are performed for enumeration of the vertebrae but they can be also used for the evaluation of the spine. Purpose To assess the accuracy of fracture detection using WS-locs of MRI and compare the findings with standard high-resolution short tau inversion recovery (STIR) sequences, and to determine whether the review of WS-locs is useful and if additional information can be gained by assessing the thoracic spine section of the WS-locs. Material and Methods A total of 298 magnetic resonance (MR) examinations of the lumbar spine with WS-locs were evaluated. Two independent readers reviewed the images. In case of fracture detection, further characterization of the fracture was performed. To assess inter-reader agreement, unweighted Cohen’s kappa with 95% confidence intervals (CI) and Phi coefficients were calculated. Results The study sample included 187 female and 111 male patients (age range = 65–94 years; median age = 75.0 years). The WS-locs detected 42 fractures of the lumbar spine and 36 of the thoracic spine. Inter-reader agreement for fracture detection in the lumbar and thoracic spine was strong (K = 0.87, 95% CI = 0.78–0.95, Phi = 0.87, and K = 0.88, 95% CI = 0.79–0.96, Phi = 0.88, respectively). Conclusion WS-locs from MR examinations of the lumbar spine provide a good diagnostic tool for the detection and evaluation of unsuspected vertebral fractures. WS-locs show strong inter-reader agreement for fracture detection in the thoracic and lumbar spine.
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Karamian, Brian A., Gregory D. Schroeder, Martin Holas, Andrei F. Joaquim, Jose A. Canseco, Shanmuganathan Rajasekaran, Lorin M. Benneker, et al. "Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures." European Spine Journal 30, no. 6 (April 2, 2021): 1635–50. http://dx.doi.org/10.1007/s00586-021-06818-z.
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Abstract Purpose To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. Methods A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1–F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. Results A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. Conclusion Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
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Vilela, Marcelo D., and Eric C. Peterson. "Atlantal fracture with transverse ligament disruption in a child." Journal of Neurosurgery: Pediatrics 4, no. 3 (September 2009): 196–98. http://dx.doi.org/10.3171/2009.4.peds0973.
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Even though fractures in children with immature spines occur predominantly in the upper cervical spine, isolated C-1 fractures are relatively rare. The fractures in almost all cases reported to date were considered stable due to the presence of the intact transverse ligament. The authors report the case of a young child who sustained a Jefferson fracture and in whom MR imaging revealed disruption of the transverse ligament. Although surgical treatment has been suggested as the treatment of choice for children with unstable atlantoaxial injuries, external immobilization alone allowed a full recovery in the patient with no evidence of instability at follow-up.
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Alam, Waqar, Faaiz Ali Shah, Ashfaq Ahmed, Qazi Muhammad Amin, Ijaz Ahmed, and Amer Aziz. "UNSTABLE FRACTURE OF THORACOLUMBAR SPINE;." Professional Medical Journal 24, no. 01 (January 18, 2017): 200–204. http://dx.doi.org/10.29309/tpmj/2017.24.01.476.
Full textAbstract:
Objectives: To evaluate the functional outcome of unstable thoracolumbarfractures fixed with pedicular screws and rods. Study Design: Descriptive case series. Setting:Department of Orthopedics and Spine surgery Ghurki Trust Teaching Hospital Lahore. Period:February 2013 to October 2015. Material & Methods: Patients of either gender or all ageswith thoracolumbar fractures fulfilling the inclusion criteria were fixed with pedicular screwsand rods under general anesthesia. Post operatively patients were reviewed monthly for oneyear and results were analyzed according to modified McNab criteria as excellent, good, fairand poor at final follow up. Results: A total of 281 patients including 193(68.68%) males and88(31.32%) females with mean age 28.32 years (range 18 to 60 years) were included in ourstudy. Majority (91 patients) had fractures of L1 followed by L2 (73 patients) fracture and D12(67 patients) fracture. Pre operatively 95(33.81%) were neurologically graded as Frankle gradeD,73 (25.98%) grade C while 49(17.44%) were graded as Frankle grade E.Post operatively finalfollow up at one year yielded excellent clinical outcome in majority (91.46%,n=257) while goodand fair outcomes were reported in 6.41%(18 patients), and 2.14%(6 patients) respectivelyaccording to modified McNab criteria. No post op neurological detoriation, mortality or othermajor complication was reported in the study. Conclusion: Pedicular screw and rod fixationfor unstable thoracolumbar fractures gave excellent functional results in majority of patient as itreduces complications of recumbency and helps in early mobilization. We recommend it as afirst line treatment for such fractures.
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Nakayama, Tetsuo, and Shigeru Ehara. "Cervical vertebral injuries associated with the ossification of the posterior longitudinal ligament: Imaging features." Acta Radiologica Open 6, no. 3 (March 2017): 205846011769585. http://dx.doi.org/10.1177/2058460117695855.
Full textAbstract:
Background Spinal injuries associated with ossification of the posterior longitudinal ligament (OPLL) have been characterized. However, the imaging features of traumatic cervical spine fractures in patients with OPLL have not been assessed adequately. Purpose To characterize the patterns of traumatic cervical spine fractures associated with different types of OPLL. Material and Methods We retrospectively analyzed the patterns of fractures resulting from cervical spine injury in patients with OPLL of different types and assessed the fracture patterns in patients with ankylosed segments. Results Twenty-six patients (23 men, 3 women; median age, 67.0 years; age range, 43–87 years) were included. Fall from a height <3 m was the most common trauma. Contiguous type OPLL was seen in 11 patients (42%), segmental type in 11 (42%), and mixed type in four (15%). Four of the contiguous OPLL and one of the mixed OPLL patients had ankylosed segments. The incidence of cervical fractures was 69% (16/26): seven (64%) in contiguous OPLL, five (46%) in segmental OPLL, and in all four patients with mixed OPLL. Unilateral interfacetal fracture-dislocation was most common (4/16); the others were bilateral interfacetal fracture-dislocation, fractures through the ankylosed segment, transdiscal fractures, isolated facet fractures, and compression fractures. Cervical fractures were exclusively observed in the C4 to C7, except in one case occurred at the C2 level. Conclusion Interfacetal fracture-dislocation in the lower cervical vertebrae constitutes the most common injury resulting from minor trauma.