Population based epidemiologic and morphologic study of femoral shaft fractures.

The epidemiologic and morphologic features of all femoral shaft fractures in skeletally mature patients treated during a 10-year period in a semi-urban county were analyzed. Among an average adult population of 202,592 residents, 192 people sustained 201 traumatic femoral shaft fractures during the study period. The incidence was 9.9 fractures per 100,000 person-years. The highest age and gender specific incidences were seen in males from 15 to 24 years of age and in females 75 years of age or older. Seventy-five percent (151) of the fractures were the result of a high-energy trauma, 131 of which occurred in road traffic accidents. Unexpectedly, there were 50 low-energy fractures. Fractures of the middle 1/3 of the diaphysis were 79%. The majority, 155 (77%), of all fractures were transverse, oblique, or oblique transverse. Regarding the degree of comminution, the Winquist and Hansen Grade 0 (noncomminuted) fracture was the most common. Forty-eight percent of fractures were AO Type A, 39% were Type B, and 13% were Type C fractures. Of the 25 open fractures, 14 were Gustilo Type II. All six Type III open injuries were Type IIIA. Based on the data from the current study, most of the femoral fractures in this community might be treated adequately with conventional intramedullary nails, rather than using interlocking nails, provided the stability of fixation and fracture alignment can be maintained. Preventive measures against femoral shaft fractures should focus on protection of automobile drivers, especially young men, and on effective treatment of osteoporosis in elderly women.

Asymmetry of paraspinal EMG-time characteristics in idiopathic scoliosis.

The purpose of this study was to investigate the activation pattern of the paraspinal muscles in scoliotic and normal subjects. Force-time and electromyography (EMG)-time curves of paraspinal muscles were recorded during maximal isometric trunk extensions in 15 girls with adolescent idiopathic scoliosis (AIS) and in 14 healthy girls with structurally normal spines. The isometric force-time curves as well as the maximal integrated electromyography (IEMG) activities that were recorded from both sides of the thoracic and lumbar spine did not show any significant differences between the two subject groups. However, in the subjects with AIS, the IEMG activities recorded at the onset and during the early (submaximal) phases of muscle contraction were significantly higher in the left lumbar muscles compared with the right side. The observed intensity-specific EMG asymmetry in the present scoliotic subjects may be attributed to the imbalanced neural input associated with AIS that may also have pathogenetic importance in the etiology of idiopathic scoliosis.

Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results.

Fourteen patients with acute or chronic patellar instability had treatment with a new reconstructive procedure. It consists of isokinetic augmentation of the medial patellofemoral ligament (PFL) by making a tenodesis of the distal adductor magnus tendon to the medial border of patella. The patients were reviewed at a mean of 6.9 +/- 0.5 years after operation. In 12 patients, the subjective result was good. One patient had redislocation.

Blunt injury patients benefiting from intensive care.

The files of 2,002 trauma patients admitted to our intensive care unit between 1966 and 1984 were analyzed. 74% of the patients were admitted because of the trauma after primary care and 26% later. The main reasons for later admissions were respiratory distress in 11% and postoperative follow-up in 8% of the cases. The series consists of blunt injury patients with a mean age of 39 years for those who survived and 52 years for those who died. 65% of the patients were injured in road traffic accidents. Injuries to the lower extremity were the most frequent (60%) and injuries to the cervical spine the least frequent (11%). The injury Sum (= sum of injuries) ranged from 1 to 18 with an average of 5.6 in the whole series. Two thirds of the patients were multiply injured. A statistical analysis showed that the most important determinants between the dead and those who survived were resuscitation, need for respirator treatment, age of the patient, amount of primary blood transfusions, brain and renal complications. The ICU mortality was 9.0% and the total hospital mortality was 11.9%.

A high incidence of spinal curvature. A study of 100 young female students.

A hundred adult female students were clinically examined for scoliosis and other spinal abnormalities. Ninety-nine per cent of them participated voluntarily in X-ray examination of the spine. Of the X-rays only 34 per cent were classified into group without spinal curvature. Mild curvature (3-10 degrees) was observed in 51 per cent and a curvature of 11 degrees or more in 15 per cent. The average angle of curvatures was 7.7 degrees. The incidence of 66 per cent of spinal curvatures exceeds what has been observed before. Rotation was observed in spinal X-ray in 86 per cent, but the average of rotation was the same both in spines with curvature or without. In grades of kyphosis and lordosis no difference was observed between the groups with spinal curvature and without. Mild scoliotic curvature and rotation of the spine must be seen as a normal phenomenon at least in females. What makes these curvatures progress during the growth period in idiopathic scoliosis remains to be clarified.