PLOS ONE / Osteoporosis associated vertebral fracturesHealth economic implications

Introduction Osteoporosis-associated vertebral fractures represent an increasing clinical and public health problem, one with important socioeconomic effects within western countries. The purpose of this study was to analyse demographic, medical, gender and socioeconomic aspects of osteoporotic vertebral fractures of the thoracic or lumbar spine over a period of at least 10-years. Material and methods Included for analysis were 694 patients who had suffered a vertebral fracture due to primary or secondary osteoporosis, and who were treated at our Level-I trauma center between 2000 and 2013. Collected data included demographic, medical and socioeconomic aspects. Results Clinical results revealed that 669 patients (96%) were treated conservatively. The remaining 25 patients (4%) underwent surgical therapy: 4 were treated with vertebroplasty, 15 with kyphoplasty and 6 patients with posterior stabilization. The mean age was 75.6 years (range: 5098), with the vast majority of patients being female (n = 515). A statistically significant demographic difference (i.e., increase) in fractures was observed between the age groups 6069 and 7079 (p = 0.041). Concerning socioeconomic aspects, statistical analysis showed that the number of sick leaves and the need for professional domestic help was higher in female patients. Concerning treatment costs, statistical analysis did not reveal any significant differences between female and male patients. Conclusion Significant gender differencesto the detriment of the female populationcould be demonstrated within this study. A regrettably low rate of adequate treatment after diagnosis of osteoporosis and its associated fracturesspecifically relating to primary and secondary preventioncould also be identified. To prospectively avoid complications and consequential cost increases, more awareness of the necessity for prevention, early diagnosis and adequate treatment of osteoporosis and its related fractures should be considered.(VLID)486960

Displaced juvenile Tillaux fractures : Surgical treatment and outcome

Background Approximately 15% of all juvenile injuries of the long bones involve the epiphyseal growth plate, and 2.9% of these are juvenile Tillaux fractures. The Tillaux fracture is of great importance because it involves a major weight-bearing articular surface. Treatment protocols in the literature are not uniform for this kind of fracture, and numerous case reports can be found describing various treatment methods. The aim of this study was to present the clinical outcome at long-term follow-up after treatment of displaced Tillaux fractures. Methods In all, 168 children and adolescent patients with physeal injuries of the distal tibia were treated from 2003 to 2012. Seven patients were identified as having Tillaux fractures requiring surgical treatment and therefore were included in our study and evaluated retrospectively. Results Seven patients with Tillaux fractures underwent surgical reconstruction by open or closed reduction. Excellent results were achieved in 90% of the patients, with a mean Foot and Ankle Score at the last follow-up of 98.71. Conclusion Anatomical reduction is required for every displaced epiphyseal fracture via open reduction and internal fixation, especially in cases with 2 mm fragment displacement. Plaster cast immobilization and non-weight-bearing mobilization for at least 4 weeks might be a good way of ensuring optimal surgical results and preventing complications.(VLID)352482

International Orthopaedics / Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

Purpose The purpose of this study was to assess recovery and clinical outcome in patients with primary or secondary radial nerve palsy following humeral shaft fracture. Methods We retrospectively assessed 102 patients (45 female and 57 male) with humeral shaft fracture and concomitant radial nerve palsy, who were followed up for 12 months. Patients were divided into two groups with primary or secondary radial nerve palsy depending on the onset. Muscle function was measured according to Daniels classification and degree of nerve damage was assessed by the Sunderland classification. Results The average time for onset of recovery after primary RNP was 10.53.31 weeks, in the case of secondary RNP it was 8.97.98 weeks (p<0.05). Full recovery or significant improvement was achieved with average of 26.78.86 weeks and 23.96.04 weeks respectively (p<0.05). Trauma mechanism and type of treatment had no significant influence on time of onset of recovery or time to full recovery (p<0.904). Conclusion Secondary RNP shows tendency for earlier recovery and is more commonly associated with ORIF.(VLID)349714

Displaced Neer Type IIB distal-third clavicle fractures\u2014Long-term clinical outcome after plate fixation and additional screw augmentation for coracoclavicular instability

Abstract Background Unstable Neer Type IIB fractures require meticulous surgical treatment. Thus, the aim of this study was to present long-term outcomes after plate fixation and minimally invasive coracoclavicular (CC) stabilization using screw fixation. Methods A consecutive series of patients with unstable Neer Type IIB displaced clavicle fractures, treated by open reduction and internal fixation (ORIF) with a plate and additional screw fixation for coracoclavicular ligament instability, was reviewed in order to determine long-term clinical and radiological outcome. Results Seven patients, six males and one female, with a mean age of 37\u2009\ub1\u20098\ua0years (median: 36\ua0years; range, 28\u201351 years), were evaluated. At latest follow-up, after a mean of 67\ua0months (range, 11\u2013117 months), patients presented with the following mean scores: DASH: 0.57, ASES: 98.81, UCLA: 34.29, VAS: 0.43, Simple Shoulder Test: 11.57. However, two complications were observed: one case of implant loosening and one non-union. There were no differences observed between the CC distances comparing postoperative X-rays to those in final follow-up. In 25% of our patients early postoperative complications occurred. In all patients reoperation was necessary to remove the implanted screw. Conclusion The results of the present study indicate that the treatment of Neer Type IIB lateral clavicle fractures with ORIF using a plate and additional CC screw fixation, leads to satisfying clinical and radiological outcomes in the long-term. However, considering an early postoperative complication rate of 25% and a 100% rate of secondary surgery due to removal of the CC screw does not seem to justify this technique anymore

Associated Pathologies following Luxatio Erecta Humeri: A Retrospective Analysis of 38 Cases

Inferior shoulder dislocation in fixed abduction, also known as luxatio erecta humeri (LEH), is a rare injury with little data available. Therefore, the primary aim of this study was to evaluate and present our case series of this type of injury with special emphasis on associated pathologies; the secondary aim was to present diagnostic recommendations to detect for potential associated pathologies typically seen with this injury. A total of 38 patients (13 females, average age 72.8 years and 25 males, average age 41.4 years), who have been treated for inferior shoulder dislocation between 1992 and 2020, were included in this study. Associated pathologies after LEH were found in 81% of the cases. Twenty-one of these patients presented with secondary bony pathologies. Six patients revealed rotator cuff injuries diagnosed by magnetic resonance imaging (MRI). Seven patients exhibited pathological findings at the capsule-ligament complex. Eight patients presented with neurological findings. All neurologic symptoms except one axillary nerve palsy and a radialis paresis dissolved during the follow-up period. Five patients received surgical treatment of the affected shoulder. Inferior shoulder dislocation is a rare condition presenting with a high number of associated injuries. According to the findings of the present study, we want to raised awareness of the high rate of potential secondary shoulder pathologies associated with LEH. Beside a thorough clinical examination and immediate standard radiographs in two planes, we recommend to perform computed tomography scanning and an MRI of the shoulder as soon as possible. In the case of neurologic deficiencies, a determination of nerve conduction should be performed

Treatment costs.

<p>Average Treatment Costs and gender- differences per patient relating to the type of treatment.</p

Complications.

<p>Distribution of complications.</p

Osteoporotic fractures.

<p>Distribution of patients with osteoporotic fractures.</p

Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years – still an adequate procedure?

Abstract Background The acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring. Methods This study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study. Results The study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 – representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result. Conclusion Summarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure. Level of Evidence: Level IV, retrospective study