J. H. Hegeman

Augmented pin fixation with Cortoss for an unstable AO-A3 type distal radius fracture in a patient with a manifest osteoporosis.

Distal radius fractures are one of the most common fractures in the elderly females. In this article, we report a case of a distal radius fracture type AO-A3 with dorsal instability, in an older woman with manifest osteoporosis, treated with minimally invasive Cortoss® composite and FFS-wires®. A 63-year-old woman sustained an unstable distal radial fracture of her left wrist after falling from a kitchen step. She underwent an open reduction of the fracture and fixation with two crossed-fixation pins and Cortoss® composite. Post-operative plaster cast immobilization was given for 2 weeks, after which the plaster cast and the fixation pins were removed. At 4 weeks follow-up, she had a good functional result of her left wrist, after 11 months there was a complete return of grip strength with also, except for the palmar flexion, a full return of function. We report here the first case of a successful surgical treatment with Cortoss® composite of an AO-A3 type distal radius fracture.

Thoracolumbar Spine Fractures in the Geriatric Fracture Center Early Ambulation Leads to Good Results on Short Term and Is a Successful and Safe Alternative Compared to Immobilization in Elderly Patients With Two-Column Vertebral Fractures

Introduction: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a vertebral fracture. Methods: This study is a retrospective cohort study, which included all patients with an age of 65 years and older, who were diagnosed with a vertebral fracture and where therefore admitted to the Geriatric Fracture Center over a period of 2 years. Primary outcome was the level of functioning 6 weeks and 3 months after admission. Results: We included 106 patients with 143 vertebral fractures, of which 61 patients were evaluated after 3 months. In our population, 53% of the patients had a fracture involving both middle and anterior columns. The majority of the patients functioned sufficiently 6 weeks and 3 months after admission. Analysis showed that age <80 years is an independent predictor of a sufficient level of functioning after 6 weeks. Discussion: The nonoperative treatment of elderly patients with a vertebral fracture leads to a sufficient level of functioning 6 weeks and 3 months after admission. In our population, only age <80 years is an independent predictor for a sufficient level of functioning 6 weeks after admission. The level of functioning at 6 weeks predicts the level of functioning 3 months after admission. On comparison, the level of functioning after early ambulation is equal to the level of functioning after immobilization. Where immobilization may lead to complications, early ambulation was not associated with new complications or neurological damage. Based on these advantages, the treatment of elderly patients with a fracture involving both middle and anterior columns may be altered from immobilization to mobilization in the future.

The (a)-Symptomatic Vertebral Fracture: A Frequently Discovered Entity With Clinical Relevance in Fracture Patients Screened on Osteoporosis

Objective. Description of the prevalence of vertebral fractures in a fracture and osteoporosis outpatient clinic (FO-Clinic) and evaluation of the value of spinal radiographs by screening on osteoporosis. Design. Retrospective data collection, description, and analysis. Methods. All patients admitted to the FO-Clinic during the period of December 2005 until October 2006 were enrolled in this study. At the FO-Clinic spinal radiographs were obtained and bone mineral density (BMD) was measured by Dual energy X-ray-Absorptiometry (DXA). Results. During the study period, a total of 176 patients were screened at our FO-Clinic. In 41.5% of these patients, a vertebral fracture was diagnosed. There appeared to be an indication for anti-osteoporotic medication in 95 of the 176 patients. Of these 95 patients, 77% could be identified by spinal radiographs. Moreover, only 36% of all patients with a vertebral fracture did suffer from osteoporosis. Conclusion. The prevalence of vertebral fractures in patients screened at an FO-Clinic is high and spinal radiographs can identify up to 77% of patients in which anti-osteoporotic medication should be considered. However, fracture risk is not only dependent on bone quality but also on bone density. Therefore, the preferred method of screening on osteoporosis is DXA with vertebral fracture assessment and, if necessary, spinal radiographs. If DXA is not available, spinal radiographs might be used as a first step in osteoporosis screening.

Twee patiënten met een osteochondrale fractuur in de knie

Een osteochondrale fractuur wordt bij jeugdigen vaak gezien ten gevolge van osteochondritis dissecans. Bij volwassenen is een traumatische patellaluxatie de meest voorkomende oorzaak van een osteochondrale fractuur. Wij beschrijven twee patienten met een losliggend fragment in de knie ten gevolge van een osteochondrale fractuur op een ongebruikelijke plaats in de knie, zonder voorafgaande patellaluxatie. Aan de hand van deze casus worden epidemiologie, ongevalsmechanisme, diagnostiek, behandeling en prognose van osteochondrale fracturen in de knie beschreven.