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Fulltext ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): randomised controlled, feasibility trial in older people

Ong T, Suazo Di Paola A, Brookes C, Drummond A, Hendrick P, Leighton P, et al.

BMJ Open, 2022 May 03;12(5):e050535.
PMID: 35504639 DOI: 10.1136/bmjopen-2021-050535

OBJECTIVE: To determine the feasibility of designing and conducting a definitive trial to evaluate the effectiveness of sacral fracture fixation compared with non-surgical management among older people admitted with a lateral compression pelvic fragility fracture (PFF).
DESIGN: Single-site, parallel, two-arm randomised controlled feasibility trial.
SETTING: A UK tertiary centre hospital.
PARTICIPANTS: Patients aged ≥70 years who were ambulating pre-injury requiring hospital admission (within 28 days of injury) with a type 1 lateral compression PFF.
INTERVENTIONS: The intervention group received sacral fracture fixation (cement augmentation±screw fixation) within 7 days of randomisation. Routine preoperative and postoperative care followed each surgical intervention. The control group received usual care consisting of analgesia, and regular input from the medical and therapy team.
PRIMARY AND SECONDARY OUTCOME MEASURES: The feasibility outcomes were the number of eligible patients, willingness to be randomised, adherence to allocated treatment, retention, data on the completeness and variability of the proposed definitive trial outcome measures, and reported adverse events.
RESULTS: 241 patients were screened. 13 (5.4%) were deemed eligible to participate. Among the eligible participants, nine (69.2%) were willing to participate. Five participants were randomised to the intervention group and four to the control group. The clinicians involved were willing to allow their patients to be randomised and adhere to the allocated treatment. One participant in the intervention group and two participants in the control group received their allocated treatment. All participants were followed up until 12 weeks post-randomisation, and had an additional safety follow-up assessment at 12 months. Overall, the proportion of completeness of outcome measures was at least 75%. No adverse events were directly related to the trial.
CONCLUSIONS: There were significant challenges in recruiting sufficient participants which will need to be addressed prior to a definitive trial.
TRIAL REGISTRATION NUMBER: ISRCTN16719542.

Matched MeSH terms: Fractures, Stress*
Fulltext Bilateral scaphoid stress fracture in a platform diver presenting with unilateral symptoms

Mohamed Haflah NH, Mat Nor NF, Abdullah S, Sapuan J

Singapore Med J, 2014 Oct;55(10):e159-61.
PMID: 25631904

Scaphoid stress fracture is rare and occurs mainly in gymnasts. The current literature has only two reported cases: unilateral scaphoid stress fracture in a platform diver and bilateral scaphoid stress fracture in a gymnast. We herein report bilateral stress fracture of the scaphoid in a platform diver who presented with only one symptomatic side. Our patient was a 16-year-old competitive platform diver with an 18-month history of pain in the right wrist. Radiography revealed fracture of the right scaphoid at the waist. As part of our preoperative plan of measuring the scaphoid length to determine the appropriate screw, radiography of the contralateral side was performed, revealing an unexpected fracture of the left scaphoid. Due to the frequency of stress fractures in competitive sports, especially gymnastics, we recommend that bilateral scaphoid radiography be performed for athletes presenting with a unilateral scaphoid fracture, to avoid missing a fracture in the contralateral side.

Matched MeSH terms: Fractures, Stress/surgery
Fulltext Evaluation of Interfacial Fracture Toughness and Interfacial Shear Strength of Typha Spp. Fiber/Polymer Composite by Double Shear Test Method

Ikramullah, Rizal S, Nakai Y, Shiozawa D, Khalil HPSA, Huzni S, et al.

Materials (Basel), 2019 Jul 10;12(14).
PMID: 31295885 DOI: 10.3390/ma12142225

The aim of this paper is to evaluate the Mode II interfacial fracture toughness and interfacial shear strength of Typha spp. fiber/PLLA and Typha spp. fiber/epoxy composite by using a double shear stress method with 3 fibers model composite. The surface condition of the fiber and crack propagation at the interface between the fiber and the matrix are observed by scanning electron microscope (SEM). Alkali treatment on Typha spp. fiber can make the fiber surface coarser, thus increasing the value of interfacial fracture toughness and interfacial shear strength. Typha spp. fiber/epoxy has a higher interfacial fracture value than that of Typha spp. fiber/PLLA. Interfacial fracture toughness on Typha spp. fiber/PLLA and Typha spp. fiber/epoxy composite model specimens were influenced by the matrix length, fiber spacing, fiber diameter and bonding area. Furthermore, the interfacial fracture toughness and the interfacial fracture shear stress of the composite model increased with the increasing duration of the surface treatment.

Matched MeSH terms: Fractures, Stress
Fulltext Causative Factors for Femoral Pin Track Fractures inNavigated Total Knee Arthroplasty

Ewe, T.W., Chee, E.K., Chooi, Y.S., Ng, W.M.

Malays Orthop J, 2010;4(1):8-11.
MyJurnal

This retrospective radiographic analysis of 57 patients (62 knees) examined two possible factors involved in pin tract fractures of the femur due to navigated total knee arthroplasty (TKA): the angle of the tracker pin with respect to the lateral femoral cortex, and the distance between the tracker pin and the lateral joint line. Our findings demonstrate a relationship between postoperative pin tract induced stress fractures (3 patients), with pin tract angles exceeding 15Â°. Pin placement at a site more than 10cm from the lateral joint line, did not show any significant association with risk of fracture. These findings lead to enhanced understanding of the causative factors underlying pin track femoral fractures in TKAs.

Matched MeSH terms: Fractures, Stress
Fulltext Spontaneous subtrochanteric femoral stress fracture related to alendronate : a case report

Chew PC, Julaihi B, Ibrahim Z

Malays Orthop J, 2013 Mar;7(1):70-3.
PMID: 25722811 MyJurnal DOI: 10.5704/MOJ.1303.002

Spontaneous atypical fractures of the femur have been reported in patients on long-term antiresorptive bisphosphonate therapy. Here, we report a case of subtrochanteric stress fracture in a seventy-year-old female patient on long-term alendronate therapy, and accompanying management challenges. Potential measures to prevent this complication of antiresorptive treatment for osteoporosis include the following: setting strict criteria for prescribing antiresorptive therapy, limiting the duration of continuous antiresorptive therapy, and increasing the use of bone anabolic agents.

Matched MeSH terms: Fractures, Stress
Fulltext Bilateral Stress Fractures of the Femoral Neck from RenalOsteomalacia: A Case Report

Sengupta, S.

Malays Orthop J, 2008;2(1):55-57.
MyJurnal

A rare case of spontaneous bilateral stress fractures of femoral neck leading to coxa vara in a young female with history of chronic renal disease and secondary osteomalacia is described. Once the underlying disease was controlled, the fracture was treated by valgus osteotomy with good result.

Matched MeSH terms: Fractures, Stress
Fulltext Insufficiency fractures related to low-dose adefovir dipivoxil treatment for chronic hepatitis B

Poh F, Sing WH, Mohan PC

Med J Malaysia, 2015 Feb;70(1):38-41.
PMID: 26032529

We present a case of a 53-year-old woman who developed multifocal insufficiency fractures associated with adefovir dipivoxil (ADV) induced osteomalacia, including recurring metatarsal insufficiency fractures and a subtrochanteric femoral insufficiency fracture requiring surgical fixation. She had received low-dose ADV treatment for 59 months for chronic hepatitis B viral infection at the time of presentation with subtrochanteric fracture. Imaging evidence of multifocal insufficiency fractures and metabolic disease on background of hypophosphatemia is attributed to hypophosphatemic osteomalacia from adefovir-induced renal proximal tubular dysfunction. Radiologists and clinicians should be aware of the possibility of insufficiency fractures in patients receiving ADV therapy to avoid delayed diagnosis and progression of high-risk proximal femoral fractures.

Matched MeSH terms: Fractures, Stress
Fulltext Subcapital Femoral Neck Tension Stress Fracture - A Rare Injury in A Child: A Case Report

Hayyun MF, Jamil K, Abd-Rashid AH, Ibrahim S

Malays Orthop J, 2021 Mar;15(1):132-134.
PMID: 33880161 DOI: 10.5704/MOJ.2103.021

Femoral neck stress fractures are rare in children. To the best of our knowledge, the tension type stress fracture has been reported only twice in the English language literature. We report on a five years follow-up of a 10-year-old boy with this injury which was initially missed. The fracture healed after screw fixation. We highlight the importance of considering stress fracture as a differential diagnosis in a child with chronic hip pain. A careful physical examination and the appropriate imaging will avoid missing the diagnosis.

Matched MeSH terms: Fractures, Stress
Fulltext Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

Tan T, Ho W

Malays Orthop J, 2015 Nov;9(3):65-67.
PMID: 28611915 DOI: 10.5704/MOJ.1511.010

Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA) bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

Matched MeSH terms: Fractures, Stress
Fulltext Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis?

Singh N, Pandey CR, Tamang B, Singh R

Malays Orthop J, 2020 Jul;14(2):64-71.
PMID: 32983379 DOI: 10.5704/MOJ.2007.014

Introduction: The study was conducted to evaluate the efficacy of arthroscopic debridement, microfracture and plasma rich in growth factor (PRGF) injection in the management of type V (Scranton) osteochondral lesions of talus and its role in healing the subchondral cyst and cessation of progression of ankle osteoarthritis.
Material and Methods: This is a prospective case series conducted on patients who were diagnosed with type V osteochondral lesions of talus. All the cases were treated with arthroscopic debridement, microfracture, and PRGF injections. The patients were evaluated for the healing of subchondral cysts and progression of osteoarthritis with radiography (plain radiographs and computerised tomography Scan). Also, the patients' outcome was evaluated with Quadruple Visual Analogue Scale, Ankle Range of Motion, Foot and Ankle Disability Index, Foot and Ankle Outcome Instrument and a Satisfaction Questionnaire.
Results: Five male patients underwent arthroscopic debridement, microfracture and PRGF injection for type V osteochondral lesion of talus. The mean age of patients was 27.4 years (19-47 years). All the patients gave history of minor twisting injury. Subchondral cyst healing was achieved in all patients by six months post-surgery. However, four out of five patients had developed early osteoarthritic changes of the ankle by their last follow-up [mean follow-up 29 months (ranged 15-36 months)]. Despite arthritic changes, all the patients reported 'Good' to 'Excellent' results on satisfaction questionnaire and Foot and Ankle Disability Index and could perform their day to day activities including sports.
Conclusion: Arthroscopic debridement, microfracture, and PRGF causes healing of the subchondral cyst but does not cause cessation of progression to osteoarthritis of ankle in type V osteochondral defects of talus. However, despite progress to osteoarthritis, patient satisfaction post-procedure is good to excellent at short-term follow-up.

Matched MeSH terms: Fractures, Stress