Structural Health Monitoring of Long Bone Fractures Using Instrumented Intramedullary Nails

2008 ◽  
Author(s):  
Darren Wilson ◽  
Si Janna
Keyword(s):  
Fracture Healing ◽  
Stance Phase ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Radiographic Evidence ◽  
Linear Load ◽  
Single Sensor ◽  
Primary Bone

Clinical assessment of fracture healing is usually subjective, relying upon the detection of movement (‘feel’) by the surgeon, the patient’s response in terms of pain and confidence, and radiographic evidence of callus and primary bone union. A more quantitative, objective method of measuring the strength of a healing callus would be useful in assessing many aspects, such as the effectiveness of different forms of treatment, the pattern and rate of healing, and the stage at which the patient can return to full weight-bearing activity. The results presented in this paper demonstrate the complexity of monitoring fracture healing in leg stance phase using an instrumented intramedullary (IM) nail equipped with a single sensor. The bone healers exhibited both sigmoidal and linear load responses during fracture healing. Ambulating non-healers demonstrated high nail forces which did not change significantly over time whereas lame non-healers demonstrated a decreasing nail load due to reduced GRF or loosening of fixation.

scholarly journals Radiation-free interlocking intramedullary nailing of three-hundred and seventy long bone fractures in Ogbomoso, Nigeria

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephen Adesope Adesina ◽  
Samuel Uwale Eyesan ◽  
Innocent Chiedu Ikem ◽  
Olalekan Akeem Anipole ◽  
Isaac Olusayo Amole ◽  
...  
Keyword(s):  
Developing Countries ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Age Groups ◽  
Previous Treatment ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Post Discharge ◽  
Long Bone Fractures ◽  
Wide Range

AbstractLong bone fracture care in developing countries remains largely different from that of the developed world where closed reduction and internal fixation with locked intramedullary nail is the standard treatment. This study in a developing country presents the pattern and outcome of treatment of 370 long bone fractures using the SIGN nail over a five-year period in order to underline the wide array of patients and fractures treatable with the nail. Using a prospective descriptive approach, all the 342 patients with 370 fractures of the humerus, femur and tibia treated from July 2014 to June 2019 were studied. The fractures were reduced without image intensifier or fracture table and fixed with the SIGN nail. Post-discharge, the patients were followed up at the out-patient clinic. The mean age of the patients was 43.45 years with a range of 10–99 years. Sixty-six percent were males who were mostly injured in motorcycle accidents. Femur, tibia and humerus fractures accounted for 59.7%, 28.4% and 11.9% respectively. Eighty-six percent were diaphyseal fractures, 73% were fresh and the main previous treatment was traditional bone setting. Deep infection occurred in 4.9%, 66.0% achieved knee flexion > 90° by sixth week, the majority achieved full weight bearing and could squat and smile by 12th week. The SIGN nail is versatile, useful for treating a wide range of fractures in most age groups particularly in developing countries where orthopaedic fractures are prevalent but the more sophisticated facilities are lacking or poorly maintained.

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

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 2 ◽  
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.

scholarly journals Titanium elastic percutaneous nails for pediatric long bone shaft fractures: current concept

2017 ◽  
Vol 16 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Ramji Lal Sahu ◽  
Nadeem Ahmed
Keyword(s):  
Bone Fractures ◽  
Weight Bearing ◽  
Medical Science ◽  
Early Mobilization ◽  
Lower Limbs ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Entry Site ◽  
Early Weight Bearing ◽  
Mean Time

Introduction: The objective of this study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in long bone fractures in children.Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2009. Eighty two patients were recruited from Emergency and out patient department having closed fracture of long bones of upper and lower limbs. All patients were operated under general or spinal anaethesia. All patients were followed for twelve months.Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 5 (6.09%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and two delayed union. The results were excellent in 97.310% and good in 2.44% patients.Conclusion: We concluded that this technique is advantageous because of early mobilization (early weight bearing), less complication with good results and is economical.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.61-68

HEALING PATTERN OF INTERLOCKED INTRAMEDULLARY NAILED HUMERAL SHAFT FRACTURE

2016 ◽  
Vol 19 (04) ◽  
pp. 1650018
Author(s):  
Myung-Sang Moon ◽  
Dong-Hyeon Kim ◽  
Min-Geun Yoon ◽  
Sang-Yup Lee
Keyword(s):  
Bone Fractures ◽  
Weight Bearing ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Long Bone ◽  
Patients Âgés ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Entry Points

Design: Study on the cases of the united interlocked intramedullary (IM) nailed humeral shaft fractures. Objective: To assess the healing pattern of nailed humeral shaft fracture and to compare it with the results of the other previous authors’ nail-treated large bone fractures. Background data: Based on the relevant previous studies related with healing patterns of the interlocked IM nail-managed humeral shaft fractures, the current age-matched study on the participating callus for union was conceived. The comparative study on the healing patterns between the fractures of non-weight-bearing long bone — the humerus — and other large weight-bearing long bones have never been carried out previously. Materials and methods: Eighty-nine cases of the humeral shaft fractures, fixated with antegrade interlocked IM standard Kuentscher nail were subjected to the study. The patients’ ages ranged from the late teens to 9th decade of life. For the antegrade nailing, two entry points were chosen; conventional entry point in the early series, and rotator cuff interval in the late series. Results: External callus was very rarely formed [12 cases (13.4%)]. It was formed at post-fixation 6.5 weeks on average in cases with unreduced displaced fragment, and proximal interlocking. Radiographic union occurred at post-fixation 17.6 weeks on an average by primary osteonal callus. Conclusion: It was concluded that in most cases union was obtained primarily by the contact or gap healing irrespective of the patients’ ages, and that periosteal participation was very rare or negligible. Use of smaller diameter nail or new development of less rigid IM nail without external nail shape change is thought desirable to induce periosteal callus in early healing stage.

scholarly journals Development and Biocompatibility Characterization of a BioMEMS Sensor for Monitoring the Progression of Fracture Healing

2009 ◽  
Author(s):  
Brandon G. Santoni ◽  
Rohat Melik ◽  
Emre Unal ◽  
Nihan Kosku Perkgoz ◽  
Debra A. Kamstock ◽  
...  
Keyword(s):  
United States ◽  
Fracture Healing ◽  
Bone Fractures ◽  
Financial Burden ◽  
Early Period ◽  
The United States ◽  
Long Bone ◽  
Extremity Injuries ◽  
Manual Manipulation

Orthopaedic extremity injuries present a large medical and financial burden to the United States and world-wide communities [1]. Approximately six million long bone fractures are reported annually in the United States and approximately 10% of these fractures do not heal properly. Though the exact mechanism of impaired healing is poorly understood, many of these non-unions result when there is a communited condition that does not proceed through a stabilized healing pathway [2]. Currently, clinicians may monitor healing visually by radiographs, or via manual manipulation of the bone at the fracture [3]. Unfortunately, the course of aberrant fracture healing is not easily diagnosed in the early period when standard radiographic information of the fracture is not capable of discriminating the healing pathway. Manual assessment of fracture healing is also an inadequate diagnostic tool in the early stages of healing [4].

Titanium Elastic Nails for Distal Radius-ulna Fractures in Young Dogs

2021 ◽  
Author(s):  
Harmanpreet Singh Sodhi ◽  
Ashwani Kumar ◽  
Arun Anand ◽  
Vandana Sangwan ◽  
Dhiraj Kumar Gupta
Keyword(s):  
Distal Radius ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Medullary Canal ◽  
Long Term Results ◽  
Long Bone ◽  
Uneventful Recovery ◽  
Fractures In Children ◽  
Ulna Fractures ◽  
Elastic Nails

Background: Radius-ulna is the most frequently fractured bone of the pectoral limb in dogs with high predisposition to distal fractures. The smaller size of the distal fragment and open physis restrict the use of rigid fracture fixation techniques in distal fractures of growing dogs. Titanium elastic nails (TENs) are recommended in medical practice to stabilize long bone fractures in children. There is paucity of literature on TENs for the repair of radius-ulna fractures in dogs. Methods: This clinical study enrolled 10 dogs (7 grey hound and one each of Crossbred, Pomerenarian and Siberian Husky) suffering from distal radius-ulna (6 transverse and 4 short oblique) fractures since a mean ± SD duration of 3.40±4.5 days. The mean ± SD age and body weight of the dogs was 12.60±6.45 months and 14.09±6.41 Kg, respectively. All except one fracture was stabilized with two TENs inserted into the medullary canal of radial bone in a normograde manner from distal to proximal end using open cranio-lateral surgical approach. Result: Majority fractures achieved satisfactory reduction (n=8), radiographically. Weight bearing scores on walking increased gradually from day 12 (1.62 ± 1.51) to 45th (2.57±1.51), day 60th (3.75±0.5) and day 90 (4.0±0). Five dogs had uneventful recovery whereas remaining had major (n=2) or minor (n=3) complications. The length of the operated bone was non-significantly lesser as compared to contralateral healthy bone on day 60. Goniometric assessment of carpal joint of operated limb showed restricted range of motion on day 12 that improved to the near normal as contralateral healthy limb on day 60. Long-term results showed full (9) and acceptable (1) functional outcome. In conclusions, the TENs technique is simple and less invasive alternative fixation technique for distal radius-ulna fractures in young and light weighing dogs. As per authors, this is the first report on the use of TENs for the management of radius-ulna fracture in dogs.

scholarly journals What is the role of ultrasound in fracture management?

2019 ◽  
Vol 8 (7) ◽  
pp. 304-312 ◽  
Author(s):  
J. A. Nicholson ◽  
S. T. J. Tsang ◽  
T. J. MacGillivray ◽  
F. Perks ◽  
A. H. R. W. Simpson
Keyword(s):  
Image Processing ◽  
Fracture Healing ◽  
Bone Fractures ◽  
Therapeutic Ultrasound ◽  
Long Bone ◽  
Future Application ◽  
Current Evidence ◽  
Potential Clinical Benefit ◽  
Fracture Management

Objectives The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management. Methods A review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”. Results The use of ultrasound in musculoskeletal medicine has expanded rapidly over the last two decades, but the diagnostic use in fracture management is not routinely practised. Early studies have shown the potential of ultrasound as a valid alternative to radiographs to diagnose common paediatric fractures, to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. Ultrasound has also been shown to be advantageous in the early identification of impaired fracture healing; with the advent of 3D image processing, there is potential for wider adoption. Detection of implant-related infection can be improved by ultrasound mediated sonication of microbiology samples. The use of therapeutic ultrasound to promote union in the management of acute fractures is currently a controversial topic. However, there is strong in vitro evidence that ultrasound can stimulate a biological effect with potential clinical benefit in established nonunions, which supports the need for further investigation. Conclusion Modern ultrasound image processing has the potential to replace traditional imaging modalities in several areas of trauma practice, particularly in the early prediction of impaired fracture healing. Further understanding of the therapeutic application of ultrasound is required to understand and identify the use in promoting fracture healing. Cite this article: J. A. Nicholson, S. T. J. Tsang, T. J. MacGillivray, F. Perks, A. H. R. W. Simpson. What is the role of ultrasound in fracture management? Diagnosis and therapeutic potential for fractures, delayed unions, and fracture-related infection. Bone Joint Res 2019;8:304–312. DOI: 10.1302/2046-3758.87.BJR-2018-0215.R2.

Development of a Bioabsorbable Glass-Reinforced-Glass Intra-Osseous Scaffold for Fracture Healing

2011 ◽  
Vol 9 ◽  
pp. 81-91
Author(s):  
Philip Boughton ◽  
Y. Chen ◽  
C. Thompson ◽  
G. Roger ◽  
Jari Hyvarinen ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Long Bone ◽  
Hematopoietic Tissue ◽  
Shear Tests ◽  
Intramedullary Canal ◽  
Long Bone Fracture ◽  
Torsional Loads ◽  
Mechanically Stabilized

Intramedullary (IM) nails are routinely used to stabilize long bone fractures. They can however lead to stress shielding, pain, migration, obstruct hematopoietic tissue, become a loci for infection, and require subsequent surgical retrieval. Novel intra-osseous scaffold (IOS™) prototypes for fracture healing have been developed to function as a regenerative scaffold to enhance callous formation under mechanically stabilized conditions then resorb. Prototype fixation pins and rod systems were formed from glass-reinforced-glass. Flexion, torsion and shear tests were performed to evaluate the composite pins and rods. A modular rod design was successfully deployed and dilated while in a deformable state. When fitted and gripping the intramedullary canal then set in a rigid state. An obliquely sectioned ovine femur was used as a long bone fracture model for deployment and mechanical verification. Flexural support provided by the intramedullary scaffold was superior to multiple k-wire fixation, while the k-wire approach was more stabilizing under torsional loads. Glass reinforced glass samples were mechanically tested after soaking for up to 4 weeks in saline. Strength and modulus of the composite was reduced to approximately 25% of initial values after 2 weeks.

scholarly journals Prognostic Significance of Alkaline Phosphatase Activity and Callus Volume in Operatively Treated Bone Fractures

2020 ◽  
Vol 44 (1) ◽  
pp. 43-48
Author(s):  
Ante Muljačić ◽  
Matea Majstorović-Matejić ◽  
Marko Guberina ◽  
Ognjen Živković ◽  
Renata Poljak-Guberina
Keyword(s):  
Alkaline Phosphatase ◽  
Fracture Healing ◽  
Bone Fractures ◽  
Prognostic Significance ◽  
Bone Alkaline Phosphatase ◽  
Long Bone ◽  
Long Bone Fractures ◽  
Rapid Healing ◽  
Relationship Of ◽  
Callus Volume

Total and bone alkaline phosphatase are indicators of bone formation, a process essential in bone healing. The aim of this study was to assess the relationship of both total and bone alkaline phosphatase with the course and features of healing in surgically treated long bone fractures as compared to the callus volume. In this study, total and bone alkaline phosphatase levels and the callus volume were measured in two patients with long bone fractures. Fracture healing was rapid in one patient and slow in the other. Depending on the healing outcome, on day 7 an increase in the case of slow healing and a decrease in the case of rapid healing was noted for both total and bone alkaline phosphatase. In the case of slow healing, the callus volume was significant whereas in the case of rapid healing the callus was almost invisible on day 7. This result indicates a possible prognostic significance of aforementioned clinical biochemical and radiographic parameters in the monitoring of long bone fracture healing.

scholarly journals Effects of Natural Substances on Healing of Long Bone Fractures: A Narrative Review of Traditional Persian Medicine

2016 ◽  
Vol 5 (4) ◽  
pp. 165-72
Author(s):  
Ghazaleh Heydarirad ◽  
Seyed Mohammad Hasan Sadeghi ◽  
Seyed Mehdi Hosseini Khameneh ◽  
Mahmood Khodadoost ◽  
Mohammad Kamalinejad ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Bone Fractures ◽  
Complementary Therapy ◽  
Long Bone ◽  
Current Evidence ◽  
Social Burden ◽  
Natural Substances ◽  
Related Substances ◽  
Persian Medicine ◽  
Traditional Persian Medicine

Fractures, especially leg fractures, are one of the most common problems in the world, and it causes a considerable economic and social burden for patients and societies. Orthopedic surgery plays the most important role in the treatment of fractures, but it is expensive and requires anesthesia which has a variety of side effects. Besides surgery and conventional treatments, it seems that the use of natural substances as complementary therapy can be useful. In Traditional Persian Medicine (TPM) manuscripts, many diverse natural substances, especially medicinal herbs, are mentioned as useful medications for fracture healing. The aim of this study was to investigate medicinal plants and natural substances used in TPM as useful in fracture healing, by an overview of traditional knowledge as compared with new investigations. The main manuscripts of TPM, including the Canon of Medicine, Tohfat-ol-Moemenin, Exir-e–azam and Makhzan-ol-advieh, were assembled through a literature search, to select the substances used in fracture healing. Also, current evidence on related substances were studied through a search of Google Scholar and PubMed databases. In this study, eleven substances were identified and categorized into three groups: plants, animals, and minerals. The results of our study showed that the most cited substances were used due to their effects on fracture or wound healing, inflammations, and pain. This historical assessment can help in obtaining new data about natural substances for faster fracture healing, which may lead to subsequent opportunities to assess their potential medicinal use. [GMJ. 2016;5(4):165-72]

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