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Kümmell's disease is defined as delayed post-traumatic vertebral collapse, common in osteoporotic people with/without a trauma history. Its clinical course is progressive, and treatment modalities have to be tailored to the patient. In the literature, no staging system has been reported. Based on clinical symptomatology, radiographic and MRI imaging, a staging system for Kümmell's disease was developed. This study involved 129 Kümmell's disease patients with 348 compression fractures involving 136 vertebrae. The mean age was 72.5 ± 6.6 years, with a female to male ratio of 103 to 26. Osteoporosis is a common risk factor. Minor trauma can be traced in some of the patients. A three-stage system was proposed. Stage I: Intact or minor compression on plain X-ray films with signs of osteonecrosis on the MRI. Stage II: Body collapse with dynamic mobility, but with intact posterior body wall. Stage III: Collapse of posterior body wall with resultant cord compression. There were 19, 90 and 33 vertebrae respectively classified in Stages I, II and III. Kümmell's disease is most common threat to the thoracolumbar junction. Treatments based on clinical symptomatology and radiographic findings were well correlated with the staging system. The present staging system therefore seems appropriate to describe the natural course of Kümmell's disease and to guide management policy.

This in vitro biomechanical study reports on a new implant, called an intravertebral expandable pillar (IVEP). The implant is aimed at restoring the height and strength of collapsed vertebra after fracture in an osteoporotic patient. The hypothesis is that the IVEP can effectively restore the body height of the compressed vertebra and provide proper stiffness for the collapsed vertebra. Although the reported complication rate of percutaneous vertebroplasty by injection of polymethylmethacrylate (PMMA) is low, the sequelae are severe; other potential adverse effects of PMMA injection into the vertebral body include thermal necrosis of the surrounding tissue caused by a high polymerization temperature, and lack of long-term biocompatibility. We test the mechanical properties before and after fracture of 14 human cadaver lumbar vertebrae by a material testing system. The fractured vertebra was implanted with the IVEP, and its mechanical properties tested. The vertebral body height at each stage was evaluated by a digital caliper and radiographic films. After IVEP implantation, the vertebral body height restoration rate was 97.8%. The vertebral body height lost 12.7% after the same loading to create fracture. The vertebra lost half of its strength after compressed fracture, while IVEP implantation restored 86.4% of intact vertebra strength. The stiffness of intact vertebrae was significantly greater than that of untreated vertebrae after fracture and fractured vertebrae with IVEP treatment, while the stiffness of fractured vertebrae after IVEP treatment was significantly greater than that of untreated vertebrae after fracture. The bipedicularly implanted IVEP restores the initial height and strength of the vertebral body following an induced compression fracture, and could be used by a minimally invasive procedure to treat lumbar vertebra compression factures and avoid the disadvantage of using bone cement in vertebroplasty or kyphoplasty.

We report two rare cases of existing or worsening symptoms due to Kienböck’s disease after distal radius fracture (DRF). During examination, radiographs show changes in the lunate bone; there was persistent wrist pain after treatment for DRF. In each case, surgeries were performed: A combined therapy (bone marrow transfusion, bone peg graft, external fixation, and low intensity pulsed ultrasound) for one, as well as carpal coalition for another. The etiology of these case presentations suggest that a compression fracture of the lunate due to a DRF resulted in softening and sclerosis.

This paper describes an image analysis method that uses automatic algorithms for the evaluation of 3D geometry of vertebral bones and spinal anatomic curve in the diagnosis of compression and burst fractures. The method uses a radial B-spline curve to approximate the ellipse-like vertebral body on a transverse section with a concave feature to evaluate the compression of the canal, and infers the anatomic curve of a vertebral body by linearly regressing the centers of B-spline approximate ellipse-like boundaries of the transversal sections passing the vertebral body. This method, then, calculates the reduced angle and height for recovering the compression fracture by comparing the regressed centerlines of neighboring bodies of the fracture body with the normal spinal anatomic curve. The prototype system can be used as a qualitative and quantitative tool for the diagnosis of compression and burst fractures using transverse sections, and for the instruction to plan accurate surgical procedures. An example demonstrates the fractured spine can be accurately diagnosed and instructed to operate by our method that achieved anatomic stability, released the syndrome of nerve compression and bone pain.