THE TREATMENT OF FRACTURES OF THE MANDIBLE.
(57/515)
One hundred and eleven cases of mandibular fracture in 67 patients who were seen at the San Francisco General Hospital from 1960 to 1962 were reviewed. With the exception of two cases in which displaced fragments interfered with the mandibular range of motion, condylar fractures were successfully treated with closed reduction. Undisplaced fractures of the angle were treated successfully by intermaxillary fixation alone, but the significantly displaced fractures were treated by open reduction and interosseous wire fixation. Fractures of the anterior body and midbody were usually treated with closed reduction if adequate teeth were present for satisfactory intermaxillary fixation. Some fractures of the anterior body, particularly those in the region of the symphysis require open reduction because of the strong pull of the muscles in that area. In this series of patients, clinical infection and non-union were most commonly associated with fractures communicating with teeth. If open reduction is necessary, the results in this series suggest that it should be delayed until the oral tract left by extraction is healed. Prophylactic antibiotics did not appear to be of value in preventing infection or non-union in this small series of patients, although sufficient data were not available for a statistical conclusion. (+info)
Hip fracture in the immobile patient.
(58/515)
Immobility has been used as an indication for conservative treatment of patients with fractures of the hip, although there is little in the literature to support this view. We conducted a prospective review of 3515 patients with hip fractures of whom 152 (4.3%) were immobile prior to the fracture. Nine patients were treated conservatively, the rest by operation. The mean age was 83 years (42 to 99); the mean length of hospital stay was 17.8 days; 19 patients (12.5%) died whilst still in hospital and 120 (79.0%) went back to their original residence. There were 38 post-operative complications. At one year after injury, 73 patients were still alive. Of the survivors, 54 (74.0%) had none or minimal pain in the hip and 58 (79.5%) had the same residential status as before the fracture. Immobility in patients with hip fracture is uncommon and is not a valid reason for withholding surgical treatment. (+info)
Evaluation and management of toe fractures.
(59/515)
Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe. Joint hyperextension and stress fractures are less common. Most patients have point tenderness at the fracture site or pain with gentle axial loading of the digit. Anteroposterior and oblique radiographs generally are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. Stable, nondisplaced toe fractures should be treated with buddy taping and a rigid-sole shoe to limit joint movement. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. Patients with displaced fractures of the first toe often require referral for stabilization of the reduction. (+info)
Osteosynthesis-associated bone infection caused by a nonproteolytic, nontoxigenic Clostridium botulinum-like strain.
(60/515)
A nonproteolytic, nontoxigenic Clostridium botulinum strain identified by conventional and molecular techniques as type B-, E-, or F-like (BEF-like) was isolated from a human postsurgical wound. All previous reports of such strains have been from environmental sources. Since toxin production is the main taxonomic denominator for C. botulinum, a new name is needed for nonproteolytic, nontoxigenic BEF-like clinical isolates. (+info)
Antiphospholipid antibody associated thrombosis in juvenile chronic arthritis.
(61/515)
A child with systemic onset juvenile chronic arthritis (JCA) who developed a bilateral femuropopliteal vein thrombosis after plaster immobilisation following a tibial fracture is described. When the thrombosis was diagnosed, antiphospholipid antibodies detected either as lupus anticoagulant and anticardiolipin antibodies were found. This suggests that short term prophylatic antithrombotic treatment should be considered in antiphospholipid antibody positive JCA patients who require immobilisation after fractures of demineralised bones. (+info)
Growing skull fractures.
(62/515)
Growing skull fractures or craniocerebral erosions are rare sequel to cranial fractures where progressively growing cranial defects follow lacerations involving the duramater. Their usual site is the parietal region. They present as a cystic, non-tender swelling with an underlying palpable bony defect. One such case is reported. (+info)
A retrospective analysis of health care costs for bone fractures in women with early-stage breast carcinoma.
(63/515)
BACKGROUND: In this retrospective data base study, the authors sought to estimate direct costs for bone fractures in women age > or =65 years with early-stage breast carcinoma and to compare those costs with treatment costs for bone fractures in older women without early-stage breast carcinoma. METHODS: Direct costs for bone fractures in patients with early-stage breast carcinoma, which consist of excess treatment costs for bone fracture and excess costs of long-term care for bone fracture, were evaluated by using the 1997-1998 Standard Analytical File. The statistical significance of the difference in inpatient costs, medical treatment costs, and long-term care admission rates were determined with the t test and the Fisher chi-square test, respectively. RESULTS: For older women with early-stage breast carcinoma, the direct costs for bone fracture were estimated at $45,579, and 57% of those costs came from treating the bone fracture (32% came from inpatient hospital costs, and 25% came from noninpatient hospital costs), 25% came from other excess treatment costs, and 18% came from excess long-term care costs. The women who had early-stage breast carcinoma and sustained bone fracture did not differ significantly from the women without early-stage breast carcinoma who sustained a bone fracture. CONCLUSIONS: Bone fracture was associated with high direct costs in older women with early-stage breast carcinoma. Additional research should include appropriate, incidence-based studies to investigate the potential benefit of an intervention for preventing bone fracture in this increasingly large patient population. (+info)
Outcome of longstanding dislocated elbows treated by open reduction and excision of collateral ligaments.
(64/515)
AIM: To study the long term result of open reduction of longstanding dislocated elbows with regard to stability, avascular necrosis of the distal humerus and degenerative changes of the joint. METHODS: Nine patients, aged between nine and 60 years (average 30 years) with longstanding posterior dislocation of the elbow underwent open reduction. The operative procedure featured a medial and lateral incision, excision of the capsule, fibrous adhesions and the collateral ligaments with no attempt to reconstruct the ligaments, as well as anterior transposition of the ulnar nerve. The procedure was performed on an average eight months after the injury (range 1.5 to 30 months). RESULTS: All elbows had improved flexion at follow-up which ranged from one to eleven-and-half years (average 48 months). The average arc of flexion improved from 11 degrees to 87 degrees. The average flexion at the elbow improved from 32 degrees (range 20 degrees - 50 degrees ) to 111 degrees (range 85 degrees - 140 degrees ). Younger patients with fractures of the articular surface of distal humerus had smaller gain in the range of motion. No patient complained of instability or had recurrence of dislocation. No patient developed avascular necrosis of the distal end of the humerus. The radiographs of the 60-year-old man at 11.5 years follow-up showed extensive degenerative changes of the joint but he still maintained a painless arc of flexion from 10 degrees to 135 degrees. CONCLUSION: There was improvement in the range of motion and function in all nine patients. The elbows were stable despite excision of the collateral ligaments. There was no evidence of avascular necrosis. Patients with eight or more years of follow-up showed degenerative changes of the joint. (+info)