Qualitative and Quantitative Scintigraphic Imaging to Predict Fracture Healing

SummaryPurpose: Evaluate the value of 24- hour postoperative quantitative bone scintigraphy to identify devascularized fragments and predict delayed fracture bridging in canine clinical patients; to determine the effect of fracture type, fixation type, age, sex, and weight on fracture bridging and the quantitative scintigraphic ratios; and to evaluate the relationship between qualitative scintigraphic assessment and quantitative scintigraphic ratios. Methods: Forty-two adult dogs, with diaphyseal long bone fractures treated with minimally invasive biological or invasive surgical techniques, were evaluated with 24-hour postoperative bone scintigraphy and six and 12 week postoperative radiographs. Fractured bones were classified as simple, moderately multiple, or severely multiple. Bone scintigrams were qualitatively and quantitatively analyzed. Radiographs were made at six and 12 weeks after the operation and graded as fracture gap(s) bridged or not bridged with bone opacity material. The data was evaluated statistically to determine the relationship between age, sex, and weight of the dogs, fracture type, fixation type, and results of scintigram analysis to fracture bridging at six and 12 weeks. Results: Fourteen of the 42 fractures were bridged at six weeks after the operation and 33 at 12 weeks. Prediction of fracture healing was not possible. There was not any statistical relationship of fracture type, fixation, sex, nor weight to bridged fractures or non-bridged fractures at six and 12 weeks. There was a trend toward more of the fractures with multiple fragments treated with minimally invasive biological techniques to be bridged by 12 weeks when compared to similar fractures treated with invasive techniques. The mean age of dogs with bridged fractures at six and 12 weeks was significantly lower than the mean age of dogs with non-bridged fractures at six and 12 weeks. Qualitative scintigraphic assessment scores were not significantly related to the quantitative scintigraphic ratios or to fracture bridging. Conclusions: Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging at six or 12 weeks postoperatively.The value of 24-hour postoperative qualitative and quantitative bone scintigraphy to predict fracture bridging by 12 weeks in canine clinical patients with diaphyseal long bone fractures was evaluated. Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging by 12 weeks.Supported in part by a grant from the AO Vet Centre, Zurich, Switzerland.

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Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i2.27206 ◽

2019 ◽

Vol 6 (2) ◽

pp. 5-11

Author(s):

Balakrishnan M. Acharya ◽

Rojan Tamrakar ◽

Pramod Devkota ◽

Abhishek K. Thakur ◽

Suman K. Shrestha

Keyword(s):

Road Traffic ◽

Bone Fractures ◽

Long Bone ◽

Fracture Union ◽

Surgical Implant ◽

Non Union ◽

Generation Network ◽

Diaphyseal Fractures ◽

The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

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Delayed healing of lower limb fractures with bisphosphonate therapy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588415x14181254789321 ◽

2015 ◽

Vol 97 (5) ◽

pp. 333-338 ◽

Cited By ~ 13

Author(s):

B Yue ◽

A Ng ◽

H Tang ◽

S Joseph ◽

M Richardson

Keyword(s):

Lower Limb ◽

Bone Fractures ◽

Operative Management ◽

Delayed Union ◽

Bisphosphonate Therapy ◽

Long Bone ◽

Non Union ◽

Lower Limb Fractures ◽

The Mean ◽

Limb Fractures

Introduction Bisphosphonate therapy (BT) is used commonly in the management of osteoporosis. A systematic review was conducted investigating delayed union of lower limb, long bone fractures in patients on BT. We specifically assessed whether BT increases the risk of delayed union or non-union in lower limb, long bone fractures. Methods A literature search was conducted in the PubMed and Embase™ on 4 November 2014. Articles that investigated lower limb fractures, history of BT and fracture union were included in the review. Results A total of 9,809 papers were retrieved and 14 were deemed suitable for this review. The mean time to union in patients on BT was 8.5 months. A longer time to union was reported in a study investigating BT users versus controls (6.5 vs 4.8 months respectively). The mean rate of delayed or non-union for BT associated atypical fractures was 20% per fracture. Specifically in one study, delayed union was more common in the cohort with more than three years of BT (67%) than in the group with less than three years of BT (26%). Surgical fixation was associated with improved outcomes compared with non-operative management. Conclusions BT has been described to be associated with multiple adverse outcomes related to atypical fractures. Current evidence recommends operative management for this patient group. Further investigation is required to evaluate the exact effects of BT on lower limb fractures, in particular typical femoral fractures.

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Reliability of a Classification of Fractures of the Hand Based On the AO Comprehensive Classification System

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409355256 ◽

2010 ◽

Vol 35 (5) ◽

pp. 392-395 ◽

Cited By ~ 4

Author(s):

J.-D. Szwebel ◽

V. Ehlinger ◽

V. Pinsolle ◽

P. Bruneteau ◽

P. Pélissier ◽

...

Keyword(s):

Bone Fractures ◽

Kappa Coefficient ◽

Observer Agreement ◽

Long Bone ◽

Fracture Type ◽

Logical System ◽

Hand Fractures ◽

Bone Segment ◽

Comprehensive Classification

The AO/ASIF Comprehensive Classification of Fractures is a logical system to describe and compare long-bone fractures. We adapted this classification to the hand to classify fractures of the metacarpals and phalanges. The alphanumeric sequence codes the bone involved, the bone segment, and the fracture type. To assess the reliability of this classification, one hundred radiographs of hand fractures were classified by nine observers in four sessions. Using Cohen’s kappa coefficient, overall inter-observer agreement was 0.93 for bone identification, 0.80 for bone segment, and 0.44 for fracture type. Corresponding intra-observer agreement was 0.94, 0.92 and 0.62 respectively.

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Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180682 ◽

2018 ◽

Vol 4 (2) ◽

pp. 291

Author(s):

Yeshwanth Subash

Keyword(s):

Bone Marrow ◽

Bone Fractures ◽

Autologous Bone Marrow ◽

Functional Results ◽

Long Bone ◽

Female Ratio ◽

Long Bone Fractures ◽

The Mean ◽

Autologous Bone ◽

Mean Time

Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union. Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results.

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Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes

SICOT-J ◽

10.1051/sicotj/2017058 ◽

2018 ◽

Vol 4 ◽

pp. 2 ◽

Cited By ~ 5

Author(s):

Michele Bisaccia ◽

Andrea Cappiello ◽

Luigi Meccariello ◽

Giuseppe Rinonapoli ◽

Gabriele Falzarano ◽

...

Keyword(s):

Bone Fractures ◽

Weight Bearing ◽

Excellent Result ◽

Operation Time ◽

Tibial Fractures ◽

Long Bone ◽

Full Weight Bearing ◽

Distal Tibial Fractures ◽

Study Results ◽

The Mean

Introduction: Distal tibial fractures are the most common long bone fractures. Several studies focusing on the methods of treatment of displaced distal tibial fractures have been published. To date, locked plates, intramedullary nails and external fixation are the three most used techniques. The aim of our study was to compare intramedullary nail (IMN) and locked plate (LP) for treatment of this kind of fracture. Materials and methods: We collected data on 81 patients with distal tibial fractures (distance from the joint between 40 and 100 mm) and we divided into two groups: IMN and LP. We compared in the 2 groups the mean operation time, the mean union time, the infection rate the rate of malunion and nonunion, the full weight bearing time. Results: No patient in the two groups developed a nonunion. None of the patients obtained a fair or poor outcome. Overall 52 patients obtained an excellent result (69.3%) and 23 obtained a good result (30.6%). Discussion: Our study results indicate a superiority of IMN over LP in terms of lower rates of infections and statistically significant shorter time to full weight bearing. Whereas LP appeared to be advantageous over IMN in terms of leading to a better anatomical and fixed reductions of the fracture and a lower rate of union complications. The two treatments achieved comparable results in terms of operation time, hospital stay, union time and functional outcomes.

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Association of bone fracture type and degree of callus formation with leptin concentration in children with long bone fractures

Vojnosanitetski pregled ◽

10.2298/vsp190314062p ◽

2019 ◽

pp. 62-62

Author(s):

Zoran Paunovic ◽

Ivan Stanojevic ◽

Dzihan Abazovic ◽

Mia Rakic ◽

Nikola Stankovic ◽

...

Keyword(s):

Bone Fracture ◽

Bone Fractures ◽

Callus Formation ◽

Long Bone ◽

Fracture Type ◽

Long Bone Fractures

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The biomechanical properties of the feline femur

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-07-08-0077 ◽

2008 ◽

Vol 21 (04) ◽

pp. 312-317 ◽

Cited By ~ 3

Author(s):

N. M. M. Moens ◽

R. J. Runciman ◽

D. L. Holmberg ◽

G. M. Monteith ◽

T. W. G. Gibson

Keyword(s):

Bone Fractures ◽

Maximum Load ◽

Biomechanical Properties ◽

Long Bone ◽

Three Point Bending ◽

Pull Out ◽

Fracture Stabilization ◽

Surgical Implants ◽

Load To Failure ◽

The Mean

SummaryThe purpose of this study was to determine the biomechanical properties of feline long bone by testing cadaver bone from mature cats in compression, threepoint bending, notch sensitivity and screw pull-out strength. The determination of these properties is of clinical relevance with regard to the forces resulting in long bone fractures in cats as well as the behaviour and failure mode of surgical implants utilized for fracture stabilization and repair in the cat. Cadaveric cat femurs were tested in compression, three-point bending and in three-point bending after the addition of a 2.0 mm screw hole. Cortical screws, 2.7 mm in diameter, were inserted in cadaveric cat femur samples for screw pullout testing. The mean maximum load to failure of mid diaphyseal feline femurs tested in compression was 4201 ± 1218 N. Statistical analysis of the parameter of maximum load tested in compression revealed a statistical difference between sides (p=0.02), but not location (p=0.07), or location by side (p=0.12). The maximum strength of mid diaphyseal feline femurs tested in compression was 110.6 ± 26.6 MPa. The modulus of elasticity of mid-diaphyseal cat femurs tested in compression was determined to be 5.004 ± 0.970 GPa. The mean maximum load to failure of feline femurs tested in three-point bending was 443 ± 98 N. The mean maximum load to failure of feline femurs tested in three-point bending after a 2.0 mm diameter hole was drilled in the mid-diaphyseal region of each sample through both cortices was 471 ± 52 N. The mean maximum load required for screw pull-out of 2.7 mm cortical screws placed in feline femurs tested in tension was 886 ± 221 N. This data should be suitable for investigating fracture biomechanics and the testing of orthopaedic constructs commonly used for fracture stabilization in the feline patient.

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HEALING OF LONG BONE FRACTURES IN PATIENTS WITH CONCOMITANT HEAD OR SPINAL CORD INJURIES

Journal of Musculoskeletal Research ◽

10.1142/s0218957715500189 ◽

2015 ◽

Vol 18 (04) ◽

pp. 1550018

Author(s):

Fathy G. Khallaf ◽

Elijah O. Kehinde

Keyword(s):

Spinal Cord ◽

Healing Rate ◽

Spinal Cord Injuries ◽

Bone Fractures ◽

Head Injuries ◽

Delayed Union ◽

Long Bone ◽

Controlled Study ◽

Long Bone Fractures ◽

The Mean

The aim of this prospective controlled study is to compare healing rate and amount of union callus formed in patients with long bone fractures and concomitant head or spinal cord injuries to patients with long bone fractures only. The healing markers of fractures were compared in three groups of patients: (A) patients with head injuries and long bone fractures, (B) patients with acute traumatic spinal cord injuries and long bone fractures, and (C) patients with long bone fractures only. The mean (range) time to union of long bone fractures in groups (A), (B), and (C) patients was 6.9 (3–20), 6.2 (3–7.7), and 22.4 (13–41) weeks. The mean (range) healing rate of long bone fractures in groups (A), (B), and (C) patients was 4.5(0.2–10.6), 4.7 (2.6–7.5), and 0.38(0.11–1)[Formula: see text] mm/week. The mean (range) thickness of callus formed at fracture sites in groups (A), (B), and (C) patients was 26(4–48), 29(10–48), and 1(2–20)[Formula: see text]mm. There were no cases of delayed or nonunion in groups (A) and (B) patients while 5 of 69 fractures (7.3%) had delayed union in group (C) and 9/69 (13%) fractures had nonunion. These results suggest acceleration of long bone fractures in patients with head or spinal cord injuries.

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Plate-Rod Osteosynthesis in Dogs and Cats

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.98196 ◽

2019 ◽

Vol 47 ◽

Author(s):

Mariana De Jesus De Souza ◽

Marcio Poletto Ferreira ◽

Augusto Amadori ◽

Rafael Carneiro Kretzer ◽

Amanda Junqueira ◽

...

Keyword(s):

Bone Healing ◽

Bending Strength ◽

Bone Fractures ◽

Clinical Signs ◽

Postoperative Recovery ◽

Medullary Canal ◽

Long Bone ◽

Complication Rates ◽

Intramedullary Canal ◽

The Mean

Background: Most fractures are caused by traumatic processes due to car accidents, but they can also occur due to bullets, fights and falls. Surgical stabilization is often necessary and shows high rates of bone healing when its basic concepts are followed. The objective of this study is to report cases of shaft fracture in long bones stabilized with intramedullary pin and plate (IMPP) in order to evaluate pre- and postoperative clinical and radiographic signs, correlating the ideal surgical technique described on recent studies with complications resulting from the surgical procedure.Cases: This study includes patients undergoing osteosynthesis with intramedullary pin and plate from January 2015 to December 2016 at the Veterinary Medical Teaching Hospital of UFRGS. During this period, 13 animals (five cats and eight dogs) with long bone fractures were treated with the abovementioned association. Information on breed, age, sex, etiology of the fracture, affected bone, clinical signs, osteosynthesis technique, clinical progress, fracture healing, and postoperative complications was collected for the study. Late postoperative recovery was evaluated by telephone contact with owners. The mean age was 5.4 years (3 months - 15 years) and body weight 17.66 kg (3 - 28.4 kg). The fractures were due to being hit by a vehicle (5), bites (1), accident with a toy (1), and unknown (6).Discussion: All cases included in this study were in the femur, humerus or tibia. Fractures in the radius are also frequent in small animal traumatology, but in this case the use of an intramedullary pin is not recommended. All animals had diaphyseal fractures, which is an important prerequisite for IMPP stabilization. The IMPP association is mainly indicated in cases of comminuted fractures, when it is anatomically impossible to reduce fracture fragments, as occurred with nine patients in this study. The plate did not break of fail in any of the cases, as the association of an intramedullary pin with the plate significantly reduces tension on the plate, increasing bending strength up to ten times. One of the animals presented severe postoperative pain and could not adequately lean on the operated limb. Orthopedic and neurological evaluation led to the conclusion that the long pin in the region of the subtrochanteric fossa could be injuring the sciatic nerve and the animal was reoperated to cut the pin shorter. Pain stopped and after seven months the animal could lean on the limb and move normally, being proprioceptive and showing no pain on palpation and manipulation. The pin used in the IMPP technique should fill 30 to 40% of the diameter of the intramedullary canal at its narrowest portion. Of the 13 patients included in this study, six received pins within the recommended diameter, one received a pin larger than recommended, and five received pins smaller than recommended. The mean diameter of the pin related to the diameter of the medullary canal was 32.3% (19% - 54.8%). The bone healing rate described for IMPP is high (98%), three patients returned for this study reevaluation and all of them presented visible radiographic bone healing. We concluded that osteosynthesis associated with the use of intramedullary pin and plate resulted in adequate stabilization of fractures in the femur, tibia and humerus, allowing fast functional recovery with low complication rates.

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Pediatric long bone fractures treated by elastic intramedullary nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214175 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1095

Author(s):

Manoj P. Gupta ◽

Lokraj Chaurasia ◽

Sanjeet Kumar Jha

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Medical Records ◽

Bone Fractures ◽

Long Bone ◽

High Morbidity ◽

Long Bone Fractures ◽

The Mean ◽

Elastic Intramedullary Nailing ◽

Mean Time

Background: Pediatric long bone fractures can have a high morbidity and long term disability among the survivors. The present study was aimed to study the clinical outcomes of children with long bone fractures managed by elastic intramedullary nail.Methods: We retrospectively reviewed the medical records of children (aged 2 to 15 years) who were admitted and treated for unilateral femoral, tibial or forearm fractures with elastic intramedullary nail from January 2018 till February 2020. All were managed with elastic intramedullary nailing. The union times and complications were noted from the medical records.Results: Femoral, tibial and forearm bones were involved in 15 patients each (33.3%). Road traffic accident was reported by 31%) and physical abuse by one case (2%). The mean time of union was 10 weeks, ranging from 6 to 12 weeks. The mean time for union of the femur and tibia was 11.54 and 11.34 weeks respectively. It was significantly lower for forearm (6.67 weeks, p value <0.05). Two patients reported of bursitis and impingement, which were resolved after nail removal. One case had limb length discrepancy of about 0.5 cm in femur fracture, which was not impairing functional activity. Functional status was assessed based on Flynn criteria was found to be excellent in 36%, good in 44% and fair in 20%.Conclusions: The results of the present study show that titanium elastic nail (TEN) is an effective treatment modality for managing pediatric long bone fractures. We recommend the use of TEN in managing long bone fractures in children.

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