The point of view of the clinician: a prospective study of the mechanism of accidents and the morphology of tibial and fibular shaft fractures

Johner, R; Stäubli, H.-U.; Gunst, M; Cordey, J.

doi:10.1016/s0020-1383(00)80031-5

Cited by 22 publications

(14 citation statements)

References 7 publications

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“…This may, however, be explained by the use of only two, relatively similar rotational velocities. The results of our study do compare favourably with the clinical observations of Johner et al, 14 however, who reported steeper fracture angles in 87% of children injured in high velocity incidents.…”

Section: Discussionsupporting

confidence: 90%

Biomechanical investigation into the torsional failure of immature long bone

Theobald

Qureshi

Jones

2012

Journal of Clinical Orthopaedics and Trauma

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a b s t r a c tApproximately 50% of infant and toddler long bone fractures are attributed to nonaccidental trauma; however, differentiating from benign mechanisms is subjective, due to an absence of evidence-based diagnostic tools. Previous studies investigated small ranges of rotational velocities in animal long bone models, although did not report the variation in the spiral fracture angle. This study considered the fracture angle as a potential clinical measure, correlating this data with a wider range of rotational velocities. The spiral fracture angle was measured relative to the long axis, whilst noting the narrowest diaphysial diameter, location of the fracture, and the extent of comminution and periosteal disruption. Twenty-six bones failed in spiral fracture, with the potting material failing in the remaining tests. All spiral fractures centred on the narrowest diaphysial diameter.Slower rotational velocities caused fracture angles approaching 45 , whereas fractures at greater velocities caused fracture angles nearer 30 . A relatively strong trend (R 2 ¼ 0.78) is reported when the normalised fracture angle (against the narrowest diaphysial dimension) was plotted against the rotational rate. A relationship has been identified between the angle of spiral fracture and the rotational velocity using the immature bovine metatarsal model. This trend forms a scientific foundation from which to explore developing a diagnostic, evidence-based tool that may ultimately serve to assist differentiating between accidental and non-accidental injury.

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Section: Discussionsupporting

confidence: 90%

Biomechanical investigation into the torsional failure of immature long bone

Theobald

Qureshi

Jones

2012

Journal of Clinical Orthopaedics and Trauma

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“…In the public sphere, women worked in shops, food establishments, crafts and trades, some of which may have been more physically challenging (e.g., brick makers, olive pickers) than others (e.g., midwives, scribes) (Allison 2007;Flemming 2013;Gardner 1986;Giardina 1993b). Extremity fractures that are indicative of greater forces or higher energy mechanisms include oblique and spiral fractures that are often related to falls or jumps from a height (Johner et al 2000;Petaros et al 2013;Smith et al 2006), as well as transverse fractures, associated with direct blows from other people (interpersonal violence), accidents involving animals, or damage from the use of tools (e.g., mallets, spades, and hoes), equipment (e.g., carts, ploughs), and construction materials (e.g., heavy wooden beams or stones) (Sölveborn 2007). …”

mentioning

confidence: 99%

Gendered Differences in Accidental Trauma to Upper and Lower Limb Bones at Aquincum, Roman Hungary

Gilmour

Gowland

Roberts

et al. 2015

International Journal of Paleopathology

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Additional information:Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. AbstractIt is hypothesized that men and women living in the border provinces of the Roman Empire may have encountered different physical dangers associated with variation in their occupations and activities. Limb bone trauma data were used to assess sex-based differences in physical hazards and evidence for fracture healing and treatment. Two hundred and ten skeletons were examined from a late 1 st to early 4 th century AD cemetery at Aquincum (Budapest, Hungary). Upper and lower limb bone fracture types, frequencies, distributions, and associated complications were recorded, and gendered patterns in injury risks were explored. Of the 23 fractures identified, both sexes had injuries indicative of falls; males exhibited the only injuries suggestive of higherenergy and more direct forces. Most fractures were well-healed with few complications. The extremity trauma at Aquincum suggests that people buried here experienced less hazardous physical activities than at other Roman provincial sites. The patterns of trauma indicate that "traditional" gender roles were in place, whereby male civilians participated in more physically dangerous activities than females. Additionally, treatment may have been equally accessible to men and women, but certain fracture types proved more challenging to reduce using the techniques available.

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“…Çalışmamızda da 22 hastanın yaş ortalaması 33 yıl olarak bulunmuştur. Yapılan çalışmalarda; tibia cisim kırıklarının oluşumunda % 37.5-46.4 oran ile başlıca sorumlu etkenin trafik kazaları olduğu bildirilmektedir [9]. Bizim serimizde de trafik kazaları % 45.5 ile ilk sırayı almıştır.…”

Section: Discussionunclassified

Results in the Treatment of Tibial Diaphyseal Fractures with Expandable Intramedullary Nails

Serbest¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Tibia şaft kırıklarında genişleyebilir intramedüller çivilerin klinik kullanımı, etkinliği ve kısa dönem sonuçları araştırıldı. Gereç ve Yöntem: Tibia şaft kırığı olan 22 hasta (9 kadın, 13 erkek; ort. yaş 33; dağılım 21-65) çalışmaya alındı. Tüm hastalarda kapalı kırık vardı. Tüm hastalarda genişleyebilir intramedüller çiviyle internal tespit uygulandı. Kırık oluşumundan ameliyata kadar geçen süre ortalama 2,5 gün (dağılım 12 saat-5 gün) idi. Sonuçlar JohnerWrush ve Kalstrom-Olerud ölçütlerine göre değerlendirildi. Hastalar ortalama 10 ay (dağılım 7-21) izlendi. Bulgular: Tüm olgularda kaynama sağlandı. Tibia kırıklı hastalarda ameliyat süresi ortalaması 45 dakika (25-80 dakika); kaynama süresi ortalaması 10 hafta (7-21 hafta) bulundu. Johner-Wrush kriterlerine göre 14 hastada (% 63,6) mükemmel, 7 hastada (% 31.8) iyi sonuç, bir hastada (% 4.5) orta sonuç elde edildi. Kalstrom-Olerud ölçütlerine göre 17 hastada (% 77.2) mükemmel, 5 hastada (% 22.7) iyi sonuç alındı. Gecikmiş kaynama, erken veya geç enfeksiyon, kompartman sendromu gibi komplikasyonlar görülmedi. Tartışma: Sonuçlarımız, şişirilebilir intramedüller çivilerin tibia kırıklarının tedavisinde hızlı, basit ve etkili bir çözüm sağlayan, klasik çivilere alternatif bir yöntem olduğunu göstermektedir. Anahtar KelimelerTibia Diafiz Kırıkları; İntramedüller Çivileme; Şişirilebilir Çivi Abstract Aim: We investigated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of tibia shaft fractures. Material and Method: The study included 22 patients (9 females, 13 males; mean age 33 years; range 21 to 65 years) who were treated with expandable intramedullary nails for the tibia shaft fractures. All patients had tibial fractures, all of which were closed. The mean duration from injury to surgery was 2,5 days (range 12 hours to 5 days). The results were evaluated using the Johner-Wrush and Kalstrom-Olerud criteria. The mean follow-up was 10 months (range 7 to 21). Results: Union was achieved in all the patients. In tibial fractures, the mean operation time was 45 minutes (range 25 to 80 min) and the mean time to union was 10 weeks (range 7 to 21 weeks). Results in 14 patients (63.6 %) were excellent, in 7 patients (31.8 %) good and in 1 patient (4.5 %) moderate according to Johner-Wrush criteria. Results in 17 patients (77.2 %) were excellent, in 5 patients (22.7 %) good according to Kalstrom-Olerud criteria. No complications were seen such as delayed union, early or late infections, compartment syndrome. Discussion: In conclusion, the good results of this study show that the expandable tibial intramedullary nail provides a successful option to classical intramedullary nails.

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The point of view of the clinician: a prospective study of the mechanism of accidents and the morphology of tibial and fibular shaft fractures

Cited by 22 publications

References 7 publications

Biomechanical investigation into the torsional failure of immature long bone

Biomechanical investigation into the torsional failure of immature long bone

Gendered Differences in Accidental Trauma to Upper and Lower Limb Bones at Aquincum, Roman Hungary

Results in the Treatment of Tibial Diaphyseal Fractures with Expandable Intramedullary Nails

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