Isopsoralen accelerates tibia fracture healing by promoting bone formation in mice / 陆军军医大学学报

Objective To determine the effect of isopsoralen(ISO)on the healing of tibia fracture in mice and explore its underlying mechanism.Methods Fifty male C57BL/6 mice(2 month old,20±2 g)were randomly divided into model group and ISO treatment group,with 25 animals in each group.From the 3rd day after modeling,the mice from the ISO group were given an intragastric gavage of 40 mg/kg ISO,once per day for 28 consecutive days,while those of the model group was given same volume of normal saline in same way.On the 7th,14th,21st,and 28th day after gavage,the tibia on the surgical side was taken,and the fracture area was quantified by bone volume/total volume(BV/TV)after micro-CT scanning.The healing and shaping of the fracture end were observed through HE staining.ELISA was used to detect the serum contents of bone alkaline phosphatase(BALP)and procollagen type I N-terminal peptide(PINP)on the 14th day of gavage.Western blotting was employed to determine the expression levels of Collagen Ⅰ,Runx2,BMP2,OSX,and VEGF in the tibial callus tissue in 7 and 14 d after gavage.Vascular perfusion was applied to observe the callus microvessels in 28 d to quantitatively analyze the vascular volume fraction and vessel diameter.Immunohistochemical staining was conducted to observe the expression of VEGF in the callus in 14 d after gavage.Results HE staining displayed that the ISO group had faster healing process than the model group.Micro-CT quantification results showed that the ISO group had higher BV/TV ratio in 7 d after gavage though no statistical difference,significantly higher ratio in 14 d(P＜0.05),but obviously lower ratio in 21 and 28 d after gavage(both P＜0.05)when compared with the model group.The serum contents of BALP and PINP were also remarkably higher in the ISO group than the model group(P＜0.05).Western blotting results indicated that the expression levels of Collagen Ⅰ,Runx2,BMP2,OSX and VEGF in the ISO group were higher than those in the model group(P＜0.05).The results of angiography revealed that the vascular volume fraction and vessel diameter were notably increased in the ISO group than the model group(both P＜0.05).Immunohistochemical assay showed that the expression of VEGF was higher in the ISO group than the model group(P＜0.05).Conclusion ISO can improve the activity of osteoblasts,increase the expression of osteogenesis-related proteins,and accelerate the angiogenesis to promote fracture healing.

Application of biomaterials in Masquelet technology / 中国组织工程研究

BACKGROUND:The remediation and treatment of bone defects present considerable challenges,with a variety of clinical intervention strategies available.One such approach,the Masquelet technique,has demonstrated high rates of success and reliable outcomes and is currently employed in clinical practice.However,the underlying mechanisms of this technique remain incompletely understood,and certain challenges persist in its clinical application,indicating that this technique is not yet fully mature. OBJECTIVE:To compile and categorize the biomaterials currently employed in research aimed at improving the Masquelet technique,in order to provide insights and references for the further development of this technique. METHODS:A literature search of the China National Knowledge Infrastructure and PubMed databases was conducted,spanning publications from January 2013 to November 2022.The search terms used included"Masquelet technique;induced membrane technique;induced membrane;biomaterial;bone defect"in both Chinese and English.A total of 58 articles meeting the inclusion criteria were reviewed. RESULTS AND CONCLUSION:(1)The emergence and continual development of the Masquelet technique provide a therapeutic strategy for treating bone defects.Some researchers are focusing on developing superior spacer materials,autograft substitutes,and membrane materials that mimic the properties of the induced membrane,to simplify the two-stage procedure,shorten treatment duration,and reduce patient distress.(2)Calcium sulfate,silicone,poly(lactic-co-glycolic acid),and polypropylene can replace polymethylmethacrylate bone cement to form induced membranes in animal experiments or clinical applications,each with their advantages.Contrary to expectations,common materials such as titanium and polyvinyl alcohol sponge cannot replace polymethylmethacrylate bone cement.(3)Autograft substitutes are diverse,with allograft bone,β-tricalcium phosphate,absorbable gelatin sponge,α-calcium sulfate hemihydrate,bioactive glass,titanium,and tantalum demonstrating their ability to reduce the quantity of autologous cancellous bone graft required in the second stage of the procedure.Among them,allograft bone,β-tricalcium phosphate,bioactive glass,titanium and tantalum can replace autogenous bone as grafts,and other materials need to be mixed with autogenous bone,in both clinical and fundamental experiments.(4)Biomimetic-induced membranes,human amnion,human decellularized dermis,polytetrafluoroethylene,and even autogenous cortical bone have been shown to possess properties similar to the induced membrane.(5)Most of the application and research of biomaterials in this technology still exist in the stage of basic research and have not been applied in clinical practice or popularized on a large scale,but the above materials can provide more sufficient theoretical basis and new ideas for the exploration of Masquelet technical mechanism,the improvement of surgical methods and clinical application.

Emprego de dupla abordagem em fratura complexa de face: relato de caso / Use of dual approach in complex fracture of the face: case report / Uso de abordaje dual en fractura compleja de cara: reporte de caso

Objetivo: Relatar o tratamento de fratura de osso frontal e OPN. Relato de caso: Paciente G.S.M, 25 anos, foi encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do Hospital Geral Clériston Andrade (HGCA). Em análise facial, notaram-se lesões em tecidos moles, hiposfagma em ambos os globos oculares, equimose periorbital bilateral e edema da região hemifacial esquerda, além de crepitação em região de OPN. Após a solicitação de Tomografia Computadorizada (TC) de face observou-se fratura complexa em região de terço superior esquerdo e região de glabela, acometendo osso frontal e margem supra orbital esquerda, além de fratura de OPN sem deslocamento considerável. Foi realizada uma abordagem cruenta por meio de um acesso coronal, e por meio deste foi realizada a redução e fixação dos arcos com placas e parafusos de titânio do sistema 2.0. Para o tratamento da fratura de OPN optou-se por uma abordagem incruenta devido ao mínimo deslocamento. Conclusão: O tratamento cruento com redução aberta e fixação interna rígida, mostrou-se uma abordagem eficaz para o alinhamento das fraturas do osso frontal, da mesma forma, a abordagem incruenta da fratura de OPN, embora conservadora, também apresentou bons resultados, demonstrando o sucesso da técnica empregada nesse caso... (AU)

Objective: To report the treatment of frontal bone fracture and OPN. Case report: Patient G.S.M, 25 years old, was referred to the Oral and Maxillofacial Surgery and Traumatology Service (CTBMF) of Hospital Geral Clériston Andrade (HGCA). In facial analysis, soft tissue lesions, hyposphagma in both eyeballs, bilateral periorbital ecchymosis and edema of the left hemifacial region were noted, in addition to crackling in the OPN region. After requesting a Computed Tomography (CT) scan of the face, a complex fracture was observed in the upper left third and glabella region, affecting the frontal bone and left supraorbital margin, in 5addition to an OPN fracture without considerable displacement. An open approach was performed through a coronal access, and through this the arches were reduced and fixed with titanium plates and screws of the 2.0 system. For the treatment of the OPN fracture, a closed approach was chosen due to the minimal displacement. Conclusion: Open reduction treatment with open reduction and rigid internal fixation proved to be an effective approach for the alignment of frontal bone fractures. success of the technique employed in this case... (AU)

Objetivo: Reportar el tratamiento de la fractura de hueso frontal y OPN. Caso clínico: Paciente G.S.M, de 25 años de edad, remitido al Servicio de Cirugía y Traumatología Oral y Maxilofacial (CTBMF) del Hospital Geral Clériston Andrade (HGCA). En el análisis facial se observaron lesiones de partes blandas, hiposfagma en ambos globos oculares, equimosis periorbitaria bilateral y edema de región hemifacial izquierda, además de crepitantes en región OPN. Tras solicitar una tomografía computarizada (TC) de rostro, se objetivó una fractura compleja en tercio superior izquierdo y región de glabela, afectando hueso frontal y margen supraorbitario izquierdo, además de una fractura OPN sin desplazamiento importante. Se realizó un abordaje abierto a través de un acceso coronal, mediante el cual se redujeron las arcadas y se fijaron con placas de titanio y tornillos del sistema 2.0. Para el tratamiento de la fractura OPN se optó por un abordaje cerrado debido al mínimo desplazamiento. Conclusión: El tratamiento de reducción abierta con reducción abierta y fijación interna rígida demostró ser un abordaje eficaz para la alineación de las fracturas del hueso frontal, éxito de la técnica empleada en este caso... (AU)

Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb / 中国骨伤

OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

Effects of isopsoralen on tibial fracture and vascular healing in mice / 中国骨伤

OBJECTIVE@#To explore effects of isopsoralen (ISO) with different doses on fracture and vascular healing in mice.@*METHODS@#Sixty 2-month-old male C57BL/6 mices with body mass of (20±2) g were selected and divided into 4 groups by random number table method:model group (model), low dose group (isopsoralen-low dose, ISO-L), medium dose group (isopsoralen-medium dose, ISO-M) and high dose group (isopsoralen-high dose, ISO-H), with 15 animals in each group. The right tibial fracture model was established. After operation, ISO-L group, ISO-M group and ISO-H group were given ISO concentration of 10 mg·kg-1, 20 mg·kg-1 and 40 mg·kg-1, respectively. Model group was given same volume of normal saline once a day for 28 days. Weighed once a week. X-ray was performed on 7, 14, 21 and 28 days, respectively, and modified I.R. Garrett scoring method was used to evaluate callus growth. After 28 days, the main organs were stripped and weighed, and organ coefficients were calculated. Hematoxylin eosin staining (HE staining) was performed on the organs to observe whether there were pathological structural changes. Micro-computed tomography (Micro-CT) was used to scan fracture area and conduct three-dimensional reconstruction to obtain the effect map, and quantify bone volume fraction (bone volume/total volume, BV/TV). After decalcification, the tibia was embedded in paraffin wax and sectioned. The healing and shape of fracture end were observed by HE staining and ferruxin solid green staining. The right tibia was removed and decalcified after intravascular infusion of Microfil contrast agent. Micro-CT was used to scan the callus microvessels in the fracture area, and the vascular volume fraction and vessel diameter were quantified.@*RESULTS@#After 28 days of administration, there was no significant difference in body mass and organ coefficient among all groups (P>0.05), and no significant pathological changes were found in HE staining of organs. The results of X-ray and improved I.R. Garrett score showed that ISO-M group was higher than that of Model group at 28 days (P<0.05). Scores of ISO-H group at 14, 21 and 28 days were higher than those of the other 3 groups (P<0.05). Micro-CT results showed intracavitary callus in ISO-M group was significantly reduced, which was lower than that in Model group (P<0.05), most of the callus in ISO-H group were subsided, and BV/TV in ISO-H group was lower than that in the other 3 groups (P<0.05). The results of HE staining and ferrubens solid green staining showed fracture area of ISO-H group was closed, continuous laminar bone had appeared, and the fracture healing process was higher than that of other groups. Angiographic results showed vascular volume fraction in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05), and the vascular diameter in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05).@*CONCLUSION@#In the concentration range of 10-40 mg·kg-1, ISO has no obvious toxic and side effects, and could improve bone microstructure, promote formation of callus microvessels, and accelerate healing of fracture ends in a concentration-dependent manner.

Metacarpal fractures treatment: comparasion between kirschner wire and intramedullary screw / Tratamento de fraturas metacarpais: comparação entre fios de kirschner e fixação intramedular

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

Research progress of predictive potential of the body mass index in fracture risk of children / 中华实用儿科临床杂志

The increasing prevalence of obesity in children worldwide has been a global healthy issue.It is important to identify the effect of fat mass on the bone, which contributes to promote the peak bone mass and prevent osteo-porosis-induced fracture.Body mass index (BMI), as an index to evaluate the state of obesity, is simple and easy to measure, and is suitable for self-test of a large range of people.This review aims to discuss the role of BMI in evaluating the interaction between obesity and bone density, and the predictive potential in fracture risk of children.

Fatores de risco para osteoporose em uma amostra da população de atenção primária em São Paulo, Brasil / Risk factors for osteoporosis in a sample of the primary attention population in São Paulo, Brazil

Objetivo: esse estudo teve como objetivo avaliar a instrução sobre osteoporose de uma amostra da população que frequenta o Centro de Saúde Butantã (CSE), visando incentivar a forma mais adequada de prevenção e/ou tratamento. Metodologia: Foi elaborado e aplicado, durante um mês, um questionário para identificar os fatores de risco de 101 pacientes, de ambos os sexos. Resultados: do total desses pacientes, 49% tinham idade inferior a 45 anos, 33% entre 45 e 65 anos e 18% acima de 65 anos. A cor branca prevaleceu em 66%, sendo que 36% do total possuíam hipertensão, 10% diabetes e 7% outras doenças crônicas. Em relação ao índice de massa corpórea (IMC), 4% estavam abaixo de 20Kg/m2, 37% eutróficos, 30% com sobrepeso, 24% com obesidade grau I e 5% com IMC superior a 35Kg/m2. Foi verificado que 76% da população era sedentária, 35% fumantes, 32% com consumo alcoólico inferior a 3 vezes na semana, 3% superior a 3 vezes e 65% sem consumo de álcool. Quanto a ingestão de leite, 37% não o consumiam e 40% apenas 1 vez ao dia. Não houve diferença estatística entre as pessoas que conheciam ou não a osteoporose, sendo que 60% tinham conhecimento sobre a doença, porém esse grau de instrução não implicou em diferenças nos hábitos de vida. Discussão: em 100% da amostra estudada foi encontrado pelo menos 1 fator de risco para o seu desenvolvimento, principalmente a baixa ingestão de cálcio e a falta de atividade física, confirmando a importância da intervenção nesses fatores preveníveis.

Objective: this study aimed to evaluate the education on osteoporosis in a sample of the population who attends the Center for Health Butantã (CSE), to encourage the most appropriate way of preventing and / or treatment. Methodology: was developed and implemented over a month, a questionnaire to identify risk factors of 101 patients of both sexes. Results: of the total of these patients, 49% were below 45 years, 33% between 45 and 65 and 18% over 65 years. The white prevailed in 66% and 36% of the total had hypertension, diabetes 10% and 7% other chronic diseases. In relation to body mass index (BMI), 4% were below 20Kg/ m2, 37% normal, 30% overweight, 24% with obesity grade I and 5% with BMI greater than 35kg/m2. It was found that 76% of the population was sedentary, 35% smokers, 32% with alcohol consumption less than 3 times a week, 3% more than 3 times and 65% with no consumption of alcohol. As the intake of milk, not the 37% and 40% consumed only 1 day. There was no statistical difference between people who knew or not osteoporosis, while 60% had knowledge about the disease, but this level of education did not lead to differences in living habits. Discussion: in 100% of the studied sample was found at least 1 risk factor for its development, especially the low calcium intake and lack of physical activity, confirming the importance of intervention in those preventable factors.

Reparo inicial de defeito ósseo crítico na calvária de rato após aplicação de ondas vibratórias / Initial repair of critical bone defect in rat calvary after the application of vibratory waves

Introdução: fraturas ósseas extensas representam grande causa de morbidade e geram custos para o serviço de saúde. A vibração de baixa magnitude e alta frequência foi proposta como um tratamento alternativo para aumentar a massa óssea. Objetivo: Avaliar histomorfologicamente o reparo inicial de defeitos ósseos críticos após aplicação de ondas mecânicas vibratórias Metodologia: foram utilizados 10 Rattus norvegicus. Confeccionou-se defeitos críticos de 8,5 mm de diâmetro na calvária dos ratos. Os animais foram distribuídos em dois grupos: Grupo Controle de Defeito Ósseo (GCDO) e Grupo Experimental de Vibração Imediata (GEVI). Animais do GEVI foram submetidos a ondas vibratórias de 60 Hz e aceleração vertical de 0,3 g; elas foram aplicadas três vezes/ semana, durante vinte minutos. Após quinze dias do ato operatório, os animais foram eutanasiados para a mensuração da extensão do defeito. Considerando que estes defeitos tinham o mesmo diâmetro inicial, admitiu-se como indicador indireto de deposição osteóide, a redução da extensão linear final dos mesmos. Resultados: observou-se neoformação de matriz osteoide, restrita às bordas ósseas, em ambos os grupos. A média de extensão linear, em milímetros, do defeito ósseo do GEVI foi de 5,83 (DP=0,79) e no GCDO, foi de 6,62 (DP= 0,63). Não houve diferença estatisticamente significante entre as médias (U=8,00, z=-1,604, p=0,132). Conclusão: evidenciou-se resposta osteogênica a partir da utilização da terapêutica vibratória, contudo de forma estatisticamente não-significante. Deste modo, o presente estudo demonstrou que a utilização das ondas vibratórias não favoreceu um reparo ósseo estatisticamente significante, no período e regime vibratório estudados.

Introduction: extensive bone fractures represent a major cause of morbidity and generate costs for the health service. Vibration of low magnitude and high frequency has been proposed as an alternative treatment to increase bone mass. Objective: to evaluate histomorphologically the initial repair of critical bone defects after application of vibrating mechanical waves. Methodology: 10 Rattus norvegicus were used. Critical defects of 8.5 mm in diameter were made in the calvaria of the rats. The animals were divided into two groups: Bone Defect Control Group (GCDO) and Experimental Immediate Vibration Group (GEVI). GEVI animals were submitted to 60 Hz vibrating waves and 0.3 g vertical acceleration; they were applied three times/week, for twenty minutes. Fifteen days after the surgery, the animals were euthanized to measure the extent of the defect. Considering that these defects had the same initial diameter, a reduction in their final linear extension was admitted as an indirect indicator of osteoid deposition. Results: neoformation of an osteoid matrix, restricted to bone borders, was observed in both groups. The mean linear extension, in millimeters, of the GEVI bone defect was 5.83 (SD = 0.79) and in the GCDO, it was 6.62 (SD = 0.63). There was no statistically significant difference between the means (U = 8.00, z = -1.604, p = 0.132). Conclusion: an osteogenic response was evidenced from the use of vibratory therapy, however in a statistically non-significant way. Thus, the present study demonstrated that the use of vibrating waves did not favor a statistically significant bone repair, during the studied period and vibration regime

Perfil das fraturas faciais em um serviço de emergência no Maranhão / Profile of facial fractures in an emergency service in Maranhão

O bjetivo: Avaliar o perfil das fraturas faciais em pacientes atendidos em serviço de emergência no estado do Maranhão. Método: Utilizou-se abordagem indutiva, com procedimento estatístico-descritivo e técnica de documentação direta, cuja amostra foi selecionada por conveniência e constituída pelos pacientes internados em decorrência de trauma facial (n = 100). Os dados foram coletados a partir dos prontuários dos pacientes que consentiram a participação na pesquisa mediante assinatura do TCLE. A análise dos dados empregada foi descritiva e inferencial (qui-quadrado; p<0,05), utilizando o software Statistical Package for Social Sciences. Resultados: O gênero masculino foi o mais acometido (63%), com a faixa etária de 19 a 30 anos (34%). Os atendimentos ocorreram frequentemente, no domingo (24%), e o acidente com motocicletas (56%) foi a principal etiologia. As principais fraturas identificadas foram na região mandibular (54%), maxilar (48%) e orbital (22%). O tratamento comumente realizado foi inclusão de miniplacas sem bloqueio intermaxilar (66%), com tempo de internação de 6-15 dias (49%). Conclusão: Houve maior prevalência de fraturas mandibulares em pessoas do gênero masculino com faixa etária jovem, sendo o acidente de motocicleta o principal fator etiológico e a ocorrência da maior parte dos casos nos finais de semana (domingo), com ingestão de bebida alcoólica... (AU)

Goal: Evaluate the profile of facial fractures in patients admitted in emergency care services in the state of Maranhão. Method: It was used na inductive approach, with a statistical-descriptive procedure and a right documentation technique, which sample was selected conveniently and constituted by the patients hospitalized because of facial trauma (n = 100). The data were collected through patients' medical reports who allowed their participating in the data research by signing the consent form. The data analysis applied was descriptive and inferential (qui-square; p<0,05), using the software Statistical Package for Social Sciences. Outcomes: the male gender was more affected (63%), with an age range from 19 to 30 years old (34%). The attendances occurred commonly on Sundays (24%) and the accident involving motorcycles (56%) was the major etiology. The main identified fractures were in the mandibular region (54%), jaw (48%) and orbital (22%). The treatment commonly performed was the application of miniplates withou intermaxillary blocking (66%), with admittance time between 6-15 days (49%). Conclusion: There was greater prevalence of mandibular fractures on male gender people in Young ages, being motorcycle accident the main etiological and the occurrence of most cases on the weekend (Sundays), involving alcoholic beverages ingestion... (AU)

Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Facial paralysis in longitudinal versus oblique and otic-sparing versus non otic-sparing temporal bone fractures

Objective@#To compare the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis.@*Methods@#Design: Retrospective Case Series. Setting: Tertiary Government Hospital. Participants: Records of 49 patients diagnosed with temporal bone fracture in our institution from August 2016 to June 2018. @*Results@#A total of 41 records of patients with temporal bone fractures, 32 males, 9 females, aged 5 to 70 years-old (mean 37.5-years-old) were included. In terms of laterality 23 (56%) involved the right and 17 (41%) the left side. Traditionally classified, 32 (78%) were longitudinal and 9 (22%) were transverse. Using newer classification based on otic involvement and non-otic involvement, 38 (93%) were otic-sparing and 3 (7%) were non otic-sparing. Only 9 (22%) out of 41 total fracture patients developed facial paralysis, involving 7 of the 32 longitudinal fractures and 2 of the 9 transverse fractures, or 8 of the 38 otic-sparing and 1 out of 3 non otic-sparing fractures. @*Conclusion@#Because of the small sample size, no conclusions regarding the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis can be drawn in this study.

Facial Paralysis in Longitudinal versus Oblique and Otic-Sparing versus Non Otic-Sparing Temporal Bone Fractures

OBJECTIVE: To compare the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis.METHODS:        Design:           Retrospective Case Series        Setting:         Tertiary Government Hospital       Participants:         Records of 49 patients diagnosed with temporal bone fracture in our institution from August 2016 to June 2018.RESULTS: A total of 41 records of patients with temporal bone fractures, 32 males, 9 females, aged 5 to 70 years-old (mean 37.5-years-old) were included.  In terms of laterality 23 (56%) involved the right and 17 (41%) the left side.  Traditionally classified, 32 (78%) were longitudinal and 9 (22%) were transverse. Using newer classification based on otic involvement and non-otic involvement, 38 (93%) were otic-sparing and 3 (7%) were non otic-sparing. Only 9 (22%) out of 41 total fracture patients developed facial paralysis, involving 7 of the 32 longitudinal fractures and 2 of the 9 transverse fractures, or 8 of the 38 otic-sparing and 1 out of 3 non otic-sparing fractures.CONCLUSION: Because of the small sample size, no conclusions regarding the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis can be drawn in this study.KEYWORDS: head injuries; head trauma; skull fracture; temporal bone fracture; motor vehicles; traffic accidents; facial paralysis

Morbimortalidad en trauma ortopédico de alta energía: estudio descriptivo retrospectivo / Morbimortality of High-energy Orthopedic Trauma: a Descriptive Retrospective Study / Morbimortalidade em trauma ortopédico de alta energia: estudo descritivo retrospective

Resumen Objetivo: Describir la mortalidad y las principales complicaciones secundarias en los pacientes con trauma ortopédico de alta energía, admitidos en el servicio de urgencias del Hospital Universitario San Vicente Fundación. Metodología: Se llevó a cabo un estudio descriptivo retrospectivo de los pacientes, en un período de 18 meses, que cumplieron los criterios de inclusión luego de realizar la búsqueda en la base de datos del Hospital. Se revisaron 10 259 historias clínicas, de las cuales 161 cumplían los criterios de inclusión. Las variables cuantitativas se analizaron mediante medias y desviaciones estándar, y las cualitativas, a través de frecuencias y proporciones. El análisis estadístico se efectuó con el SPSS® 21. Resultados: La mayoría de pacientes afectados correspondía al sexo masculino (80,7 %), con edad promedio de 37,5 años; el principal hueso afectado fue la tibia (68,3 %). El principal mecanismo de trauma fue accidente de tránsito (82 %), siendo la motocicleta el vehículo involucrado con mayor frecuencia (65,8 %). La mortalidad fue baja, fallecieron tres pacientes. Las principales complicaciones fueron osteomielitis crónica y tromboembolismo pulmonar (7,4 y 6,8 %, respectivamente). Dieciséis pacientes requirieron ingreso a la unidad de cuidados intensivos (9,9 %), con un promedio de estancia de 6,9 días. Conclusiones: El trauma ortopédico de alta energía no es un factor de mortalidad independiente; sin embargo, impacta sobre la salud pública, debido a la discapacidad que esta lesión genera en individuos laboralmente activos, lo que lleva a ausentismo laboral y pérdida de la productividad.

Abstract Objective: to describe the mortality and the main secondary complications in patients with high-energy orthopedic trauma treated at the emergency service of the Hospital Universitario San Vicente Fundación. Methodology: descriptive retrospective study carried out in an 18-month period with patients following the inclusion criteria and after a search conducted in the hospital's database. 10,259 patient medical records were reviewed, out of which 161 followed the inclusion criteria. The quantitative variables were analyzed by standard means and deviations. The qualitative variables were analyzed by frequency and proportions. Results: most of the affected patients were males (80.7%), with a mean age of 37.5 years, the most affected bone was the tibia (68.3). Transit accident was the main mechanism of trauma (82%), and the most frequently involved vehicle was the motorcycle (65.8%). There was a low mortality of three patients. The main complications were chronic osteomyelitis and pulmonary thromboembolism (7.4% and 6.8%, respectively). Sixteen patients needed attention in the Intensive Care Unit (9.9%), remaining there for an average of 6.9 days. Conclusions: high-energy orthopedic trauma is not an independent mortality factor. However, it affects public health by generating medical leaves of active workers, which causes work absences and diminishes productivity.

Resumo Objetivo: Descrever a mortalidade e as principais complicações secundárias nos pacientes com trauma ortopédico de alta energia, tratados no serviço de urgências do Hospital Universitario San Vicente Fundación. Metodologia: foi feito um estudo descritivo retrospectivo dos pacientes, em 18 meses, respeitando critérios de inclusão após realizar a pesquisa na base de dados do Hospital. Revisaram-se 10 259 histórias clínicas, das quais 161 acatavam os critérios de inclusão. As variáveis quantitativas analisaram-se por meio de medições e desvios standards. As variáveis qualitativas analisaram-se através de frequências e proporções. Resultados: a maioria dos pacientes afetados eram de sexo masculino (80,7 %), com idade média de 37,5 anos, o principal osso afetado foi a tíbia (68,3 %). O principal mecanismo de trauma foi acidente de trânsito (82%), sendo a motocicleta o veículo envolvido com mais frequência (65,8 %). A mortalidade foi baixa, morreram três pacientes. As principais complicações foram a ostomielite crônica e o tromboembolismo pulmonar (7,4 e 6,8 %, respetivamente). Dezesseis pacientes precisaram atenção na Unidade de Terapia Intensiva (9,9%), com média de tempo na uti de 6,9 dias. Conclusões: o trauma ortopédico de alta energia não é um fator de mortalidade independente. Porém, afeta a saúde pública pelo impedimento gerado em pessoas que trabalham, porque elas devem se ausentar dos seus labores e a produtividade diminui.

Management of Post Traumatic Facial Nerve Palsy: A Hospital Based Study

Background: Facial nerve loss of motion by injury is normal cause after idiopathic. Facial paralysis accordingly of intra cranial, intra fleeting and additional transient limit harm or break and both. Sudden and prompt facial nerve paralysis require early surgical intervention for better result. Facial nerve decompression and termino- terminal anastomosis surgical intervention had done in present study. Methods: A prospective study of the 15 cases of traumatic facial nerve palsy attending Department of Otorhinolaryngology, Government Medical College, Shivpuri, MP. The complete clinic examination, otoscopic, audio logical, topo diagnostic, and radiological evaluation were done in all the patients. The outcome of these patients were done on the House-Brackmann nerve grading system. Results: All patients have infra nuclear type of facial nerve palsy. The maximum incidence of facial nerve paralysis found in the age group between 26 to 35 years. Out of 15 patients ,12 patients were normal hearing. Suprachordal (54%) involvement is the most common site of lesion in traumatic facial nerve paralysis. Conclusions: Sudden and immediate onset facial nerve paralysis need early surgical intervention for better outcome .facial nerve decompression were better outcome comparing to termino terminal anastmosis. The facial nerve paralysis prognosis depends upon degree of paralysis, duration of paralysis, site of injury and patients’ factors.

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism: A case report

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.

Advance in Facial Nerve Decompression for Facial Palsy Resulting from Zygomatic Fractures (review) / 中国康复理论与实践

@#The facial nerve is the longest nerve shaped the bone tube, which has many turnings and narrow path. About 7% to 10% of patients with temporal bone fracture have facial paralysis. Most of the patients showed loss of frontal lines, inability to close eyes, and deflection of the teeth. Facial nerve decompression has been an effective way to relieve the symptoms and restore facial nerve functions. However, the issue of surgical indications, timing of surgery, and scope of decompression still need further research.

Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.

Panfacial bone fracture: cephalic to caudal

Theoretically, panfacial bone fractures involve all three areas of the face: frontal bone, midface, and mandible. In practice, when two out of these three areas are involved, the term “panfacial bone fracture” has been applied. We can use physical examination, simple radiologic examination, and computed tomography study for diagnosis. Linear fracture are treated by conservative treatment. But, most of panfacial bone fracture patients need to be treated by open reduction and internal fixation. Facial width is most important thing that we need to care during operation. There are many ways about sequence like “top to bottom,”“bottom to top,”“outside to inside,” or “inside to outside” and the authors prefer “top to bottom” and “outside to inside” ways. The authors apply arch bar from the first of surgery and then, set frontal bone fracture, midface fracture and mandible fracture in sequence. Usually, we remove the stitches for 5 days after surgery and the intraoral stitch removed after 2 weeks. Usually arch bar is going to be removed 4 weeks after surgery. We could get acceptable results with the above way.

Research progress on the relationship between osteosarcopenic obesity syndrome and fracture / 中华老年医学杂志

The ageing process is accompanied by osteoporosis,sarcopenia and obesity,which are named as osteosarcopenic obesity(OSO)syndrome.It is a recently identified syndrome characterized by simultaneous presence of osteopenia/osteoporosis,sarcopenia and increased adiposity(obesity),with a potential interconnection within these diseases via common pathophysiology.OSO is harmful for the elderly's physical-mental health and living quality,especially for bone fracture.Therefore,we reviewed a research progress on the relationship between OSO and fractures in the elderly.