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John A Eisman - One of the best experts on this subject based on the ideXlab platform.
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a meta analysis of the association of Fracture risk and body mass index in women
Journal of Bone and Mineral Research, 2014Co-Authors: Helena Johansson, John A Kanis, Anders Oden, E V Mccloskey, Roland Chapurlat, Claus Christiansen, S R Cummings, Adolfo Diezperez, John A EismanAbstract:Several recent studies suggest that obesity may be a risk factor for Fracture. The aim of this study was to investigate the association between body mass index (BMI) and future Fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic Fractures (6457 hip Fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic Fractures (81%) and hip Fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic Fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic Fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic Fracture, but is a protective factor for lower leg Fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) Fracture. When adjusted for BMD, low BMI remained a risk factor for hip Fracture but was protective for osteoporotic Fracture, tibia and Fibula Fracture, distal forearm Fracture, and upper arm Fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm Fracture but was also a risk factor for all osteoporotic Fractures. The association between BMI and Fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility Fracture. The contribution of increasing population rates of obesity to apparent decreases in Fracture rates should be explored. © 2014 American Society for Bone and Mineral Research.
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a meta analysis of the association of Fracture risk and body mass index in women
Journal of Bone and Mineral Research, 2014Co-Authors: Helena Johansson, John A Kanis, Anders Oden, E V Mccloskey, Roland Chapurlat, Claus Christiansen, S R Cummings, Adolfo Diezperez, John A EismanAbstract:Several recent studies suggest that obesity may be a risk factor for Fracture. The aim of this study was to investigate the association between body mass index (BMI) and future Fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic Fractures (6457 hip Fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic Fractures (81%) and hip Fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic Fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic Fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic Fracture, but is a protective factor for lower leg Fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) Fracture. When adjusted for BMD, low BMI remained a risk factor for hip Fracture but was protective for osteoporotic Fracture, tibia and Fibula Fracture, distal forearm Fracture, and upper arm Fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm Fracture but was also a risk factor for all osteoporotic Fractures. The association between BMI and Fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility Fracture. The contribution of increasing population rates of obesity to apparent decreases in Fracture rates should be explored.
Thomas Muckley - One of the best experts on this subject based on the ideXlab platform.
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biomechanical comparison of a lateral polyaxial locking plate with a posterolateral polyaxial locking plate applied to the distal Fibula
Foot and Ankle Surgery, 2014Co-Authors: J Hallbauer, A Grafenstein, Claudia Beimel, Sascha Rausch, Felix Wipf, G.o. Hofmann, Kajetan Klos, Thomas MuckleyAbstract:Abstract Background Polyaxial locking plates are becoming popular for the fixation of distal Fibula Fractures. This study establishes how construct stiffness and plate loosening, measured as range of motion, differs between lateral and posterolateral plate location. Methods Seven matched pairs of cadaver Fibulae were osteotomized in standardized fashion to produce a Weber type B distal Fibula Fracture. The fragments were fixated with an interfragmentary lag screw and polyaxial locking plates, with one Fibula in each pair receiving a posterolateral anti-glide-plate, and the other a lateral neutralization-plate. In a biomechanical test, the bending and torsional stiffnesses of the constructs and the ranges of motion (ROM) were measured and subjected to a paired comparison. Results The laterally plated group had a higher median (interquartile range) bending stiffness (29.2 (19.7)N/mm) and a smaller range of motion (2.06 (1.99)mm) than the posterolaterally plated group (14.6 (20.6)N/mm, and 4.11 (3.28)mm, respectively); however, the results were not statistically significant ( p bending =0.314; p ROM =0.325). Similarly, the torsional stiffness did not differ significantly between the two groups (laterally plated: 426 (259)Nmm/°; posterolaterally plated: 248 (399)Nmm/°; p torsion =0.900). The range of motion measurements between the two groups under torsional loading were also statistically insignificant (laterally plated: 8.88 (6.30)mm; posterolaterally plated: 15.34 (12.64)mm; p ROM =0.900). Conclusion In biomechanical cadaver-model tests of Weber type B Fracture fixation with polyaxial locking plates, laterally plated constructs and posterolaterally plated constructs performed without significantly difference. Therefore, other considerations, such as access morbidity, associated injuries, patient anatomy, or surgeon's preference, may guide the choice of plating pattern. Further clinical studies will be needed for the establishment of definitive recommendations. Clinical relevance : Information on the behavior of polyaxial locking plates is relevant to surgeons performing internal fixation of distal Fibula Fractures.
Edward Ebramzadeh - One of the best experts on this subject based on the ideXlab platform.
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distal Fibula Fracture fixation biomechanical evaluation of three different fixation implants
Foot and Ankle Surgery, 2016Co-Authors: Ashleen R Knutsen, Sophia N Sangiorgio, Steve Zhou, Tibor Warganich, Thomas G Harris, John Fleming, Edward EbramzadehAbstract:Abstract Background The goal of this study was to evaluate the biomechanical performance of three distal Fibula Fracture fixation implants in a matched pair cadaveric Fibula model: (1) a 5-hole compression plate with lag screw, (2) a 5-hole locking plate with lag screw, and (3) the 6-hole tabbed-plate with locking screws. Methods Three-dimensional motions between the proximal and distal Fibular segments were measured under cyclic valgus bending, cyclic compressive axial loading, and cyclic torsional external-rotation loading. During loading, strains were measured on the surfaces of each Fibula near the simulated Fracture site, and on the plate, to assess load transfer. Bone quality was quantified globally for each donor using bone mineral density (BMD) measured using Dual X-ray absorptiometry (DEXA) and locally at the Fracture site using bone mineral content (BMC) measured using peripheral quantitative computed tomography (pQCT). Results Mean failure loads were below 0.2Nm of valgus bending and below 4Nm of external-rotational torque. Mean failure angulation was below 1degree for valgus bending, and failure rotation was below 7degrees for external-rotation. In the compression plate group, significant correlations were observed between bone quality (global BMD and local BMC) and strain in every one of the five locations (Pearson correlation coefficients >0.95, p Conclusions Overall, the tabbed-plate had similar construct stability and strength to the compression and locking plates. However, the distribution of load with the locking and tabbed-plates was not as heavily dependent on bone quality.
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distal Fibula Fracture fixation biomechanical evaluation of three different fixation implants
Foot and Ankle Surgery, 2016Co-Authors: Ashleen R Knutsen, Sophia N Sangiorgio, Steve Zhou, Tibor Warganich, Thomas G Harris, John Fleming, Edward EbramzadehAbstract:Abstract Background The goal of this study was to evaluate the biomechanical performance of three distal Fibula Fracture fixation implants in a matched pair cadaveric Fibula model: (1) a 5-hole compression plate with lag screw, (2) a 5-hole locking plate with lag screw, and (3) the 6-hole tabbed-plate with locking screws. Methods Three-dimensional motions between the proximal and distal Fibular segments were measured under cyclic valgus bending, cyclic compressive axial loading, and cyclic torsional external-rotation loading. During loading, strains were measured on the surfaces of each Fibula near the simulated Fracture site, and on the plate, to assess load transfer. Bone quality was quantified globally for each donor using bone mineral density (BMD) measured using Dual X-ray absorptiometry (DEXA) and locally at the Fracture site using bone mineral content (BMC) measured using peripheral quantitative computed tomography (pQCT). Results Mean failure loads were below 0.2Nm of valgus bending and below 4Nm of external-rotational torque. Mean failure angulation was below 1degree for valgus bending, and failure rotation was below 7degrees for external-rotation. In the compression plate group, significant correlations were observed between bone quality (global BMD and local BMC) and strain in every one of the five locations (Pearson correlation coefficients >0.95, p Conclusions Overall, the tabbed-plate had similar construct stability and strength to the compression and locking plates. However, the distribution of load with the locking and tabbed-plates was not as heavily dependent on bone quality.
Selene G Parekh - One of the best experts on this subject based on the ideXlab platform.
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the use of modern intramedullary nailing in distal Fibula Fracture fixation
Foot and Ankle Specialist, 2018Co-Authors: Joseph Tracey, Tyler J Vovos, Danny Arora, Samuel B Adams, Selene G ParekhAbstract:Background. Lateral malleolus (LM) fixation is necessary for unstable ankle Fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for...
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biomechanical comparison of 4 different lateral plate constructs for distal Fibula Fractures
Foot & Ankle International, 2013Co-Authors: Tobin T Eckel, Prashanth Anand, Richard R. Glisson, Selene G ParekhAbstract:Background:Displaced lateral malleolar Fractures are often treated with reduction and surgical stabilization. However, there has not been a comprehensive laboratory comparison to determine the most appropriate device for treating these patients. This study subjected a range of contemporary lateral Fibular plates to a series of mechanical tests designed to reveal performance differences.Methods:Forty fresh frozen lower extremities were divided into 4 groups. A Weber B distal Fibula Fracture was simulated with an osteotomy and stabilized using 1 of 4 plate systems: a standard Synthes one-third tubular plate with interfragmentary lag screw, a Synthes LCP locking plate with lag screw, an Orthohelix MaxLock Extreme low-profile locking plate with lag screw, or a TriMed Sidewinder nonlocking plate. Controlled monotonic bending and cyclic torsional loading were applied and bending stiffness, torsional stiffness, and Fracture site motion were quantified. Resistance to cyclic torsional loading was determined by qua...
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biomechanical comparison of 4 different lateral plate constructs for distal Fibula Fractures
Foot & Ankle International, 2013Co-Authors: Tobin T Eckel, Prashanth Anand, Richard R. Glisson, Selene G ParekhAbstract:BACKGROUND: Displaced lateral malleolar Fractures are often treated with reduction and surgical stabilization. However, there has not been a comprehensive laboratory comparison to determine the most appropriate device for treating these patients. This study subjected a range of contemporary lateral Fibular plates to a series of mechanical tests designed to reveal performance differences. METHODS: Forty fresh frozen lower extremities were divided into 4 groups. A Weber B distal Fibula Fracture was simulated with an osteotomy and stabilized using 1 of 4 plate systems: a standard Synthes one-third tubular plate with interfragmentary lag screw, a Synthes LCP locking plate with lag screw, an Orthohelix MaxLock Extreme low-profile locking plate with lag screw, or a TriMed Sidewinder nonlocking plate. Controlled monotonic bending and cyclic torsional loading were applied and bending stiffness, torsional stiffness, and Fracture site motion were quantified. Resistance to cyclic torsional loading was determined by quantifying the number of loads withstood before excessive rotation occurred. Correlation between bone mineral density and each of the mechanical measures was determined. RESULTS: There was no difference in angulation or bending stiffness between plates. All plates except the LCP showed greater lateral deflection than in the other bending directions. Bending stiffness was lowest in lateral distal fragment deflection for all 4 plates. There was a positive correlation between bone mineral density and bending stiffness for all plate types. There was no difference in Fracture site rotation between plate types in internal or external torsion, but internal rotation of the distal fragment consistently exceeded external rotation. Torsional stiffness in external rotation exceeded stiffness in internal rotation in nearly all specimens. LCP plates performed relatively poorly under cyclic torsion. CONCLUSIONS: Significant differences in plate performance were not demonstrated. The effects of bone quality variability and differences in interfragmentary screw purchase resulted in data dispersion that confounded absolute ranking of plate performance. CLINICAL RELEVANCE: Identification of an optimal lateral Fibular plating system has the potential to improve the clinical outcome of malleolar Fracture fixation, particularly when patient conditions are unfavorable.
Palanisamy Ramesh - One of the best experts on this subject based on the ideXlab platform.
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achilles tendon rupture with open distal tibia and Fibula Fracture
Foot and Ankle Specialist, 2011Co-Authors: Gareth Nicholas Hill, Richard Barksfield, Palanisamy RameshAbstract:The authors present a previously unreported case of an open Fracture of the distal tibia and Fibula with associated Achilles tendon rupture in a 27-year-old motorcyclist. Management followed established trauma principles of wound exploration, debridement, and stabilization of the Fracture with reamed locked intramedullary nailing of the tibia. The injury to the Achilles tendon was not identified until surgical exploration for fixation of the Fracture. This required a 2-stage operative approach, involving initial debridement and Fracture fixation followed by Achilles tendon repair during the second-look wound review procedure. The authors believe this to be the first reported case of Achilles tendon rupture in association with an open transverse distal tibia Fracture. Prior to surgical exploration of the wound, Achilles tendon rupture was not suspected, emphasizing the need for clinical suspicion, thorough examination, and adequate wound exploration at operation for Fracture fixation.