Alendronato administrado en el foco de fractura: Estudio experimental en conejos / Alendronate administered at the fracture site. Experimental study in rabbits

Introducción: El objetivo de este estudio experimental fue evaluar el resultado radiológico e histológico del empleo de alendronato colocado localmente en el foco de fracturas de fémur en conejos. Materiales y Métodos: Se utilizaron 30 conejos a los cuales se les fracturó el fémur derecho y se los dividió en tres grupos de 10 animales cada uno. A los conejos del grupo 1 se les colocó una solución con alendronato en el foco de fractura; los del grupo 2 fueron sometidos al mismo procedimiento a los siete días de la fractura y el grupo 3 era de control. Se realizó la evaluación radiográfica en el momento de la fractura y a los 42 días del procedimiento. Se evaluaron las características del callo óseo mediante anatomía patológica, radiología y tomografía computarizada. Resultados: Se evaluaron 24 conejos (2 conejos del grupo 2 y 4 del grupo 3 murieron). El análisis histológico reveló moderada formación ósea en los tres grupos, sin diferencias estadísticamente significativas (p = 0,8336). Según los resultados de los estudios por imágenes, no existieron diferencias estadísticamente significativas en el tamaño del callo óseo entre los grupos para los dos estudios (radiografía: p = 0,777 y tomografía: p = 0,349). Conclusión: El alendronato colocado localmente en el foco de fractura, en la etapa aguda y luego de una semana, no alteró, de manera estadísticamente significativa, el proceso normal de consolidación, determinado por anatomía patológica y radiología, a las seis semanas de la fractura de fémur en conejos. Nivel de Evidencia: II

Introduction: The aim of this experimental study was to evaluate the radiologic and histological results of the use of alendronate administered locally at the fractures site in rabbits. Methods: The fractured right femur of 30 rabbits was used for evaluation. The animals were distributed in three groups of 10 rabbits each. A solution with alendronate was placed at the fracture site in group 1; the same procedure was performed 7 days after the fracture in group 2, and group 3 functioned as control. Radiographic evaluation was performed at the time of the fracture and at day 42. Radiological, PA and CT-scan evaluations of bone callus characteristics in each rabbit were performed. Results: Twenty-four rabbits were evaluated (2 rabbits in group 2 and 4 in group 3 died). Histological evaluation evidenced moderate bone formation in the three groups without statistically significant differences (p=0.8336). Concerning imaging studies, there were no statistically significant differences in the size of bone callus among groups for both studies (X-rays: p=0.777 and CT: p=0.349). Conclusion: The use of alendronate administered locally at the fracture site, in the acute period and after one week, did not alter the normal consolidation process determined by PA and radiology, six weeks after femur fracture in rabbits. Level of Evidence: II

Displasia fibrosa ósea / Fibrous dysplasia of bone

La displasia fibrosa ósea es un trastorno no hereditario del desarrollo esquelético caracterizado por una proliferación anormal de fibroblastos y diferenciación deficiente de osteoblastos que conduce a un reemplazo del tejido óseo esponjoso por tejido conectivo fibroso. Es producida por una mutación somática activadora del gen GNAS1 que induce una activación y proliferación de células mesenquimales indiferenciadas con formación de tejido fibroso y trabéculas óseas anómalas. Existen formas monostóticas, poliostóticas y craneofaciales con diversos grados de dolor, deformidades y fracturas óseas, aunque muchos casos son asintomáticos. En ocasiones se producen quistes óseos aneurismáticos, hemorragias, compromisos neurológicos y raramente osteosarcomas. Algunos casos se asocian a síndrome de McCune-Albright, síndrome de Mazabraud y a osteomalacia por hipofosfatemia por pérdida tubular renal inducida por el FGF23 producido por el tejido displásico. Los hallazgos en las radiografías convencionales son característicos, aunque variables y de carácter evolutivo. La gammagrafía ósea es la técnica de imagen con mayor sensibilidad para determinar la extensión de la enfermedad. El diagnóstico diferencial incluye múltiples lesiones óseas de características similares y en raras ocasiones se requiere biopsia ósea o estudio genético para confirmarlo. No existe un consenso unánime acerca del abordaje terapéutico de estos pacientes, razón por la cual es necesario un enfoque multidisciplinario. La conducta puede ser expectante o quirúrgica según el tipo de lesiones y es importante el manejo del dolor y de las endocrinopatías asociadas. La mayor experiencia publicada se refiere al uso de bifosfonatos y, más recientemente, denosumab. Los tratamientos actuales son insuficientes para modificar el curso de la enfermedad y es necesario el desarrollo de nuevas moléculas que actúen específicamente en el gen GNAS1 o sobre las células mesenquimales afectadas. (AU)

Fibrous dysplasia of bone is a noninherited developmental anomaly of bone characterized by abnormal proliferation of fibroblasts and differentiation of osteoblasts that cause a replacement of trabeculous bone by fibrous connective tissue. It is caused by a somatic mutation in the GNAS1 gene, which induces an undifferentiated mesenquimal cells activation and proliferation with formation of fibrous tissue and abnormal osseous trabeculae. There are monostotic, polyostotic and craniofacial variants with different grades of bone pain, deformities and fractures, although many cases remain asymptomatic. Aneurysmal bone cysts, bleeding, neurological compromise and infrequently osteosarcoma are possible complications. Some cases are associated to McCune-Albright syndrome, Mazabraud syndrome or hypophosphatemia and osteomalacia due to to renal tubular loss induced by FGF23 produced by dysplastic tissue. The findings on conventional radiography are characteristic although variable and evlolve with time. Bone scintigraphy is the most sensitive technique to evaluate the extent of disease. Differential diagnosis include several osseous lesions of similar appearance and, in some cases, bone biopsy or genetic testing may be necessary. Today, there is no consensus regarding the therapeutic approach for these patients and it is necessary a multidisciplinary medical team. Watchful waiting or surgical interventions can be indicated, depending on the type of bone lesions. Bone pain and associated endocrinopathies management are very important. Most published experience refers to the use of bisphosphonates and, more recently, denosumab. Current treatments are insufficient to modify the natural curse of the disease and therefore, new molecules with specific action on GNAS1 gene or affected mesenchymal cells are necessary. (AU)

Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model

Abstract Purpose: To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. Methods: Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. Results: Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. Conclusion: The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.

Reporte de caso y revisión de la literatura: luxofractura de codo en niños / Case report and literature review: elbow fracture dislocation in children

La luxación de codo en niños es un evento traumático muy poco frecuente descrito por primera vez por Stimson en 1900 y por Tachdjian en 1990, con una incidencia estimada que va de 3 a 6% de todas las lesiones en codo, con un pico de incidencia entre los 13 y 14 años, el trauma de codo se clasifica basándose en la dirección que toma el desplazamiento de la articulación radio ulnar proximal con el húmero, dividiéndolas en luxaciones posteriores y anteriores, siendo la primera más frecuente, ocurriendo en 95% de los casos, por otra parte las luxofracturas del codo son eventos aún más raros presentándose fractura por avulsión del epicóndilo medial con una incidencia de 25 a 36%; cóndilo lateral 4%, olécranon 1.7%, cabeza radial 8%, apófisis coronoides 3.5%, y otras 3.5%, hasta el momento no existe en la literatura un consenso sobre cómo manejar este tipo de lesiones, en especial porque hay autores que respaldan el manejo no quirúrgico, y otros que proponen el manejo quirúrgico como método definitivo; sin embargo, lo que sí se tiene claro es que un diagnóstico tardío o un manejo inoportuno puede repercutir en el crecimiento del niño llevando a serias complicaciones, de esta manera con el presente estudio pretendemos dar a reconocer nuestra experiencia en el manejo quirúrgico de estos casos tan poco frecuentes obteniendo buenos resultados.

Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.

Long Backbone Fracture Caused by Blunt Force: 99 Cases Analysis / 法医学杂志

OBJECTIVE@#To investigate the main point of long backbone fracture caused by blunt force in forensic clinical identification and to provide a reference for the inspection and appraisal practices of such injury.@*METHODS@#Ninety-nine cases of adult long backbone fractures were collected from January 2006 to December 2013 in Gutian County of Fujian Province. According to the terms of fracture location, mode of injury, type, the data were summarized.@*RESULTS@#In the 99 cases, there were 36 cases caused by hitting, kicking, and falling and 63 cases caused by vehicle collision. The majority of the former was ulna, and those of the latter were tibia and fibula. The types of fracture were transverse one, short oblique one, long oblique one, and spiral one.@*CONCLUSION@#Different types of long backbone fracture, not only causing stress load of fractures as well as structural differences related to each segment.

Epidemiologia dos traumas de face do serviço de cirurgia plástica e queimados da Santa Casa de Misericórdia de São José do Rio Preto / Epidemiology of facial trauma at the plastic surgery and burns service of the Santa Casa de Misericórdia de São José do Rio Preto

Introdução: O trauma é um dos principais problemas de saúde pública em todos os países, sendo os que acometem a região facial muito frequentes. O presente trabalho objetiva avaliar dados epidemiológicos de pacientes que sofreram trauma de face com fratura. Métodos: Estudo epidemiológico realizado por meio dos prontuários de 92 pacientes. Foram selecionados indivíduos com trauma facial de qualquer intensidade, no período de janeiro de 2009 a janeiro de 2013, e agrupados de acordo com a etiologia e a localização das fraturas. Os dados coletados foram apresentados em valores absolutos e porcentagens. Resultados: Houve prevalência de pacientes do sexo masculino. A etiologia do trauma de face mais encontrada foi a violência interpessoal, observada na maioria dos grupos, exceto naquele acima de 45 anos, cuja predominância etiológica foi de queda e acidente de automóvel. A incidência das causas variou de acordo com a faixa etária: < 18 anos, de 19 a 25 anos, de 26 a 35 anos, de 36 a 45 anos e > 45 anos. Setenta e cinco por cento das fraturas de mandíbula foram unilaterais e 25%, bilaterais. O tratamento cirúrgico de fixação com placas foi o mais utilizado. No nosso estudo, catorze pacientes apresentaram complicação pós-cirúrgica. Conclusão: Há necessidade de um atendimento sistematizado para os traumas faciais. A variação na faixa etária encontrada entre os pacientes estudados demonstra que o trauma facial abrange indivíduos em qualquer idade, embora seja maior entre os jovens. Acreditamos que o presente estudo epidemiológico possibilitará a melhora da qualidade no atendimento aos pacientes com trauma facial.

Introduction: Trauma is a major public health problem in all countries, and injuries involving the facial region are very common. This study aims to assess the epidemiological data of patients who suffered facial trauma with fracture. Methods: Epidemiological study conducted on 92 patient records. Individuals with facial trauma of any intensity presenting between January 2009 and January 2013 were selected and grouped according to the etiology and location of fractures. Data were presented as absolute values and percentages. Results: There was a higher prevalence of male patients. The most frequent cause of facial trauma was interpersonal violence in most groups, except for those over 45 years old, for whom the predominant causes were falls and car accidents. The frequency of the causes varied according to age: <18 years, 19-25 years old, 26-35 years old, 36-45 years and> 45 years. Seventy-five percent of mandibular fractures were unilateral and 25% bilateral. Surgical fixation with plates was the most common treatment. In our study, fourteen patients had postoperative complications. Conclusion: There is a need for systemized care for facial trauma. The variation in the age range found among the studied patients demonstrates that facial trauma includes individuals of any age, although it is more common among young people. We believe that this epidemiological study will enable the improvement of the quality of care for patients with facial trauma.

Efeito do enxerto ósseo corticoesponjoso na osteogênese em falha cortical ulnar de galinhas domésticas (Gallus domesticus) / Effect of cortico-cancellous bone grafting in osteogenisis of cortical ulnar failure of domestic chickens (Gallus domesticus)

O objetivo do estudo foi avaliar o efeito do enxerto ósseo corticoesponjoso na osteogênese em falha cortical ulnar de galinhas domésticas. Foram utilizadas 18 galinhas, com aproximadamente 70 semanas de idade e peso corpóreo médio de 2,5kg. Criou-se uma falha óssea na porção diafisária média da ulna em ambas as asas, sendo a direita utilizada como grupo-controle (grupo I) e a esquerda como grupo-tratado (grupo II). As aves foram subdivididas aleatoriamente em quatro subgrupos de acordo com o período de observação (14, 35, 60 e 90 dias). No grupo II, dois fragmentos ósseos da carena do esterno foram retirados, seccionados e implantados na falha óssea. Ao término do período de observação de cada subgrupo, as aves foram abatidas com tiopental sódico para realização dos exames histopatológico e radiográfico post-mortem, com classificação dos resultados em escala semiquantitativa (escore). O grupo II demonstrou osteogênese mais evidente aos 35 e 90 dias de pós-cirúrgico (P<0,05). Ao comparar os grupos I e II, sem levar-se em consideração o tempo de observação, foi possível observar que houve diferença estatística significativa (P<0,05). Conclui-se que o enxerto ósseo corticoesponjoso demonstra potencial osteogênico satisfatório na espécie estudada, entretanto retarda o tempo de remodelação óssea quando aplicado sobre falhas estáveis pequenas.

The aim of this survey was to evaluate the effect of cortico-cancellous bone grafting in osteogenesis in cortical ulnar failure in domestic chickens. Eighteen chickens weighing 2.5kg with approximately 70 weeks of age were used. A bone defect in the middle portion of the ulna shaft was created in both wings; the right wing in the control group (Group I) and the left in the treated group (Group II). The birds were randomly divided into four subgroups according to the observation period (14, 35, 60 and 90 days). In group II, two bone fragments of the keel of the sternum were removed, sectioned and implanted in the bone defects. At the end of the observation period for each subgroup, the birds were euthanaized with sodium thiopental to perform the histopathological and radiographic postmortem, with ranking of results in a semi-quantitative scale (score). Group II showed a more evident osteogenisis at 35 and 90 days after surgery (P<0.05). In comparing both groups, without time observation, there was statistical difference (P<0.05). In conclusion, the cortico-cancellous bone graft demonstrated satisfactory osteogenic potential in the specie studied, however, it delays the bone remodeling time when applied in stable small failures.

Forensic identification of 50 phalangeal fracture cases / 法医学杂志

OBJECTIVE@#To study the characteristics of forensic identification of phalangeal fracture and to use a combination of medical records, imaging materials, and forensic examination data in identification.@*METHODS@#Fifty cases of phalangeal fracture involved in the forensic identification were collected from 2009 to 2011. The general situation, the distribution of fracture, the fracture morphology, the injury-causing objects and the results of identification were analyzed retrospectively.@*RESULTS@#Majority of the cases of phalangeal fracture were young and middle-aged men. The index finger and distal phalanx fractures were common. There was no difference in the number of phalangeal fracture between left and right hand. Most of the injury-causing objects were knives and sticks, followed by bricks and stones.@*CONCLUSION@#The injury-causing objects and modes are related to the morphology of fracture, the distribution of fracture and the severity of the injury. The comprehensive analysis is helpful in forensic identification of phalangeal fracture.

Analysis of 12 death cases of medical tangles after trauma / 法医学杂志

OBJECTIVE@#To explore the main problems and ideas in the death cases of medical tangles after trauma.@*METHODS@#Twelve death cases of medical tangles after trauma were selected from a forensic science institute during recent six years. Traumatic conditions, medical malpractices and contribute degree of malpractice were estimated and analyzed.@*RESULTS@#The reasons of trauma included accidents and intentional injury. Among these cases, there were 10 involved in malpractice, of which 7 cases played secondary role.@*CONCLUSION@#Diagnosis, symptom observation and emergency therapy are the important keys for determining the responsibility in death cases of medical tangles after trauma.

Comparison of four imaging examinations of shoulder joint injury in forensic expertise / 法医学杂志

OBJECTIVE@#To compare the value of four imaging examinations, including the X-ray, CT, MRI and gas-iodine double contrast CT analyses, in the forensic expertise of shoulder joint injury.@*METHODS@#Imaging data of shoulder joint injury, by the X-ray, CT, MRI and gas-iodine double contrast CT were retrieved and analyzed.@*RESULTS@#The correct diagnosis rates of fracture and soft tissue injury by X-ray, CT and MRI were 52.8%, 72.0% and 63.2%, as well as 0.0%, 32.9% and 82.5%, respectively. The correct diagnosis rate of soft tissue injury by gas-iodine double contrast CT was 100%.@*CONCLUSION@#X-ray is a useful screening method, CT is better for diagnosis of fracture, and MRI is fit for diagnosis of soft tissue injury. Gas-iodine double contrast CT can reflect not only the soft tissue injury but also its severity. Thus, combined application of X-ray, CT, MRI and gas-iodine double contrast CT can provide important imaging information for forensic expertise in shoulder joint injury.

Three-dimensional scanning with dual-source computed tomography in patients with acute skeletal trauma

OBJECTIVE: The aim of this study was to compare the efficiency of multiplanar reformatted images and threedimensional images created after multidetector computed tomography examination in detecting acute posttraumatic osseous pathology of the skeletal system. METHOD: Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R-I), and six months after this initial evaluation, three-dimensional images were assessed of each patient (R-II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies. RESULTS: The R-II score was higher in the non-articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R-I data was more significant In patients referred with polytrauma, R-II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time. CONCLUSION: By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries.

Measuring angles on digitalized radiographic images using Microsoft PowerPoint / La medición de ángulos en las imágenes radiográficas digitalizadas, mediante el uso de Microsoft PowerPoint

OBJECTIVE: To introduce the " virtual goniometer" , a method of measuring angles on digital images using Microsoft PowerPoint, a readily available and inexpensive software programme. METHODS: Twenty-six X-rays of scoliosis curves were photographed with a digital camera. Six examiners measured the angles of curvature on their computers using the goniometer (Set 1). Under a blinded protocol, repeated measurements on these digitalized X-rays were done three weeks later (Set 2). Intra-observer differences were analyzed. To assess validity, four examiners also measured the angles using the Cobb method. Measurements achieved by both methods were analyzed by the paired samples t-test. To assess inter-observer differences, the Pearson correlation coefficient was calculated. RESULTS: Pearson correlation coefficients were significant, r (24) $ 0.975, p < 0.001. For intra-observer variability, the average 95% CI range was 2.23 degrees between Set 1 and Set 2. The average 95% CI range was 2.38 degrees for the difference between the digital and Cobb methods. CONCLUSIONS: Clinicians using this technique can reliably assume that repeated measurements of scoliosis curvatures will vary in the range of less than 3 degrees. The 95% CI range for intra-observer variability, an index of the technique’s repeatability, was $ 2.4 degrees. A high correlation of measurements can also be expected between different observers with the goniometer. This new technique allows practitioners to utilize an easily accessible computer programme to evaluate angular deformities on digitalized radiographic images accurately and hence reliably make clinical decisions based on these measurements.

OBJETIVOS: Introducir el " goniómetro virtual" , un método de medición de ángulos sobre imágenes digitales usando Microsoft Power Point, un programa de software no costoso y fácilmente disponible. MÉTODOS: Veintiséis rayos X de curvas de escoliosis fueron fotografiados con una cámara digital. Seis examinadores midieron los ángulos de curvatura en sus computadoras usando el goniómetro (Set 1). Bajo un protocolo ciego, se realizaron mediciones repetidas de estos rayos X digitalizados, tres semanas más tarde (Set 2). Se analizaron las diferencias intra-observador. Para evaluar la validez, cuatro examinadores también midieron los ángulos usando el método de Cobb. Las mediciones logradas por ambos métodos fueron analizadas mediante la prueba de t de muestras pareadas. Para evaluar las diferencias inter-observador, se calculó el coeficiente de correlación de Pearson. RESULTADOS: Los coeficientes de correlación de Pearson fueron significativos, r (24) $ 0.975, p < 0.001. Para la variabilidad intra-observador, el 95% promedio del rango del CI fue de 2.23 grados entre el Set 1 y el Set 2. El 95% promedio del rango del CI fue de 2.38 grados para la diferencia entre el método digital y el método de Cobb. CONCLUSIONES: Los clínicos que usen esta técnica, pueden con toda confiabilidad asumir que las mediciones repetidas de las curvaturas de escoliosis variarán en un rango menor de 3 grados. El 95% del rango del CI para la variabilidad intra-observador Â- un índice de la repetibilidad de la técnica Â- fue $ 2.4 grados. También puede esperarse una alta correlación de las mediciones, entre diferentes observadores con el goniómetro. Esta nueva técnica permite a los practicantes utilizar un programa de computación fácilmente accesible a fin de evaluar con precisión las deformidades angulares en imágenes radiográficas digitalizadas, y tomar por lo tanto decisiones clínicas de modo confiable a partir de estas mediciones.

Fractura en hueso patológico como factor pronóstico de sobrevida en mieloma múltiple de alta masa celular / Pathological fracture as a prognostic factor of survival in multiple myeloma of high celular mass

El mieloma múltiple es una neoplasia de las células plasmáticas que ha permanecido incurable y que tiene como complicaciones la destrucción ósea, la falla renal, la hipercalcemia y la hiperuricemia. El objetivo principal del trabajo fue establecer un factor pronóstico de sobrevida de acuerdo al perfil temporal de presentación de la fractura en hueso patológico. De un total de 96 casos, se revisaron retrospectivamente 79 pacientes diagnosticados como mieloma múltiple de alta masa celular en el Hospital Dr. Gustavo Fricke, entre enero del 1996 y septiembre del 2005. Se encontró una sobrevida promedio de 25 meses y una distribución de la patología según el sexo de 1:1. Sin embargo, los hombres tuvieron la mitad de sobrevida que las mujeres. Así también se encontró que un tercio de los pacientes presentó la fractura o falta renal como debut del mieloma, teniendo una sobrevida significativamente menor.

Pseudoartrosis de acromión tras politraumatismo tratamiento con autoinjerto intercalar y de cresta iliaca / Pseudoarthrosis of acromion due to politrumatism: treatment with autologus graffting intercalar of iliac crest

Las fracturas de la escápula son poco frecuentes una incidencia en torno al 0,4 Y el 1 % de las fracturas que afectan al miembro superior. La fractura de acromion comprende el 7% de las fracturas que afectan a la escápula'. Suelen aparecer en pacientes politraumatizados con lesiones más graves que pueden enmascararlas y post-poner de este modo su diagnóstico y tratamiento. Presentamos un caso clínico de una paciente de 56 años de edad con antecedente de politraumatismo. Que presentaba unas pseudo-artrosis francas del proceso acromial de su hombro derecho con clínica dolorosa y limitación de movimiento.Se trató de manera quirúrgica mediante el aporte de injerto óseo intercalar y fijación mediante placa de osteo-síntesis obteniendo buenos resultados clínico radiológicos a día de hoy. La clínica dolorosa ha desaparecido por completo a día de hoy.

The fractures of the scapula are not very frequent, an incidence around the 0,4 and 1 % of the fractures that affect the upper limb

Analysis on the injury by lock-against-theft / 法医学杂志

Nowdays, it is common seen that criminals tend to use the lock-against-theft for motorcycle to harm others as a tool. In order to find out the chief characters of this kind of injury, 28 cases in which victims were hurt by lock-against-theft for motorcycle were analyzed. In each case, the victims carefully questioned to confirm the damage procedure. Furthermore, the wound configuration was observed and the forming mechanism was deduced to provide morphological evidences for the judgement in this kind of case.

The application of radiological image in forensic medicine / 法医学杂志

Personal identification is an important work in forensic investigation included sex discrimination, age and stature estimation. Human identification depended on radiological image technique analysis is a practice and proper method in forensic science field. This paper intended to understand the advantage and defect by reviewed the employing of forensic radiology in forensic science field broadly and provide a reference to perfect the application of forensic radiology in forensic science field.

Applicational study of 3D reconstruction with spiral computed tomography in evaluation of anatomical complicated bones fracture / 法医学杂志

OBJECTIVE@#To investigate forensic diagnosis application of three-dimentional reconstruction with spiral computed tomography in fracture of anatomical complicated bones.@*METHODS@#Selected eleven patients of bone fracture who were examined with SCT 3D and conventional X-ray examination. The location, number and characteristics were observed and analyzed.@*RESULTS@#In all of eleven patients with bone fractures, X-ray examination could detect thirty-four rib fracture, one scapula fracture, two nasal fracture, one metacarpal bone incomplete fracture and one left tibia-fibula fracture, one pubis fracture. While there were forty-seven rib fracture, one scapula smash fracture, one nasal fracture with obvious displacement and eliminate one misplace, one left tibia-fibula obsolete fracture and one sacroiliac joint dislocation, one No 5 lumbar vertebrae pedicle of vertebrae arch fracture. Combining 3D reconstruction images, coronary and sagittal reconstruction images could show clearly the fracture line, location of fracture, number of fracture, displacement and recovery.@*CONCLUSION@#3D reconstruction technique of SCT is a very useful examination method in the objective forensic diagnosis of anatomical complicated bones fracture, it excels the routine X-ray examination.

Study of fifty human tali for calcaneal articular facets.

Fifty adult dry human tali from the Department of anatomy, Nepalgunj Medical College Chisapani, were studied. Observations were made on different types of articular facets of calcaneus for the tali. They were classified into four groups and their percentages of incidences were calculated. These findings were well correlated and compared with the literatures available.