OBJECTIVES: To explore the injury mechanism of ankle fracture inferred by the Lauge-Hansen classification with the application of medical imageology and its application value in forensic medicine. METHODS: A total of 32 ankle fracture cases with known injury mechanism were collected from January 2013 to May 2018, which were identified in Yongkang Public Security Bureau, Zhejiang Province. The Lauge-Hansen classification of ankle fracture was performed by three forensic experts based on the data of X-ray and CT image. Fisher's exact test and Kappa consistency analysis were performed by SPSS 20.0 statistical software to compare the results of the Lauge-Hansen classification with the injury mechanism of ankle fracture obtained through the criminal evidence. RESULTS: In 32 cases, 84.4% （27/32） ankle fractures were classified according to the Lauge-Hansen classification based on medical imaging. The mechanism of ankle fracture identified by the Lauge-Hansen classification was consistent with that obtained through the criminal evidence. CONCLUSIONS Based on medical imaging, the Lauge-Hansen classification can be well applied to infer the injury mechanism of ankle fracture in part cases, and provide objective evidence for the crime scene reconstruction of criminal cases.
Ankle Fractures/diagnostic imaging* ; Ankle Injuries ; Forensic Medicine ; Fractures, Bone ; Humans ; Radiography

OBJECTIVEThis study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures.

METHODSTwenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination.

RESULTSPostoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening.

CONCLUSIONSExtramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

BACKGROUND: We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. METHODS: Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. RESULTS: The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. CONCLUSIONS: Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.
Adult ; Ankle Fractures/classification/etiology/radiography/*surgery ; Ankle Injuries/etiology/radiography/*therapy ; Ankle Joint/radiography/*surgery ; Aviation ; Bone Plates ; Fracture Fixation, Internal ; Fractures, Comminuted/etiology/radiography/surgery ; Fractures, Open/etiology/radiography/surgery ; Humans ; Male ; Military Personnel ; Retrospective Studies ; Young Adult

We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.
Adult ; Bone Transplantation* ; Case Report ; Endoscopy* ; Female ; Femoral Fractures/surgery* ; Femoral Fractures/radiography ; Femoral Fractures/physiopathology ; Human ; Humeral Fractures/surgery* ; Humeral Fractures/radiography ; Humeral Fractures/physiopathology ; Male ; Middle Age ; Time Factors ; Wound Healing*

PURPOSE: Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. MATERIALS AND METHODS: We observed 95 patients (mean age, 75+/-2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. RESULTS: Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001). CONCLUSION: Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.
Aged ; *Bone Nails ; Female ; Femur Neck/*radiography ; Hip Fractures/radiography/*surgery ; Humans ; Male ; Orthopedic Procedures/*methods ; Regression Analysis

BACKGROUND: This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures. METHODS: This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area. RESULTS: In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group. CONCLUSION: The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.
Fractures, Bone* ; Humans ; Incisor ; Korea ; Lacerations ; Male ; Mandible ; Mandibular Fractures ; Molar ; Radiography, Panoramic ; Retrospective Studies ; Seoul ; Tooth ; Tooth Root

PURPOSE: Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs. MATERIALS AND METHODS: Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used. RESULTS: Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type. CONCLUSION: In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.
Bone Density ; Emergency Service, Hospital ; Femur ; Fractures, Closed ; Hip ; Hip Fractures ; Humans ; Magnetic Resonance Imaging ; Radiography ; Retrospective Studies

A twenty-one year old man, who had been treated for medulloblastoma 6 years ago, complained progressive right knee joints pain and back pain. Multiple thoracic vertebral compression fracture was detected in radiography. The bone mineral density(BMD) was in osteoporotic range in duel energy X-ray absorpometry. Growth hormone deficiency and primary hypothyroidism were detected after endocrine function test. We treated him by cyclic intravenous pamidronate because he had complained severe back pain and difficulty to walk. After pamidronate therapy, the pain was decreased and the BMD was increased. No severe adverse effect was noted. This is the first case report of pamidronate therapy in patient who had osteoporotic vertebral compression fracture due to a sequela of childhood medulloblastoma.
Back Pain ; Bone Density ; Fractures, Compression ; Growth Hormone ; Humans ; Hypothyroidism ; Knee Joint ; Medulloblastoma* ; Radiography

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.
Adolescent ; Diving ; injuries ; Fractures, Stress ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography ; Scaphoid Bone ; injuries ; surgery

Adult ; Clavicle ; injuries ; surgery ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography