There are several disorders associated with Traumatic Brain Injury (TBI). In representingpeople with Traumatic Brain Injury, I find some or more of the Disorders contribute to difficulty handling a case. For Instance, when communication is affected, it can make gathering specific facts hard. I occasionally see facts patterns change over time; like when a client begins to confabulate (to give fictitious accounts of past events, believing they are true, in order to cover a gap in the memory caused by a medical condition such as dementia or Post-Concussion Syndrome.) Or, when memory is impaired, there may be concerns about a client getting to work, doctor appointments, or other tasks.

Another difficulty is separating out symptoms of disorders from a person’s pre-existing propensity and personality. People or entities interested in someone NOT having a Neuropsychiatric Disorder, (ie. An insurance company, defense lawyer, defendant) will usually point to a person’s pre-existing personality as a basis to argue that any claimed Neuropsychiatric Disorders are not related to Traumatic Brain Injury.

Here is a list of potential Neuropsychiatric Disorders that can result after a Traumatic Brain Injury.

·        Delirium and Post-Traumatic Confusion

·        Mood Disorders

·        Psychotic Disorders

·        Post-Traumatic Stress Disorder

·        Personality Change

·        Aggressive Disorders

·        Mild Brain Injury

·        Post Traumatic Epilepsy

Delirium and Post-Traumatic Confusion

Delirium is a state somewhere between Coma and normal consciousness. It is an abnormal state of consciousness and is characterized by inattentiveness, language and thought abnormality, motor and affective changes, and sleep cycle disturbance.

Mood Disorders

Neuropsychiatric illness is prevalent in Traumatic Brain Injury.  TBI has been dubbed the “signature wound” in much of the literature describing blast injury to soldiers in operation Iraqi Freedom and Operation Enduring Freedom in the last decade.

Psychotic Disorders

               A predisposition to psychotic illness following brain injury in childhood has been documented. There is also substantial evidence of elevated psychosis incidence among those exposed to Traumatic Brain Injury.

Post-Traumatic Stress Disorder

               Traumatic Events often precipitate acute anxiety and stress reactions. Focus on Post-Traumatic Stress Disorder has received significant attention as military personnel return from overseas deployment.

Personality Change

               Most often disputed as pre-existing, Personality Change is shown to be related to Traumatic Brain Injury. Studies of patients with TBI find that the most significant problems at 1, 5, and 15 years post-injury are personality changes.

Aggressive Disorders

               Frequently mischaracterized are the symptoms of aggression in TBI cases. But aggression has long been linked to Traumatic Brain Injury. Irritability and aggressiveness are significant disabilities for people with TBI as well as a source of stress for those around them.

Mild Brain Injury

               There are three generally accepted definitions of Mild Traumatic Brain Injury. One is from the Centers of Disease Control, another from the World Health Organization and another from the American Congress of Rehabilitative Medicine. There is overlap in these definitions. A main point is that Mild Traumatic Brain Injury can be diagnosed without a loss of consciousness. An altered state of consciousness is sufficient.

Post Traumatic Epilepsy

               Trauma is one of the most identifiable causes for the development of Epilepsy. It occurs in roughly 20% of the cases of symptomatic Epilepsy.

Concluding Thoughts

               Since these potential Disorders create a subterfuge to effective communication, representing people with Traumatic Brain Injury presents a unique set of challenges. Patience and perseverance are necessary. It is fair to suggest that most lawyers do not have specific training in Traumatic Brain Injury cases. Similarly, most physicians are not properly trained to diagnose or detect symptoms or Disorders as being caused by Traumatic Brain Injury.

               If you or someone you know has suffered Traumatic Brain Injury as a result of an accident, fall, car crash, truck collision or other event caused by another, research the attorney’s in your State and be sure to understand what they practice. For instance, my web site is http://www.titololawoffice.com. I also publish several blogs. The Brain and Spine Injury Law Blog, Truck Accident Blog, Las Vegas Injury Attorney Blog, and Tim Titolo. You can visit any of these sites and get a good idea of the type of cases I handle regularly. You can also get to know me by seeing and hearing me.

On the particular Friday morning, Sally woke early and stepped out of her small 2 room unit to smoke a cigarette. While standing outside of her unit she was brutally attacked by a trespasser. She does not remember the specifics of the attack but recalls being hit in the face. Her teeth were knocked out and she remembers seeing them with blood pouring out of her mouth while on her knees on the ground.

At the instant she was attacked, Sally’s dog, who was locked in the bedroom portion of the unit with Bill who was sleeping, began barking and trying to scratch her way to where she heard Sally’s attack. This caused the would-be burglars to flee the scene. They were never found or identified.

Budget Suites did not have adequate security. No security cameras, fences, gates, or patrols and only one security officer on the 17 acre campus.

Sally sustained traumatic brain injury and spinal injury in the attack and is permanently unable to walk without the assistance of a walker. Sally and Bill’s lives have been dramatically changed since January 23, 2009.

I became involved in the couple’s case later that year. Budget Suites denied responsibility for the injury and forced the couple to file a lawsuit. The medical bills for Sally exceeded $300,000 and Budget only offered $15,000 to compensate her. The trial began over two and a half years later and lasted five weeks. The couple was awarded over $4,000,000.

The Journal of Neuroscience recently published a study that supports relief of chronic pain as a precursor to the relief of brain injury symptoms and cognitive impairments.   Those with chronic pain also experience cognitive impairments and reduced gray matter in parts of the brain associated with pain processing and the emotional components of pain, like depression and anxiety.

Traumatic Brain Injury Attorneys must be able to distinguish cognitive impairments caused by organic brain injury from those associated with chronic pain.  A competent Traumatic Brain Injury Attorney works closely with neuropsychologists, neurodiagnosticians, and neurologists.

I returned last week from a seven day convention. The 2011 American Association of Justice Convention in New York City.  The annual event consisted of solid educational seminars put on by the brightest and most successful lawyers across the country and in Canada.

On Saturday, the Interstate Trucking Litigation Group sponsored an all day presentation by excellent experts in law and trucking.  The rules that affect litigation and legislative changes were discussed.  The group hopes to back higher insurance mandates for trucking companies and more regulation under the North American Free Trade Agreement (NAFTA) to deal with Mexico's influx of trucks on American roads near the borders.

I am on the executive board of the Traumatic Brain Injury Litigation Group, and the all day seminar featuring traumatic brain injury issues on Sunday was terrific.  

An article I wrote with Dr. Howard Friedman entitled Bearing Witness was featured in the Traumatic Brain Injury Litigation Group Newsletter.

I attended many board meetings and group meetings in which I participate such as the Inadequate Security Litigation Group, Motorcycle Litigation Group, and Products Liability Group.

I also got to visit with old and new friends from around the country who practice law, consult, offer needed legal services and more.  Of note was my dinner with Louis Siracusano, Dan Buttafuco, Ken Goldblatt and his lovely wife, Antonio Romanucci.  Many others were there too.

I also dined with Dorothy Clay Sims, and David Ball.  I had the pleasure of bringing to-go boxes of gourmet Italian food from Patsy's, in Manhattan, to two homeless men Dorothy and I found on the street.  Dorothy Clay Sims, had just received the verdict for her client Casey Anthony the day before in Florida.

I also enjoyed a meal on Arthur Avenue with the folks from the Trucking Litigation Group on Monday Night.  This group never fails to have over the top dinners with great company and food.

And of course a visit to Central Park was a must-do.  I am originally from Long Island, NY and I poke fun at myself for never having been to the Statute of Liberty.  I always took it for granted.  Maybe someday with the kids.  But I had not been to Central Park in the summer in years.  It was beautiful.

The next meeting is in Phoenix in February, a little closer to my home in Las Vegas, and I am already looking forward to a great time.

The title of the article EDITORIAL: Helmet law repeal is a horrible idea  is http://theoaklandpress.com/articles/2011/06/09/opinion/doc4df0f7e007da2700519623.txt?viewmode=default

If you're suffering from chronic lower back pain, a new review of existing research finds that spinal manipulation, the kind of hands-on regimen that a chiropractor might perform on you, is as helpful as other common treatments like painkillers.

Back pain affects 80% of Americans at some time in their lives. It comes in many forms, from lower back pain (lumbar-sacral), middle back pain, (lumbar-thoracic) or upper back pain (cervical) to low back pain with sciatica. Common back pain causes include nerve and muscular problems, degenerative disc disease, and arthritis. Many people find relief from symptoms of back pain with pain medication or pain killers.  But this is not the best way to cure what ails you.

Surveys suggest that half of working Americans suffer from back pain each year. An estimated 25 percent of American adults reported that they suffered from back pain for at least a day within the last three months, according to a 2006 Centers for Disease Control and Prevention report, and lower back pain is the fifth most common reason that people go to the doctor.

Patients frequently turn to painkillers, which can cause side effects and be addictive, or to physical therapy, which is time-consuming and expensive. The new review looks at a third option - spinal manipulation.

Blogger D. Denoon writes of the 9 Painkiller Mistakes.

They are:

• Pain Medications Mistake No.1: If 1 Is Good, 2 Must Be Better
• Pain Medications Mistake No. 2: Duplication Overdose
• Pain Medications Mistake No. 3: Drinking While Taking Pain Drugs
• Pain Medications Mistake No. 4: Drug Interactions
• Pain Medications Mistake No. 5: Drugged Driving
•  Pain Medications Mistake No. 6: Sharing Prescription Medicines
• Pain Medications Mistake No. 7: Not Talking to the Pharmacist
• Pain Medications Mistake No. 8: Hoarding Dead Drugs
• Pain Medications Mistake No. 9: Breaking Unbreakable Pills

 Consider seeing a chiropractor if you experience back or neck pain.  Even if you are referred to your family doctor, inquire of a chiropractor for treatment rather than simply taking pain medication.

A new study debunks the myth that helmets increase neck injury. A review of U.S. National Trauma Databank information on more than 40,000 motorcycle collisions between 2002 and 2006, and found that riders wearing helmets were 22 percent less likely to suffer cervical spine injury than those without helmets.

The study could prompt legislatures and lawmakers to revisit the issue of mandatory helmet laws. Over the past 15 years, a number of states have repealed their mandatory motorcycle helmet laws after lobbying from anti-helmet activists who often cite a small, 25-year-old study that suggested that the weight of a motorcycle helmet increased the risk of spine injuries. However, many experts say the study used flawed statistical reasoning.

To read more from the National Highway Traffic Safety Administration Motorcycle Safety click here.

Although golf is becoming more popular, there is a lack of reliable epidemiological data on golf injuries and overuse syndromes, especially regarding their severity.  Now a new study attempts to determine how to reduce injury from Golf.

Although golf has not been recognized as a sport associated with injuries, epidemiological studies document that back and elbow injuries are most common in male amateur golfers. Lower back and wrist injuries occur in the male golf professional while female professional golfers are more likely to suffer injuries to the wrist and lower back, respectively.  See, The frequency of golf injuries, McCarrol.

 In an effort to reduce golf injuries, many of which are treated by orthopedic surgeons, the AAOS American Association of Orthopedic Surgeons, recommends the following golf injury-prevention tips:

- Dress for comfort and make sure to wear the appropriate golf shoes; short cleats are best on the course.

- Do not hunch your neck or shoulders over the ball; it may predispose you to neck strain and rotator cuff tendinitis.

- To avoid golfer's elbow, caused by a strain of the muscles in the inside of the forearm -- perform wrist and forearm stretching exercises and try not to overemphasize your wrists when swinging.

- To avoid lower back pain caused by a poor swing -- try rowing and/or pull down exercises to improve flexibility and muscle strength. 

To return to golf after hip or knee replacement, the AAOS suggests the following safety guidelines below:

- Always warm up and stretch well before playing, but avoid undue strain on your replaced joint.

- Get back into the game slowly. Begin with chipping and putting before hitting irons and then woods. Also, it is best to play just nine holes initially; once this can be done comfortably you can try a full 18.

- Use a riding cart initially. Those who like to walk while playing should wait until they can play comfortably with a cart and then try walking. It's best to use a pull cart rather than carrying your bag.

- Be aware of weather conditions; wet weather can predispose you to falls, especially when the legs are still weak.

- Use "soft spikes" (required by most courses now) or even tennis shoes (if ground is not wet). This will reduce torque on the hip and knee.

- Don't get frustrated when you resume playing. You may not hit the ball as far as you did prior to surgery because the leg will be weak; this will get better as strength returns.

- Be careful about squatting down to line up a putt. This can put too much pressure on the knee and could possibly cause a dislocation of a hip prosthesis.

- Continue a regular exercise program to maintain as much strength in the leg as possible. 

 According to the U.S. Consumer Product Safety Commission (CPSC), more than 115,000 Americans were treated for golf-related injuries in 2009.   Be careful and enjoy the sport longer.

Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can be moderate to severe. Any part of the spine can be bent in scoliosis; but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis).

Scoliosis is thought to be caused by heredity but some other reasons are different leg lengths.  Scoliosis affects 2-3% of the population, or an estimated 6 million people in the United States, and there is no cure.

Signs and symptoms of scoliosis may include:

■Uneven shoulders
■One shoulder blade that appears more prominent than the other
■Uneven waist
■One hip higher than the other

The National Scoliosis Foundation can be contacted at  NSF@scoliosis.org  to help answer questions you may have or seek care.

 So there you have the 10 most commonly broken bones.

The positive effects of exercise while growing up seem to last longer than previously believed. New findings suggest that physical activity when young increases bone density and size, which may mean a reduced risk of osteoporosis later in life.  All men and women face the risk and dangers of osteoporosis in their lifetime. These pages help make osteoporosis understandable.
http://www.endocrineweb.com/osteoporosis/index.html.

The researchers also looked at bone density and structure in the lower leg in around 360 19-year-old men who had previously done sports but had now stopped training. They found that men who had stopped training more than six years ago still had larger and thicker bones in the lower leg than those who had never done sports.  Running was also found to benefit middle aged men.

Bones tend to adapt to the muscles around them; puny muscles can mean puny bones.   Scientists in Minnesota, using a new machine that examines bone in three dimensions and measuring the runners’ leg muscles, found that, surprisingly,  injured runners’ bones were as strong, in relation to their muscle size as the bones in the uninjured runners. But the injured runners had significantly smaller calf muscles and therefore also slighter bones.

Thicker bones are good since they are more resistant to fractures.  Since falling becomes more prevalent in older people, so do fracture causing events.  Hence the benefit.  If you are young, be SURE to exercise.  Play a sport, lift weights, and do cardiovascular work outs.   If you are not "young," you are not off the hook.  Exercising at all stages of life is beneficial.  And as we age, the circulatory system depends on cardiovascular exercise.

The researchers have established that there is a positive link between exercise while young and bone density and size. The connection is even stronger if account is taken of the type of sports done.    Running appears to be the sport of choice when it comes to fewer injuries and arthritis. 

 

- Maintain a healthy body weight.

-  If you smoke, quit. Smoking and extra weight can not only damage the spine, but are factors that can negatively impact spine surgery.

- Maintain proper posture while sitting, standing and walking.

- Use proper lifting techniques to avoid injury. Bend your knees when picking up and lowering the object, keep a straight back, and do not twist. Do not lift heavy objects that are beyond your strength ability.

- Make sure your mattress and bed pillow support your neck and back.

- Do exercises that stretch and strengthen the muscles of your abdomen and spine. Strong back and abdominal muscles can help you maintain good posture and keep your spine in its correct position.

- If you suffer from persistent, chronic, or recurring back pain, consult your doctor. In most cases there is a conservative, nonsurgical treatment that can resolve the pain. However, if left untreated or allowed to progress, back pain may lead to serious and severe disability. 

The Journal of the American College of Sports Medicine recommends an excercise machine designed specifically for back muscles as a solution.  Such exercises can only help reduce pain and disabilities caused by back pain. He recommends those who suffer severe hurt begin with stretches on the ground with low to medium effort.
 

I previously blogged about a Seven Year Study that revealed Chiropriactic was an excellent care technique.

I work with Chiropractors in appropriate cases where client care can be managed by such a physician.  These doctors often refer patients on to other specialists if the needs arise.

Low-back pain sufferers can seek relief from any number of health professionals, orthopedists, physical therapists and osteopaths among them.

Many choose chiropractors, which typically combine spinal manipulation with such treatments as exercise, massage, heat or electrical stimulation. This approach is modestly  successful in reducing pain of recent onset and improving disability, at least for a few weeks, according to a new Cochrane review. However, the review found no evidence that chiropractic works significantly better than care provided by other clinicians.

Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.

Low-back pain is one of the most common and costly musculoskeletal problems in modern society. About 80% of the population will experience low-back pain at some time in their lives. Many people with low-back pain seek the care of a chiropractor.  

For Cochrane's review, chiropractic was defined as encompassing a combination of therapies such as spinal manipulation, massage, heat and cold therapies, electrotherapies, the use of mechanical devices, exercise programs, nutritional advice, orthotics, lifestyle modification and patient education. The review did not look at studies where chiropractic was defined as spinal manipulation alone as this has been reviewed elsewhere and is not necessarily reflective of actual clinical practice. Non-specific low-back pain indicates that no specific cause is detectable, such as infection, cancer, osteoporosis, rheumatoid arthritis, fracture, inflammatory process or radicular syndrome (pain, tingling or numbness spreading down the leg).

Twelve randomised trials (including 2887 participants) assessing various combinations of chiropractic care for low-back pain were included in this review, but only three of these studies were considered to have a low risk of bias.

This tells me that chiropractic care is a useful protocol in the effort of reducing pain and healing in many circumstances.

There are several diagnostic tests to assist physicians in detecting and treating back and neck conditions.

An interesting review entitled "Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain" (Van der Windt DAWM, et al. Cochrane Database of Systematic Reviews 2010) reveals that diagnosing back pain is not a simple matter. I read the findings.

While lower back pain ranks as a common cause of disability in the United States, determining what causes a person's back pain is often challenging. A new review on diagnosing back pain finds that no single diagnostic test is good at discriminating between patients who have a herniated disc and patients who do not.

Lawrence Kurz M.D., an orthopedic spinal surgeon at Beaumont Hospital in Royal Oak, Mich., agreed with the results of this review: No one test is specific and sensitive enough to be used as the sole guide for making an accurate diagnosis of disc herniation as the cause of sciatica.

Healthy discs are spongy cushions of cartilage that fill the spaces between vertebrae in the spine. They act as shock absorbers for the spine and allow flexibility. A herniated disc can occur when a disc incurs damage because of trauma or stress and bulges outside of its normal position to press on a nerve. This can result in pain that radiates down to the lower leg - also called sciatica.
 

In other conditions, including osteoporosis and similar aging disorders, bony structures could press on nerves, causing pain.

Representing injured people with back and neck pain complaints requries diverse diagnositic testing.  Insurance company representative all too often point to one test to either deny or rule out a condition.

Merck advises Osteomyelitis occurs most commonly in young children and in older people, but all age groups are at risk. Osteomyelitis is also more likely to occur in people with serious medical conditions.

There are three types of osteomyelitis:

• Acute osteomyelitis - the infection develops within two weeks of an injury, initial infection, or the start of an underlying disease.
• Sub-acute osteomyelitis - the infection develops within one or two months of an injury, initial infection, or the start of an underlying disease.
• Chronic osteomyelitis - the bone infection starts at least two months after an injury, initial infection, or the start of an underlying disease.

Infections can reach a bone by traveling through your bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if trauma exposes your bone to germs. Bone infections commonly affect the long bones of your body, such as your leg bones and upper arm bone, as well as your spine and pelvis.

The symptoms are pain.  Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary.  Once considered incurable, osteomyelitis can be successfully treated today. Still, osteomyelitis is a serious condition, requiring aggressive treatment to prevent spread of your infection and to save the affected bone. 

Risk factors include Osteoporosis (decreased density of the bones) which can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position or walking.

Interestingly, exercise, as we know, reduces the risk due to higher bone density in woman over 65.  The Archives of Internal Medicine released a study identifying the reduction in falls among those woman engaged in physical activity.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.  In 2007, more than 261,000 people visited the emergency room due to a distal radius fracture.

 The American Academy of Orthopaedic Surgeons (AAOS) recently approved and released an evidence-based clinical practice guideline on the Treatment of Distal Radius Fractures.

The final patient-oriented guidelines for treating distal radius fractures contain 29 evidence-based recommendations overall, some of which are included below:

1.  The research suggests that a rigid cast is better than a splint if the fracture was displaced.

2.  If a fracture was not displaced - as in a hairline crack - a removable splint can be worn.

3.  If a fracture has a tendency to fall back the way it was before the physician fixed it, research suggests that these fractures heal better if the surgeon operates on them, rather than treating them with a cast. 

More than 4,000 journal articles from around the world were analyzed over the course of a year and every article was graded on a five-point scale depending on the strength and quality of the evidence. Only prospective, randomly controlled clinical trials with enough patients to establish clinical and statistical significance could earn the highest grade, ranking as strong evidence.

Being aware of fractures in general, and especially in the population aged 65 and older, makes considering treatments important.  Being informed is the best place to be if and when the need to know becomes immediate as when an unexpected fall lands us in the hospital.

 

Most people associate whiplash with one vehicle being hit in the rear by another vehicle - the driver in front sustains the whiplash. However, the impact can come from any direction and the head may move backwards or sideways, not only forwards initially. Whiplash injury may also be sustained in various ways, such as from falling off a bicycle or a horse.

 What are the symptoms of a whiplash injury?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

A whiplash injury typically takes from 12 to 24 hours after the accident or blow to develop. At the time of the incident any swelling or bruising to the neck muscles will not be apparent straight away. In most cases the discomfort, pain and stiffness is much worse on the following day, and may continue to worsen as each day goes by. A person with a whiplash injury may experience:

• A loss (or reduction) of movement in the neck
• Headaches
• Neck pain
• Neck stiffness
• The back of the neck feels tender
   
• The following signs and symptoms are also possible: 
   
• Lower back pain
• Pain in the arms and hands
• Numbness or pins and needles in the arms and hands
• Muscle spasms
• Dizziness
• Fatigue
• Swallowing difficulties
• Vision problems (vision may be blurred)
• A feeling that you are moving or spinning (vertigo)
• Ringing in the ears (tinnitus)
• Sleep disturbances
   
• The following less common signs and symptoms are also possible: 
   
• Irritability
• Memory loss
• Poor concentration

Headaches, dizziness, problems swallowing and vision problems should not last long. If they do, tell your doctor.  These could be signs, symtoms and consequences of other injury.

Be aware that certain symptoms of whiplash are also symptoms of Brain injury. A severe whiplash injury, think of shaken baby syndrome, can result in damage to the brain.  Shaken baby syndrome  is a form of child abuse. It refers to brain injury that happens to the child. It occurs when someone shakes a baby or slams or throws a baby against an object. A child could be shaken by the arms, legs, chest, or shoulders.

A coup-contrecoup injury, for example, is common in the hyperflexion/hyperextension process. 

We all have, or know someone who has, broken a bone.  Interestingly, there are numerous types of broken bones.  Not only is the probability of developing arthritis increased in the area of fracture, but additional complications result near joints.

The best way to prevent a fracture is to stop bones from reaching the point where they are prone to breaking, but understanding the process of how bones form and mature has been challenging.  A fracture, also referred to as a bone fracture, is a medical condition where the continuity of the bone is broke. A significant percentage of bone fractures occur because of high force impact or stress; however, a fracture may also be the result of some medical conditions which weaken the bones, for example osteoporosis. A fracture caused by a medical condition is known as a pathological fracture.

The word break is commonly used by lay (non-professional) people. Among health care professionals, especially bone specialists, such as orthopedic surgeons, break is a much less common term when talking about bones.

A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture. On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Most human bones are surprisingly strong and can generally stand up to fairly strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.  With travel speeds and related sudden stop velocity (crash) in cars, trains and planes far exceeding the old fashioned modes of walking, horseback riding (or elephant riding if you are from India), forces have greatly varied in modern times.

The older we get the less force our bones can withstand. Approximately 50% of women and about 20% of men have a fracture after they are 50 years old (Source: National Health Service, UK).

Because children's bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones - areas of growing bone - which may sometimes be damaged.

Some different types of fracture:

• Avulsion fracture - a muscle or ligament pulls on the bone, fracturing it.
   
• Comminuted fracture - the bone is shattered into many pieces.
   
• Compression (crush) fracture - generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
   
• Fracture dislocation - a joint becomes dislocated, and one of the bones of the joint has a fracture.
    
• Hairline fracture - a partial fracture of the bone. Often this type of fracture is harder to detect. 
   
• Impacted fracture - when the bone is fractured, one fragment of bone goes into another.
   
• Longitudinal fracture - the break is along the length of the bone.
   
• Oblique fracture - A fracture that is diagonal to a bone's long axis.
   
• Pathological fracture - when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
   
• Spiral fracture - A fracture where at least one part of the bone has been twisted.
   
• Stress fracture - more common among athletes. A bone breaks because of repeated stresses and strains.
   
• Torus (buckle) fracture - bone deforms but does not crack. More common in children. It is painful but stable.
   
• Transverse fracture - a straight break right across a bone.

 Now researchers at the University of Houston department of health and human performance have created a process that grows real human bone in tissue culture, which can be used to investigate how bones form and grow. 

The research is ready to market and hopefully will help in the prevention of broken bones and advance our ability to heal them.

On World Osteoporosis Day, October 20, centenarian Helen Daniels of Poughkeepsie, NY, has a good reason to smile; she's able to comfortably walk again following minimally invasive spine surgery. After suffering two spinal fractures caused by osteoporosis, Mrs. Daniels had debilitating back pain.

Read more here.

 "Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial"
Jeffrey G Jarvik, Bryan A Comstock, Michel Kliot, Judith A Turner, Leighton Chan, Patrick J Heagerty, William Hollingworth, Carolyn L Kerrigan,Richard A Deyo
Lancet 2009; 374: 1074-81
The Lancet