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Aly MM, Abdelwahab OA, Atteya MME, Al-Shoaibi AM. How does vertical laminar fracture impact the decision-making in thoracolumbar fractures? A systematic scoping review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1556-1573. [PMID: 38430400 DOI: 10.1007/s00586-024-08140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF's role in the decision-making of TLFs. METHODS A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to June 11, 2023, for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI). RESULTS Twenty-eight studies were included in this systematic review, encompassing 2021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n = 14), neurological deficit (n = 4), radiographic parameters (n = 3), thoracolumbar fracture classification (n = 2), and treatment outcome (n = 2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR = 7.35, 95% CI [3.97, 14.25]; P < 0.001). The pooled OR estimates for VLF predicting dural lacerations were 7.75, 95% CI [2.41, 24.87]; P < 0.001). CONCLUSION VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes.
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
- Department of Neurosurgery, Prince Mohamed Ben Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia.
| | | | | | - Abdulbaset M Al-Shoaibi
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Martin J, Johnson NA, Shepherd J, Dias J. Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fractures. Bone Jt Open 2023; 4:612-620. [PMID: 37599008 PMCID: PMC10440191 DOI: 10.1302/2633-1462.48.bjo-2023-0058.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Aims There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.
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Affiliation(s)
- James Martin
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Nick A. Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jenny Shepherd
- School of Engineering, University of Leicester, Leicester, UK
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester, UK
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May AT, Bailly N, Sellier A, Avinens V, Huneidi M, Meyer M, Troude L, Roche PH, Dufour H, Dagain A, Arnoux PJ, Farah K, Fuentes S. Spinal Fractures during Touristic Motorboat Sea Cruises: An Underestimated and Avoidable Phenomenon. J Clin Med 2023; 12:jcm12041426. [PMID: 36835959 PMCID: PMC9967971 DOI: 10.3390/jcm12041426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. METHODS We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006-2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. RESULTS A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat's bow, without anticipating the trauma, when the ship's bow suddenly elevated while crossing another wave, resulting in a "deck-slap" mechanism hitting and propelling the patient in the air. CONCLUSIONS Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat's bow are the typical victims. Some specific biomechanical patterns are involved with the boat's deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures.
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Affiliation(s)
- Adrien Thomas May
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
- Service de Neurochirurgie, Hôpital Nord, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
- Correspondence:
| | - Nicolas Bailly
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR—Université de la Méditerranée, 13005 Marseille, France
| | | | - Valentin Avinens
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Maxime Huneidi
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Mikael Meyer
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Lucas Troude
- Service de Neurochirurgie, Hôpital Nord, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre-Hugues Roche
- Service de Neurochirurgie, Hôpital Nord, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Henry Dufour
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Arnaud Dagain
- Hôpital d’Instruction des Armées, 83000 Toulon, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR—Université de la Méditerranée, 13005 Marseille, France
| | - Kaissar Farah
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Stéphane Fuentes
- Service de Neurochirurgie, Hôpital de la Timone, Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
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Comparison of the biomechanical performance of three spinal implants for treating the wedge-shaped burst fractures. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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