scholarly journals Healing physiology following delayed surgery for femoral midshaft fracture caused by high-energy injury: an in vivo study in dogs

2019 ◽  
Vol 47 (10) ◽  
pp. 5155-5173
Author(s):  
Zhijun Pan ◽  
Jingxin Pan ◽  
Hanli Wang ◽  
Zhou Yu ◽  
Zhong Li ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Fracture Healing ◽  
Soft Tissues ◽  
Early Stage ◽  
Healing Process ◽  
Light And Electron Microscopy ◽  
High Energy ◽  
Callus Growth ◽  
Delayed Surgery ◽  
Group A

Objective An experimental model of severe soft tissue damage was designed to simulate high-energy fracture and observe the fracture healing process following early surgery and surgery delayed by 1 week. Methods Forty dogs were randomized to Group A (immediate surgery) and B (delayed surgery). The femur was broken, and the two ends were forcefully stabbed to damage the surrounding soft tissues. The fracture was repaired using a custom six-hole steel plate. Four dogs were killed on day 3 and weeks 1, 2, 4, and 8 following bone fracture. Soft tissue and bone were examined by light and electron microscopy. Results In Group A, no callus was present at 1, 2, 4, and 8 weeks following fracture, resulting in atrophic nonunion. In Group B, visible weak external callus was present 1 week following fracture, and good external callus growth was present at 2, 4, and 8 weeks, leading to callus healing. Conclusion These findings suggest that the first week is critical for fracture healing. Absence of callus in the early stage is indicative of absence of callus growth throughout the entire healing process, while the presence of callus in the early stage is indicative of vigorous callus growth thereafter.

scholarly journals Comparison of the effect of collagen (amino acid) and amnion (proteinase inhibitor) on the wound healing of soft tissues

2010 ◽  
Vol 22 (1) ◽  
Author(s):  
Weko Adhiarto ◽  
Sunardhi Mangundjaja ◽  
Makmuri Yusuf ◽  
Bambang Pontjo
Keyword(s):  
Wound Healing ◽  
Amino Acid ◽  
Soft Tissue ◽  
Collagen Synthesis ◽  
Soft Tissues ◽  
Proteinase Inhibitors ◽  
Healing Process ◽  
Control Group ◽  
Wound Healing Process ◽  
The Mean

The wound healing process of the soft tissue aims to accelerate the closing of the wound by recurring, restoring the function, and minimizing the scar tissue. This process has to occur in the surgery process to obtain better-wound healing. The aim of this study was to know the stimulation effect of the wound dressing to accelerate the wound healing process of the soft tissue using Collagen (amino acid) and Amnion (proteinase inhibitors). This true experimental study was done to 36 mice (Sprague Dawley) that were divided into three different groups, two groups were the treatment groups and one group was the control group. Each group was adapted in Pathology Laboratory of Faculty of Veterinary Medicine Bogor Agricultural University. All of the mice were injured on the skin by incising the right side of the back for 2 cm in length and 4 mm in depth and then cleaned with 0.9% NaCl solution. To the first group of treatment, the wound was applicated by Amnion, and the second group was applicated by Collagen. Each 4 mice of all group were a termination by ether and encryption on the wounded tissue was conducted on day 3rd, 7th, and 14th. Assessment for a number of fibroblast and collagen synthesis on the wound of back tissue was conducted with the histological examination by painted using hematoxylin-eosin. The results concluded that Collagen application was influencing the mean of fibroblast higher than Amnion, and the lowest was controlled with statistically significant. The mean of collagen used Collagen lower than Amnion, and the lowest was control with statistically significant. It could be concluded that collagen application was preeminent in increasing the productivity of the fibroblast, as well as in developing forms of the collagen synthesis compared with Amnion and control.

PREDICTION OF THE TREND OF BONE FRACTURE HEALING BASED ON THE RESULTS OF THE EARLY STAGES SIMULATIONS: A FINITE ELEMENT STUDY

2019 ◽  
Vol 19 (05) ◽  
pp. 1950021
Author(s):  
JALIL NOURISA ◽  
GHOLAMREZA ROUHI
Keyword(s):  
Finite Element ◽  
Fracture Healing ◽  
Bone Fracture ◽  
Mechanical Stability ◽  
Early Stage ◽  
Healing Process ◽  
Fibrous Tissue ◽  
Fe Model ◽  
Bone Fracture Healing ◽  
Early Stages

To date, several studies have implied the importance of early stage mechanical stability in the bone fracture healing process. This study aimed at finding a correlation between the predicted different tissue phenotypes in the early stages of healing and the ultimate healing outcome. For this purpose, the process of fracture healing was numerically simulated employing an axisymmetric bi-phasic finite element (FE) model for three initial gap sizes of 1, 3 and 6[Formula: see text]mm and four initial interfragmentary strains (IFS) of 7%, 11%, 15% and 19%. The model was validated with experimental and other numerical studies from the literature. Results of this study showed that the amount of cartilage and fibrous tissue observed in the early stage after fracture can be used to qualitatively assess the outcome of complete bone healing process. Greater amount of cartilage in early stage of healing process yielded faster callus maturation, and delayed maturation of callus was predicted in the case of high fibrous tissue production. Results of this study can be used to provide an estimation of the performance of different fixation systems by considering the amounts of cartilage and fibrous tissues observed in the early stage of healing.

scholarly journals Staged Subtalar Fusion for Severe Calcaneus Fractures with Bone Loss

2013 ◽  
Vol 7 (1) ◽  
pp. 614-618 ◽  
Author(s):  
Chad G. Williams ◽  
Michael J. Coffey ◽  
Peter Shorten ◽  
James D. Lyions ◽  
Richard T. Laughlin
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Fusion Procedure ◽  
Subtalar Fusion ◽  
Thorough Debridement ◽  
Calcaneus Fractures

Background: With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Methods: Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. Results: We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. Conclusion: It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.

DEFINING “IMPENDING” COMPARTMENT SYNDROME AND DEVELOPING INDIAN DISTRICT HOSPITAL PROTOCOL FOR HIGH ENERGY PROXIMAL TIBIA FRACTURES.

2021 ◽  
pp. 66-70
Author(s):  
Nirjhar Maji ◽  
Anurag Das ◽  
Kuntal Bakuli
Keyword(s):  
Soft Tissue ◽  
Compartment Syndrome ◽  
Urban Areas ◽  
Soft Tissues ◽  
Proximal Tibia ◽  
District Hospital ◽  
Initial Period ◽  
High Energy ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Background and objectives: High energy proximal tibia fractures (OTA 41/Schatzker 4/5/6) are common in motorbike accidents even in semi urban and sub-urban areas. Recommended management involves two stages with conventional Mantra of 'Span-Scan-Plan'. First stage involves temporary knee spanning external xator to prevent or manage impending compartment syndrome. This is followed by CTScan. The second stage is the denitive internal xation. These recommendations are not universally followed due to certain infrastructural and acceptability constraints inuencing decision making. Summary: The study is designed as prospective observational study. It is conducted in a District Hospital setup. An effort to dene and recognise “Impending Compartment Syndrome” is made by developing a clinical criteria based evaluation score. This score was used to monitor fracture related soft tissue changes over the initial period until denitive xation. All patients underwent temporary stabilisation by different methods. These different temporary xation methods were compared amongst each other to nd out their efcacy. Patient was assessed to the end point of where soft tissues settled down for denitive xation. Surgical site infection and knee function was assessed to nd out whether the type of temporary xation had any subsequent on soft tissue and knee joint. The results were statistically analysed to nd out clinical signicance.

scholarly journals Magnetic Resonance Imaging of Postoperative Fracture Healing Process without Metal Artifact: A Preliminary Report of a Novel Animal Model

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Zhe Jin ◽  
Yuheng Guan ◽  
Guibo Yu ◽  
Yu Sun
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Fracture Healing ◽  
Healing Process ◽  
Intramedullary Fixation ◽  
Metal Artifact ◽  
Resonance Imaging ◽  
X Ray

Background. Early radiological diagnosis and continual monitoring are of ultimate importance for timely treatment of delayed union, nonunion, and infection after bone fracture surgery. Although magnetic resonance imaging (MRI) could provide superior detailed images compared with X-ray and computed tomography (CT) without ionizing radiation, metal implants used for fracture fixation lead to abundant artifacts on MRI and thus prohibit accurate interpretation. The authors develop a novel intramedullary fixation model of rat femoral fracture using polyetheretherketone (PEEK) threaded rods and investigate its feasibility for in vivo MRI monitoring of the fracture healing process without artifact.Methods. Femoral fractures of 3 adult male Sprague-Dawley rats were fixed with intramedullary PEEK threaded rods. X-ray and MRI examinations were performed at day 7 postoperatively. Radiological images were analyzed for the existence of artifact interruption and postoperative changes in bone and peripheral soft tissue.Results. Postoperative plain film revealed no loss of reduction. MRI images illustrated the whole length of femur and peripheral tissue without artifact interruption, and the cortical bone, implanted PEEK rod, and soft tissue were clearly illustrated.Conclusion. This preliminary study introduced a novel rat model for in vivo MRI monitoring of the fracture healing process without metal artifact, by using intramedullary fixation of femur with PEEK threaded rod.

scholarly journals Local hemostatic drug application for prophylaxis of pacemaker pocket hematoma

2021 ◽  
Vol 9 (3) ◽  
pp. 397-406
Author(s):  
R.E. Kalinin ◽  
◽  
I.A. Suchkov ◽  
V.O. Povarov ◽  
A.V. Plotkin ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Anticoagulant Therapy ◽  
Polyacrylic Acid ◽  
Soft Tissues ◽  
Silver Salt ◽  
Left Ventricular Ejection ◽  
Hemostatic Agents ◽  
Group A ◽  
Group B ◽  
Pocket Hematoma

BACKGROUND: Prevention of pacemaker pocket hematoma is an urgent problem of modern cardiovascular surgery. A method of prevention of hematomas may be application of local hemostatic agents. One of such means is incomplete silver salt of polyacrylic acid, registered in the Russian Federation as a medical product under the trade name “Hemoblock”. AIM: To evaluate the efficacy and safety of partial silver salt of polyacrylic acid (Hemoblock®) as a hemostatic drug for prophylaxis of pacemaker (PM) pocket hematoma. MATERIALS AND METHODS: The study included 29 patients (18 men) with average age of 72.8 ± 9.8 years and indications for PM implantation. The patients were divided into 2 groups, partial silver salt of polyacrylic acid was used during the PM implantation in group A, 0.9% NaCl solution was used in group B. Anticoagulant therapy was not cancelled. In the postoperative period, patients underwent a daily examination by a surgeon, on the 3th–5th day — an ultrasound of soft tissues in the area of the PM pocket to diagnose hemorrhagic complications. After 1 month, a control examination of the postoperative wound and an assessment of the PM function were performed. RESULTS: In 1 (6.3%) patient in group B, a PM pocket hematoma was found which required drainage in the dressing room and increased the period of hospitalization after surgery to 7 days. Soft tissue imbibition with blood was observed in 9 (56.3%) group B patients. No PM pocket hematomas and imbibition of soft tissues were observed in group A. PM implantation with uninterrupted anticoagulant therapy without the use of hemostatic agents increases the risk of soft tissue imbibition with blood by 2.3 times (p = 0.001, r = 0.605, RR 2.3, 95% CI 1.3–4). Age, gender, body mass index, body surface area, left ventricular ejection fraction, type of anticoagulation therapy, indication for PM implantation, type of PM, and the peculiarities of the operation did not influence the risk of development of PM pocket hematoma or soft tissue imbibition with blood (p > 0.05). CONCLUSION: The use of a partial silver salt of polyacrylic acid (Hemoblock®) can reduce the risk of development of hematomas and soft tissue imbibition with blood in the area of the pacemaker pocket and does not lead to the development of infectious complications and allergic reactions.

Foot Salvage After Loss of the First and Second Metatarsal Rays with a Free Fibular Osteocutaneous Flap

2011 ◽  
Vol 101 (6) ◽  
pp. 531-536 ◽  
Author(s):  
Christopher J. Salgado ◽  
Chih-Hung Lin ◽  
David A. Fuller ◽  
Alissa N. Duncan ◽  
Liliana Camison ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
High Energy ◽  
Metatarsal Bone ◽  
Tissue Loss ◽  
Metatarsal Bones ◽  
Second Metatarsal ◽  
Independent Ambulation ◽  
Soft Tissue Loss ◽  
Osteocutaneous Flap

Severely comminuted fractures of the metatarsal bones with significant bone and soft-tissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed. (J Am Podiatr Med Assoc 101(6): 531–536, 2011)

scholarly journals Generation of Open Metatarsal Fracture in Rats: A Model for Secondary Fracture Healing

2020 ◽  
Vol 2 (4) ◽  
pp. 197-211
Author(s):  
Adamu Abdul Abubakar ◽  
Ahmed Khalaf Ali ◽  
Sahar Mohammed Ibrahim ◽  
Kareem Obayes Handool ◽  
Mohammad Shuaib Khan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Fracture Healing ◽  
Tissue Injury ◽  
Healing Process ◽  
Soft Tissue Injury ◽  
Fracture Model ◽  
Suitable Model ◽  
Secondary Fracture ◽  
Post Surgery ◽  
Metatarsal Fracture

A fracture model in rats for the study of secondary bone healing was described. Standard open midshaft transverse metatarsal fracture was produced with bone cutting forceps in 28 rats. The commonly open and close fracture models utilized for bone and mineral researches are associated with varying degree of complications ranging from a high degree of fracture comminution to severe associated soft tissue injury which interferes with the healing process. We hypothesized that fracture model in rat third metatarsal bone could be associated with low -post-surgical complications and could be a reproducible model. To test this, open mid-shaft transverse fractures were created on the metatarsals of 28 rats. The objectives of the study were to evaluate the fracture complications, to determine the nature of fracture produced, evaluate the fracture consolidation during healing periods, and to assess the histological and radiographic healing of the fracture. The fracture produced in the mid metatarsal shaft of all rats was 100% transverse, 73% located at the midshaft. Minimal fracture angulations were recorded (0.48 ± 0.09o; 0.78 ± 0.17o) for anterior-posterior and lateral views respectively. Minimal soft tissue injury was recorded immediately post-surgery, but no infection and the delayed union was observed. Varying degrees of weight-bearing lameness was also recorded but seized at day six onward post-operative. Callus index observed was peaked at week 2 and 3 (2.02 ± 0.1, 1.99 ± 0.13) respectively but declined to 1.10 ± 0.04 at week 7 during the consolidation period. The fracture line disappeared completely at week 7. The histological and radiographic healing scores were (3.5 ± 0.13 and 3.75 ± 0.25) respectively (out of the maximum healing score of 4) at week 7 post-operative. There was a positive correlation between the histological and radiographic healing scores. The metatarsal fracture model is considered to be a suitable model for in vivo study of secondary fracture healing. Doi: 10.28991/SciMedJ-2020-0204-2 Full Text: PDF

scholarly journals In vivo impact testing on a lengthened femur with external fixation: a future option for the non-invasive monitoring of fracture healing?

2018 ◽  
Vol 15 (142) ◽  
pp. 20180068 ◽  
Author(s):  
Lorenza Mattei ◽  
Francesca Di Puccio ◽  
Stefano Marchetti
Keyword(s):  
Fracture Healing ◽  
Soft Tissues ◽  
Healing Process ◽  
Impact Testing ◽  
Resonant Frequencies ◽  
Soft Phase ◽  
Non Invasive ◽  
Woven Bone ◽  
Healing Assessment ◽  
The Impact

Non-invasive methods for assessing fracture healing are crucial for biomedical engineers. An approach based on mechanical vibrations was tried out in the 1990s, but was soon abandoned due to insufficiently advanced technologies. The same approach is re-proposed in the present study in order to monitor the healing process of a lengthened femur with an external fixator. The pins screwed into the bone were exploited for the impact testing (IT) to excite the bone and capture its response. Transmission through the soft tissues was thus prevented, and the quality of the signals was improved. Impact tests were performed every three to four weeks for five months. Unfortunately, after seven weeks, some pins were removed due to infection, and thus, the system was modified. Two different configurations were considered: before and after pin removal. An additional configuration was examined in the last two sessions, when the fixator body was removed, while four pins were left in the femur. The evolution of the frequency response function and of the resonant frequencies of the system were analysed for the duration of the monitoring period. The IT results were compared to the indications provided by X-ray images. During the evolution of the callus from the soft phase to the woven bone, the resonant frequencies of the system were found to increase by approximately 2–3% per week. The largest increase (approx. 22%) was observed for the first resonant frequency. After formation of the woven bone, the vibratory response remained almost the same, suggesting that the healing assessment could be related to the relative variation in the resonant frequencies. The results presented support the application of the IT approach for fracture healing assessment.

scholarly journals Cerium Oxide Nanoparticles (Nanoceria): Hopes in Soft Tissue Engineering

Molecules ◽  
2020 ◽  
Vol 25 (19) ◽  
pp. 4559
Author(s):  
Hossein Sadidi ◽  
Sara Hooshmand ◽  
Ali Ahmadabadi ◽  
Seyed Javad Hoseini ◽  
Francesco Baino ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Cerium Oxide ◽  
Chronic Wounds ◽  
Soft Tissues ◽  
Healing Process ◽  
Experimental Studies ◽  
Three Dimensional ◽  
Cerium Oxide Nanoparticles ◽  
Oxide Nanoparticles ◽  
Long Term Effects

Several biocompatible materials have been applied for managing soft tissue lesions; cerium oxide nanoparticles (CNPs, or nanoceria) are among the most promising candidates due to their outstanding properties, including antioxidant, anti-inflammatory, antibacterial, and angiogenic activities. Much attention should be paid to the physical properties of nanoceria, since most of its biological characteristics are directly determined by some of these relevant parameters, including the particle size and shape. Nanoceria, either in bare or functionalized forms, showed the excellent capability of accelerating the healing process of both acute and chronic wounds. The skin, heart, nervous system, and ophthalmic tissues are the main targets of nanoceria-based therapies, and the other soft tissues may also be evaluated in upcoming experimental studies. For the repair and regeneration of soft tissue damage and defects, nanoceria-incorporated film, hydrogel, and nanofibrous scaffolds have been proven to be highly suitable replacements with satisfactory outcomes. Still, some concerns have remained regarding the long-term effects of nanoceria administration for human tissues and organs, such as its clearance from the vital organs. Moreover, looking at the future, it seems necessary to design and develop three-dimensional (3D) printed scaffolds containing nanoceria for possible use in the concepts of personalized medicine.

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