BACKGROUND & AIMS: OBJECTIVE:To identify and review early complications in the operative treatment of patella fractures. DESIGN:Retrospective review. SETTING:Single tertiary care institution with multiple surgeons, including generalists and fellowship trained subspecialists. PATIENTS:A consecutive series of eighty-seven patella fractures over a five year period was reviewed. Patients treated nonoperatively or with partial or total patellectomy were excluded. Minimum follow-up to fracture healing (four months) was available in fifty-one fractures. INTERVENTION:Modified tension band wire fixation was used in forty-nine fractures, whereas two fractures were treated with tension band wires threaded through cannulated screws. OUTCOME MEASURES:Early complications such as loss of reduction or fixation, infection, or soft-tissue problems were evaluated. RESULTS:Displacement of > or = 2 mm before healing was noted in eleven fractures. The displacement could be attributed to technical errors in five cases, and to patient noncompliance with postoperative activity restrictions in another five cases. Two cases of superficial infection were documented. Nine patients with symptomatic hardware required hardware removal. CONCLUSIONS:Twenty-two percent of fractures treated with tension band wiring and early motion displaced > or = 2 mm within the early postoperative period. Technical errors or patient noncompliance were identified as factors. The incidence of early complications in operatively treated patella fractures is higher than previously reported.

背景与目标： 目的：确定并回顾early骨骨折手术治疗的早期并发症。
设计：回顾性审查。
地点：拥有多名外科医生的单一三级护理机构，包括通才和经过研究金培训的专科医师。
患者：回顾了五年内连续发生的87例骨骨折。排除非手术治疗或部分或全部pa骨切除术的患者。对五十一个骨折进行了最少的骨折愈合随访（四个月）。
干预：改良的张力带钢丝固定术用于49处骨折，而两处骨折则用穿过空心螺钉的张力带钢丝治疗。
观察指标：评估早期并发症，如复位或固定丢失，感染或软组织问题。
结果：在11处骨折中发现愈合前位移>或= 2 mm。该移位可归因于五例病例中的技术错误，以及另外五例归因于患者不遵守术后活动限制的情况。记录了两例浅表感染病例。九名有症状硬件的患者需要移除硬件。
结论：在术后早期，有22％的骨折采用张力带布线和早期运动移位≥2 mm进行治疗。技术错误或患者违规被确定为因素。经手术治疗的骨骨折早期并发症的发生率高于以前的报道。

BACKGROUND & AIMS: STUDY DESIGN:Computed tomography aided evaluation of spinal decompression by ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. OBJECTIVES:To determine the necessity of spinal canal widening by ultrasound-guided fracture repositioning for fractures with and without neurologic deficit. SUMMARY OF BACKGROUND DATA:Ultrasound-guided spinal fracture repositioning is an alternative new approach. Reports have varied concerning ligamentotaxis and remodeling. METHODS:Computed tomography aided planimetry of the spinal canal (64 consecutive burst fractures) and neurologic evaluation by Frankel grades. RESULTS:Ultrasound-guided spinal fracture repositioning (n = 37) reduced the stenosis of the spinal canal area from 45% before surgery to 20% after surgery of the estimated original area. Fifteen patients had a primary neurologic deficit, which improved markedly in 11 cases after treatment. Patients with neurologic symptoms had a greater preoperative spinal stenosis than those without. No correlation was seen between the degree of pretreatment spinal stenosis, fracture type, and severity of the neurologic deficit. Ligamentotaxis (n = 27) reduced the stenosis from 30% before surgery to 18% after surgery and remodeling (n = 11) from 25% after surgery to 13% after metal removal. CONCLUSION:Ultrasound-guided fracture repositioning is an efficient method for spinal canal decompression of burst fractures with neurologic symptoms. The marked degree of widening of the spinal canal due to the effects of ligamentotaxis and remodeling may render the reposition of retropulsed fragments unnecessary in cases of fractures without a neurologic deficit.

背景与目标： 研究设计：计算机断层扫描技术可通过超声引导下的胸腰椎爆裂性骨折复位，韧带切开和重塑来评估脊柱减压。
目的：通过超声引导下的骨折再定位术来确定有无神经功能缺损的骨折是否需要加宽椎管。
背景数据摘要：超声引导下的脊柱骨折复位术是另一种新方法。关于韧带趋化和重塑的报道多种多样。
方法：计算机断层扫描辅助椎管平面测量（64例连续爆裂性骨折）并通过Frankel等级进行神经系统评估。
结果：超声引导下的脊柱骨折复位术（n = 37）将椎管面积的狭窄程度从手术前的45％降低到手术后估计的原始面积的20％。 15例有原发性神经功能缺损，治疗后11例明显改善。具有神经系统症状的患者比没有神经系统症状的患者具有更大的术前椎管狭窄。在治疗前的椎管狭窄程度，骨折类型和神经功能缺损的严重程度之间没有相关性。韧带切开术（n = 27）将狭窄从手术前的30％减少到手术后的18％，重塑（n = 11）从手术后的25％减少到金属去除后的13％。
结论：超声引导下骨折复位术是一种有效的方法，可用于治疗具有神经系统症状的爆裂性骨折的椎管减压术。由于韧带趋化和重塑的影响，椎管的明显增宽程度可能使无神经功能缺损的骨折患者无需重新放置后退段。

BACKGROUND & AIMS: BACKGROUND:Trabecular bone strength diminishes as a result of osteoporosis and altered biomechanical loading at the vertebral and spinal levels. The spine consists of the anterior, middle and posterior columns and the load supported by the anterior and middle columns will differ across different regions of the spine. Stress shielding of the anterior column can contribute to bone loss and increase the risk of wedge fracture. There is a lack of quantitative data related to regional spinal bone mineral density distribution over time. We hypothesize that there is an increase in the posterior-to-anterior vertebral body bone mineral density ratio and a decrease in whole-body bone mineral density over time. METHODS:Bone mineral density was measured in 33 subjects using quantitative computed tomography scans for L1-L3 vertebrae, region (anterior and posterior vertebral body), and time (baseline and 6 years after). FINDINGS:Lumbar bone mineral density decreased significantly (Δ: ~15%) from baseline to the 6th year visit. Individual vertebra differences over time (L1: ~14%, L2: ~14%, L3: ~17%) showed statistical significance. Anterior bone mineral density change was significantly greater than in the posterior vertebral body region (Δ anterior: ~18%; Δ posterior: ~13%). Posterior-to-anterior bone mineral density ratio was significantly greater in the 6th year compared to baseline values (mean (SD), 1.33 (0.2) vs. 1.23 (0.1)). INTERPRETATION:This study provides longitudinal quantitative measurement of bone mineral density in vertebrae as well as regional changes in the anterior and posterior regions. Understanding bone mineral density distribution over time may help to decrease the risk of wedge fractures if interventions can be developed to bring spine loading to its normal state.

背景与目标： 背景：由于骨质疏松症以及椎体和脊柱水平的生物力学负荷改变，小梁的骨强度降低。脊柱由前，中和后柱组成，由前柱和中柱支撑的载荷在脊柱的不同区域会有所不同。前柱的应力屏蔽可能会导致骨质流失并增加楔形骨折的风险。缺乏与区域脊柱骨矿物质密度随时间分布有关的定量数据。我们假设随着时间的推移，椎体前后骨矿物质密度比增加，而全身骨矿物质密度降低。
方法：采用定量计算机断层扫描技术对33名受试者的L1-L3椎骨，区域（椎体的前后）和时间（基线及术后6年）进行了骨矿物质密度测量。
结果：从基线到第6年随访，腰椎骨矿物质密度显着降低（Δ：〜15％）。随时间变化的各个椎骨差异（L1：〜14％，L2：〜14％，L3：〜17％）显示出统计学意义。前骨矿物质密度变化显着大于后椎体区域（Δ前：〜18％；Δ后：〜13％）。与基线值相比，第6年的前后骨矿物质密度比显着更高（平均值（SD）为1.33（0.2）对1.23（0.1））。
解释：这项研究提供了纵向定量测量椎骨中骨矿物质密度以及前后区域的变化的信息。如果可以采取干预措施使脊柱负荷恢复到正常状态，那么了解随着时间推移的骨矿物质密度分布可能有助于降低楔形骨折的风险。

BACKGROUND & AIMS: BACKGROUND:in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. OBJECTIVE:the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. METHODS:this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. RESULTS:at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. CONCLUSION:the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.

背景与目标： 背景：在男性中，同时使用两种或多种苯二氮杂类或两种或多种抗精神病药会增加骨折的风险。尚未研究同时使用药物与中枢神经系统作用与骨折风险之间的潜在关联。
目的：目的是描述在65岁或65岁以上人群中因单独使用阿片类药物，抗癫痫药或抗胆碱能药物引起的骨折的性别特异性风险；或同时使用；或或将其中一种与精神药物同时使用。
方法：本研究是在芬兰利托进行的一项基于人群的前瞻性研究的一部分。放射学报告证实了有关1,177名受试者（482名男性和695名女性）骨折的信息。
结果：在随访的3年中，同时使用阿片类药物和抗精神病药会增加男性骨折的风险。在6年的随访期间，阿片类药物与苯二氮卓类药物同时使用也与男性骨折风险有关。没有发现与女性的显着关联。
结论：阿片类药物与抗精神病药或苯二氮卓类药物同时使用可能会增加65岁以上男性骨折的风险。

BACKGROUND & AIMS: BACKGROUND:The lives of persons who use illicit substances are filled with physical adversities and negative outcomes. OBJECTIVES:The purpose of this study was to determine: 1) the frequency of substance-related fights, fractures, and driving accidents in the past year among heroin users entering an inpatient detoxification program, and 2) to determine demographic and recent substance use factors associated with the most common of these physical traumas. METHODS:Between May 2015 and December 2015, we surveyed 433 persons entering a short-term inpatient detoxification program that reported heroin use in the last month and recorded their experiences of physical traumas in the last year. RESULTS:Among participants (72% male; 74% heroin injectors), more than a quarter (28.6%) reported a substance-related fight in the past year. Multivariate modeling revealed cocaine use, hazardous alcohol use, and younger age were significantly associated with fighting, but gender was not. Forty-five (10.4%) persons reported a fracture in the past year, with 64% of fractures related to a substance-related fall or fight. Additionally, 9.0% reported being a driver in a car accident after drinking or using drugs in the past year. Trauma rates were not significantly different from a contemporaneous cohort seeking alcohol detoxification at the same facility. CONCLUSION:Heroin users, both men and women, lead physically traumatic lives, interrupted by interpersonal violence, falls, fractures, and motor vehicle accidents.

背景与目标： 背景：使用非法药物的人的生活充满了身体上的逆境和负面结果。
目的：本研究的目的是确定：1​​）参加住院排毒计划的海洛因使用者在过去一年中与药物有关的打架，骨折和驾驶事故的频率，以及2）确定人口统计资料和近期的药物使用因素与这些身体创伤中最常见的疾病相关。
方法：2015年5月至2015年12月，我们调查了433名进入短期住院排毒计划的人，他们报告了最近一个月的海洛因使用情况，并记录了他们去年的身体创伤经历。
结果：在过去的一年中，参与者中（72％的男性； 74％的海洛因注射器）中有超过四分之一（28.6％）的人报告了与毒品有关的斗争。多变量建模显示，可卡因的使用，有害酒精的使用以及年龄的降低与打架有显着联系，而性别却没有。在过去的一年中，有四十五（10.4％）人报告了骨折，其中64％的骨折与物质相关的摔倒或打架有关。此外，在过去一年中，有9.0％的人报告是在喝酒或吸毒后发生车祸的驾驶员。创伤率与同期在同一机构寻求戒毒的队列没有显着差异。
结论：无论是男性还是女性，使用海洛因的人都遭受身体创伤，被人际暴力，跌倒，骨折和机动车事故打断。

BACKGROUND & AIMS: :Fractures of the posterior wall are the most common of the acetabular fractures. The aim of this study was to assess the medium-term results of reconstruction of comminuted posterior wall fractures of the acetabulum by using the buttress technique. This is a retrospective review conducted at a level 1 trauma centre. Thirty-two patients (25 men, 7 women, mean age 41 years, range 14-80 years) with comminuted posterior wall fracture of the acetabulum underwent reconstruction of the posterior wall during the period of July 1998 to February 2004. The average follow-up was 43 months (range 24-70 months). Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Radiographic evaluation was according to criteria developed by Matta. The postoperative reduction was graded as anatomical in 28 patients (88%) and imperfect in 4 patients (12%). The clinical outcome was excellent in 11 (34% ), very good in 9 (28%), good in 4 (12%), fair in 3 (9%) and poor in 5 (15%). Radiological grading at the final follow-up was excellent 12 (37%), good 11 (34%), fair 4 (12%) and poor 5 (15%). Reconstruction of comminuted posterior wall acetabular fractures by buttress technique can be expected to produce good results. It can provide a stable fixation of the posterior wall amenable to early range of motion and weight bearing.

背景与目标： ：后壁骨折是最常见的髋臼骨折。这项研究的目的是评估通过使用支撑技术重建髋臼粉碎性后壁骨折的中期结果。这是在1级创伤中心进行的回顾性审查。 1998年7月至2004年2月，对髋臼粉碎性后壁骨折的32例患者（25例男性，7例女性，平均年龄41岁，范围14-80岁）进行了后壁重建。平均随访如下：延长了43个月（范围为24-70个月）。临床评估基于改良的Merle d'Aubigne和Postel评分。射线照相评估是根据Matta制定的标准进行的。术后减少的程度在解剖学上分为28例（88％），在不完善中有4例（12％）。临床预后良好，其中11例（34％），非常好9例（28％），好4例（12％），一般3例（9％），差5例（15％）。最后一次随访的放射学评分为优12分（37％），好11分（34％），中4分（12％）和差5分（15％）。通过支撑技术重建粉碎性后壁髋臼骨折有望产生良好的效果。它可以为后壁提供稳定的固定，以适应早期运动和负重。

BACKGROUND & AIMS: BACKGROUND:Complex and longstanding bone disease superimposed by harmful influences of immunosuppression is the reason for increased risk of bone fracture in kidney transplant recipients. The aim of our study was to analyze the incidence and prevalence of nonvertebral bone fractures and early (in the first post-transplant year) clinical and laboratory risk factors for suffering bone fracture in the long-term post-transplant period. METHODS:Clinical and laboratory data as well as bone mineral density (BMD) measurements of 507 first kidney transplant recipients who were transplanted in the period from 1976 to 2011 were analyzed. RESULTS:The mean age of included patients was 54.3 ± 12.0 years, there were 45% females, and mean time on renal replacement treatment prior to transplantation was 63.4 ± 43.6 months. The average observation time post-transplant was 9.7 years (1.4 - 36.3 years). Post-transplant, 64 (12.6%) patients suffered 89 nonvertebral fractures (44 patients suffered 1 fracture, 15 patients 2 fractures, and 5 patients 3 fractures). Patients with fractures had significantly lower late BMD of femoral neck in the period of 1 - 10 years post-transplant, had osteopenia and osteoporosis more frequently in the same time period, and higher serum alkaline phosphatase in the first year post-transplant. 13 patients (13/64, 20.3%) had major fractures. Patients with major fractures were significantly older than patients with no major fractures and had lower serum albumin. Frequency of treatment with bisphosphonate, calcium, or phosphate did not differ between the groups. Vitamin D supplement (active form in 98% of cases) was prescribed more frequently in the group without fractures, but this was not statistically significant. CONCLUSION:Fracture rate in our transplant patient population was comparable to that reported in the literature. Except for a higher level of serum total alkaline phosphatase in the fracture group, we found no other early laboratory risk factors for bone fractures. BMD at the femoral region 1 - 10 years after kidney transplantation but not BMD at the time of transplantation was a risk factor for nonvertebral fractures. Osteopenia and osteoporosis in the post-transplant period were found to be a fracture risk factor.
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背景与目标： 背景：复杂且长期存在的骨病，加上免疫抑制的有害影响，是肾移植受者发生骨折风险增加的原因。我们的研究目的是分析非椎骨骨折的发生率和患病率，以及早期（在移植后的第一年）临床和实验室在长期移植后遭受骨折的危险因素。
方法：分析了1976年至2011年间移植的507名首批肾移植受者的临床和实验室数据以及骨矿物质密度（BMD）。
结果：纳入患者的平均年龄为54.3±12.0岁，女性为45％，移植前接受肾脏替代治疗的平均时间为63.4±43.6个月。移植后的平均观察时间为9.7年（1.4-36.3年）。移植后，有64例（12.6％）患者发生了89例非椎骨骨折（44例患者发生了1例骨折，15例患者发生了2例骨折，5例患者发生了3例骨折）。骨折患者在移植后1-10年内股骨颈的晚期BMD明显降低，在同一时期内骨质疏松症和骨质疏松症的发生频率更高，并且在移植后第一年的血清碱性磷酸酶升高。重度骨折13例（13/64，20.3％）。严重骨折的患者明显比没有严重骨折的患者大，血清白蛋白较低。两组之间用双膦酸盐，钙或磷酸盐治疗的频率没有差异。在无骨折的人群中，更频繁地开具维生素D补充剂（98％的病例为活性形式），但这在统计学上没有统计学意义。
结论：我们移植患者的骨折率与文献报道的相当。除了骨折组中血清总碱性磷酸酶水平升高外，我们没有发现其他早期实验室危险因素导致骨折。肾移植后1-10年，股骨区域的BMD而非移植时的BMD是非椎骨骨折的危险因素。发现移植后骨质减少和骨质疏松是骨折的危险因素。 。

BACKGROUND & AIMS: OBJECTIVES:To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS:Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS:The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS:The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series. OBJETIVOS:Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS:Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS:O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES:A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

背景与目标： 目的：评价通过软骨下筏螺钉结合锁定板治疗的Schatzker II型骨折的功能和影像学结果。
方法：2010年至2014年间，共有24例患者参加了这项研究。关节窝凹陷处抬高，缺损处充满了同种异体移植物。接下来，将两个或三个软骨下螺钉与锁定板组合放置。在最后一次随访中，记录了临床和放射学数据。
结果：平均随访期为21.4个月（12-39）。膝关节社会评分（KSS）和拉斯穆森临床平均评分分别为91.5（77-100）和16.75（14-18）。随访期间，拉斯穆森平均放射学评分为27.9（范围为24-30）。在机械侧，胫骨近端内侧角和胫骨倾斜度方面，受伤侧和非受伤侧之间没有统计学上的显着差异。此外，尽管随访时间很短，但关节炎在未受伤的一侧没有表现出差异。
结论：关节周围的筏结构与锁定板相结合，可帮助外科医生保持手术过程中获得的关节解剖线和机械轴。尽管功能性结果令人满意，但继发性关节炎似乎是胫骨平台骨折后的主要并发症。
证据级别IV，案例系列。

客体：Avaliar os resultados funcionais eradiológicosdas fraturas de Schatzker tipo II tratadas com parafusos de plataformaemconinaçãocom placas de trava。
MÉTODOS：2010年至2014年年度个人资格评选。linha关节deprimida foi elevada e defeito foi preenchido com aloenxerto。这是一种非常诱人的功能，它既可用于组合旅行，也可以用于组合旅行。没有últimoacompanhamento，foram registrados os dadosclínicoseradiológicos。
结果：21,4阶（12-39）。膝关节社会评分（KSS）和Rasmussenclínicosde rasmussen成绩分别为91,5（faixa，77-100）和16,75（faixa，14-18）。第27,9页（faixa，24-30）的durante o acompanhamento无线电广播。 Néohouvediferençaestatisticamente entre o entre o lado comlesãoe semlesão，comelaçãoa eixomecânico，aoângulo位于胫骨近端。 Alémdisso，一位艺术专家，他正在做某事。
结论：一种平台性的结缔组织周围的结合，伴有脉络性的肛门闭塞性脉络膜性闭塞性脉络膜炎。胫腓骨肌萎缩症的重要并发症。
塞维利亚·德卡索斯（NéveldeEvidênciaIV）。

BACKGROUND & AIMS: :Fractures are the most serious consequence of osteoporosis. Non-vertebral and non-hip fractures are seldom recognised as important, even though they account for the majority of all fractures. The most prevalent localisations are distal radius, proximal humerus, ribs, clavicle, and the pelvis. According to the results from large phase III clinical trials for placebo groups, their incidence ranges from 4.9 % to 12.0 %. Hospital morbidity data in Croatia in 2006 show that peripheral non-hip fractures ranked among the leading fifteen injuries, accounting for 23.7 % of all injuries in patients aged 60 years and above. Risk factors for non-hip and non-vertebral fractures are similar to other osteoporotic fractures, and the main are low bone mineral density and earlier fractures. Quality of life is considerably affected by these fractures, and medical costs are very high, soaring as high as 36.9% of all national medical costs in the USA. Non-vertebral non-hip fractures need more attention, which was also recognised by the European regulatory bodies that approve use of anti-osteoporotic drugs.

背景与目标： ：骨折是骨质疏松症最严重的后果。尽管非椎骨和非髋骨骨折占所有骨折的大部分，但很少被认为是重要的。最普遍的定位是radius骨远端，肱骨近端，肋骨，锁骨和骨盆。根据安慰剂组大型III期临床试验的结果，其发生率在4.9％至12.0％之间。 2006年克罗地亚的医院发病率数据显示，周围的非髋关节骨折在前15名患者中排名最高，占60岁及60岁以上患者受伤总数的23.7％。非髋关节和非椎骨骨折的危险因素与其他骨质疏松性骨折相似，主要是骨密度低和早期骨折。这些骨折严重影响了生活质量，医疗费用很高，高达美国所有国家医疗费用的36.9％。非椎骨非髋关节骨折需要引起更多关注，欧洲监管机构也认可使用抗骨质疏松药物。

BACKGROUND & AIMS: :A new proximal humerus nail (Sirus) for the treatment of proximal humerus fractures has become available. This paper presents the clinical and radiological outcome of the first collective study of 36 patients. Evaluation was performed prospectively. An antero-acromial approach was used for all patients. Three fixed-angle screws were inserted in a locking technique. Thirty-six fractures were fixed with the Sirus nail. These were dislocated 2- and 3-part fractures as described by Neer (J Bone Joint Surg 52:1077-1089). Outcomes were evaluated using the Constant score. Of the 36 patients evaluated 23 had sustained a 2-part fracture and 13 a 3-part fracture. The average age at surgery was 71.2 years (range, 30-93). In 75% of the cases, good to very good outcomes were achieved. Outcomes were satisfactory in 13.8% of the cases. Twenty-five fractures were treated in a closed technique. Average operating time was 41 minutes (range, 19-106) with a fluoroscopy time of 0.6 minutes (range, 0.4-2.6). Secondary fragment dislocation occurred in two cases. After 12.1 months the average Constant score was 79.2 (range, 46-100). Initial clinical experience with the Sirus nail indicates that the procedure is straightforward and has a low complication rate. Functional outcomes are predominantly good to very good. Large fragments of the greater tuberosity and 4-part fractures are beyond the scope of this application.

背景与目标： ：一种用于治疗肱骨近端骨折的新型肱骨近端钉（Sirus）已面市。本文介绍了首次对36例患者进行集体研究的临床和影像学结果。评估是前瞻性进行的。所有患者均采用前房顶入路。在锁定技术中插入了三个固定角度的螺钉。用Sirus钉固定了36处骨折。如Neer（J Bone Joint Surg 52：1077-1089）所述，这些骨折分为两部分和三部分骨折。使用恒定评分评估结果。在评估的36位患者中，有23位发生了2部分骨折，而13位发生了3部分骨折。手术的平均年龄为71.2岁（范围30-93）。在75％的情况下，取得了很好到非常好的结果。在13.8％的病例中，结果令人满意。采用封闭技术治疗了25处骨折。平均操作时间为41分钟（范围19-106），透视时间为0.6分钟（范围0.4-2.6）。继发性碎片脱位发生在两个案例中。在12.1个月之后，平均Constant得分为79.2（范围46-100）。 Sirus指甲的初步临床经验表明该过程简单易行，并发症发生率低。功能结果主要是良好至非常好。较大的结节和四部分裂缝的大碎片超出了本申请的范围。

BACKGROUND & AIMS: :The demographic development will result in an increase of up to 30 % of distal radius fractures. There are various therapy options but what is new? Conservative therapy: conservative therapy is reserved for stable fractures only. Osteosynthesis by K-wires: due to low biomechanical stability in older patients, insufficient functional and radiological results were achieved. External fixator: external fixators are used in compound and complex fractures and show better results than K-wire osteosynthesis. Angular stable plate osteosynthesis: with angular stable plates it is possible to achieve good results with complex fractures and they are currently the method of choice. Intramedullary osteosynthesis: intramedullary nails result in a faster functional improvement than angular stable plates but have limitations. New is that 90% of osteoporotic distal radial fractures are treated with angular stable plates which have shown good results in single study groups.

背景与目标： 人口统计学的发展将导致distal骨远端骨折增加多达30％。有多种治疗选择，但有什么新功能？保守疗法：保守疗法仅适用于稳定的骨折。通过K线进行骨合成：由于老年患者的生物力学稳定性低，因此无法获得足够的功能和放射学结果。外固定器：外固定器用于复合型和复杂型骨折中，其效果比K线骨固定术更好。角稳定板的骨合成：利用角稳定板可以对复杂的骨折取得良好的效果，目前是首选方法。髓内接骨术：髓内钉的功能改善比角稳定板快，但有局限性。新的特点是使用角稳定钢板治疗90％的骨质疏松性远端radial骨骨折，在单个研究组中已显示出良好的效果。

BACKGROUND & AIMS: OBJECTIVES:To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time. DESIGN:Retrospective review. SETTING:Urban academic trauma center. PATIENTS: STUDY GROUP:54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005. INTERVENTION:Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990). MAIN OUTCOME MEASUREMENTS:Mortality rates. RESULTS:We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures. CONCLUSIONS:Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles. LEVEL OF EVIDENCE:Prognostic level III. See instructions for authors for a complete description of levels of evidence.

背景与目标： 目的：确定先前报道的与双侧股骨骨折相关的高死亡率是否随时间降低。
设计：回顾性审查。
单位：城市学术创伤中心。
耐心：
研究小组：2000年至2006年，我们中心对54例成年人的双侧股骨骨折进行了治疗。最初对108例骨折进行了外固定（11％），顺行扩钉（23％）和逆行扩钉（67％）。单侧对照组：2002年至2005年在我中心接受治疗的461例单侧股骨骨折患者。
干预：单变量分析将我们的结果与大约15年前（研究期，1984-1990年）同一中心的已发表历史对照组的结果进行了比较。
主要观察指标：死亡率。
结果：我们注意到当前与双侧股骨骨折相关的死亡率与历史对照组之间存在显着差异。在我们中心，双侧（26％-7％，P = 0.002）和单侧（12％-2％，P = 0.0001）骨折的死亡率均随时间降低。双侧（7％）的死亡率仍显着高于单侧（2％）的骨折（P = 0.037）。
结论：与15年前同一中心报道的数据相比，双侧和单侧股骨骨折的死亡率和严重程度评分降低。改善的结局可能部分与患者的复苏，分诊，重症监护和整形外科治疗有关。但是，考虑到伤害严重性评分也显着降低，可能是由于伤害模式的改变而导致的改善，这可能是机动车安全性得到改善之后的结果。
证据级别：预后等级III。有关证据水平的完整说明，请参见作者说明。

BACKGROUND & AIMS: :Isolated subcortical trabecular bone injury (bone bruise) has rarely been described. Our purpose is to report a series of patients who had a history of traumatic injury, knee effusion, normal radiographs, and initial equivocal physical examination for ligament and meniscal integrity, and who were found to have isolated injury of the trabecular bone on magnetic resonance imaging. We evaluated demographic data, physical examination findings, radiographs, magnetic resonance imaging, and clinical outcome for 23 patients. Follow-up data included time to return to preinjury activity level, International Knee Documentation Committee activity level rating before and after injury, and postinjury Lysholm scores. All magnetic resonance imaging scans were negative for associated grade III meniscal lesions and ligament injury. Time to return to preinjury activity level was under 7 months in 96% of the patients. Postinjury International Knee Documentation Committee rating was unchanged in 91% of patients. Postinjury Lysholm score was 90 or more in 91% of patients. We propose that the recognition of these injuries is important because magnetic resonance imaging can distinguish them from meniscal or ligament injury requiring surgical intervention (arthroscopy). If detected on magnetic resonance imaging as an isolated injury, surgical arthroscopy is unnecessary since these patients can be expected to recover well in the short term with restricted weightbearing and initial activity modification.

背景与目标： ：很少描述皮质下小梁下骨损伤（骨挫伤）。我们的目的是报告一系列有外伤史，膝关节积液，X线片正常，对韧带和半月板完整性进行初步模棱两可的身体检查，并在磁共振成像中发现小梁骨孤立性损伤的患者。 。我们评估了23例患者的人口统计学数据，体格检查结果，X线照片，磁共振成像和临床结局。随访数据包括恢复伤前活动水平的时间，受伤前后国际膝关节委员会的活动水平评分以及伤后Lysholm评分。所有相关的III级半月板病变和韧带损伤的磁共振成像扫描均为阴性。 96％的患者恢复到损伤前活动水平的时间不到7个月。受伤后国际膝关节文献委员会的评分在91％的患者中没有变化。 91％的患者受伤后Lysholm评分为90分或更高。我们建议识别这些损伤很重要，因为磁共振成像可以将它们与需要手术干预（关节镜）的半月板或韧带损伤区分开。如果在磁共振成像中检测为孤立的损伤，则无需进行关节镜检查，因为可以预期这些患者短期内恢复良好，并且负重和初始活动受到限制。

BACKGROUND & AIMS: :There are at least three distinct fracture patterns that occur in the proximal fifth metatarsal: tuberosity avulsion fractures, acute Jones fractures, and diaphyseal stress fractures. Each of these fracture patterns has its own mechanism of injury, location, treatment options, and prognosis regarding delayed union and nonunion. Tuberosity avulsion fractures are the most common in this region of the foot. The majority heal with symptomatic care in a hard-soled shoe. The true Jones fracture is an acute injury involving the fourth-fifth intermetatarsal facet. These injuries are best treated with non-weight-bearing cast immobilization for 6 to 8 weeks. The rate of successful union with this treatment has been reported to be between 72% and 93%. For the high-performance athlete with an acute Jones fracture, early intramedullary-screw fixation is an accepted treatment option. Nonacute diaphyseal stress fractures of the proximal fifth metatarsal and Jones fractures that develop into delayed unions and nonunions can both be managed with operative fixation with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting. Early results with the use of electrical stimulation are promising; however, prospective studies are needed to better define the role of this modality in managing these injuries.

背景与目标： ：在fifth骨近端至少发生三种不同的骨折类型：结节撕脱性骨折，急性琼斯骨折和骨干应力骨折。这些骨折类型中的每一种都有其自身的损伤机制，部位，治疗选择以及关于延迟愈合和不愈合的预后。结节撕脱性骨折最常见于脚部区域。大部分人在对鞋硬底的情况下对症治疗。真正的琼斯骨折是涉及第四至第五间间小平面的急性损伤。这些损伤最好用非承重石膏固定器治疗6至8周。据报道，采用这种治疗方法的成功结合率在72％至93％之间。对于具有急性琼斯骨折的高性能运动员，早期的髓内螺钉内固定是一种可以接受的治疗选择。近端第五meta骨的非急性干phy端应力性骨折和发展为延迟性联合和骨不连的琼斯骨折都可以通过闭合性轴向髓内螺钉内固定或自体皮质突状骨移植术进行手术固定。使用电刺激的早期结果很有希望；但是，需要进行前瞻性研究，以更好地定义这种方式在管理这些伤害中的作用。

BACKGROUND & AIMS: To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

背景与目标： 为了评估预防骨质疏松症的干预措施的成本效益，有必要估算用于治疗骨质疏松性骨折的总医疗保健支出。可以使用相关的诊断代码从辅助数据库中估计用于治疗许多疾病的资源，但是这些代码并未表明哪些骨折本质上是骨质疏松的。因此，召集了一个专家小组，根据患者的年龄，性别和种族，判断不同类型的骨折可能与骨质疏松症有关的可能性。采用三轮Delphi程序来估计与骨质疏松症相关的骨折比例（即骨质疏松症的归因概率）在72种类别中划分，该类别由四种特定的骨折类型（髋部，脊柱，前臂，所有其他部位组合）组成，按年龄划分为三个年龄层组（45-64岁，65-84岁，85岁及以上），三个种族组（白人，黑人，所有其他种族）和男女（女性，男性）。据估计，在老年白人妇女中，至少有90％的所有髋部和脊柱骨折应归因于骨质疏松症。其他骨折的比例要小得多，归因于骨质疏松症。不论骨折类型如何，男性的归因概率均低于女性，非白人的归因概率通常低于白人。这些概率将用于估算与美国骨质疏松症相关的骨折相关的直接医疗总费用。