scholarly journals Delayed healing of lower limb fractures with bisphosphonate therapy

2015 ◽  
Vol 97 (5) ◽  
pp. 333-338 ◽  
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.

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

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.

Impact of obesity on operative treatment and inpatient outcomes of paediatric limb fractures

2019 ◽  
Vol 101-B (4) ◽  
pp. 491-496 ◽  
Author(s):  
N. Y. Li ◽  
S. Kalagara ◽  
A. Hersey ◽  
A. E. M. Eltorai ◽  
A. H. Daniels ◽  
...  
Keyword(s):  
Lower Limb ◽  
Operative Management ◽  
Hospital Charges ◽  
Lengths Of Stay ◽  
Lower Limb Fractures ◽  
Inpatient Outcomes ◽  
Increased Risk ◽  
Closed Treatment ◽  
Limb Fractures ◽  
Inpatient Database

AimsThe aim of this study was to utilize a national paediatric inpatient database to determine whether obesity influences the operative management and inpatient outcomes of paediatric limb fractures.Patients and MethodsThe Kids’ Inpatient Database (KID) was used to evaluate children between birth and 17 years of age, from 1997 and 2012, who had undergone open and closed treatment of humeral, radial and ulna, femoral, tibial, and ankle fractures. Demographics, hospital charges, lengths of stay (LOS), and complications were analyzed.ResultsObesity was significantly associated with increased rates of open reduction and internal fixation (ORIF) for: distal humeral (odds ratio (OR) = 2.139, 95% confidence interval (CI) 1.92 to 3.44; p < 0.001); distal radius and ulna fractures (OR = 1.436, 95% CI 1.14 to 2.16; p < 0.05); distal femoral (OR = 2.051, 95% CI 1.69 to 3.60; p < 0.05); tibial and fibula shaft (OR = 2.101, 95% CI 2.10 to 3.50; p < 0.001); and ankle (OR = 1.733, 95% CI 1.70 to 2.39; p < 0.001). Older age was significantly associated with ORIF for all fractures (p < 0.05). LOS, hospital charges, and complications were significantly increased in obese patients following ORIF for upper and lower limb fractures (p < 0.05).ConclusionObese paediatric patients are more likely to undergo ORIF in both upper and lower limb fractures and have more inpatient complications. These findings may assist in informing obese paediatric fracture patients and their families regarding the increased risk for open operative fixation and associated outcomes. Cite this article: Bone Joint J 2019;101-B:491–496.

scholarly journals Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

2021 ◽  
Author(s):  
Saeid Samiezadeh ◽  
Pouria Tavakkoli Avval ◽  
Zouheir Fawaz ◽  
Habiba Bougherara
Keyword(s):  
Mechanical Performance ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Femoral Shaft ◽  
Delayed Union ◽  
Fracture Site ◽  
Long Bone ◽  
Fe Model ◽  
Non Union ◽  
Shaft Fractures

Background: Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the above mentioned complications. Methods: In this study, a new hybrid concept for nails made of carbon fibers/ fl ax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Results: Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23 N ( P b 0.05), and the mean stress in the vicinity of fracture by 2.11 MPa ( P b 0.05) at 45% gait cycle, while only 0.33 mm and 0.39 mm ( P b 0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Interpretation: Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.

scholarly journals Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

2021 ◽  
Author(s):  
Saeid Samiezadeh ◽  
Pouria Tavakkoli Avval ◽  
Zouheir Fawaz ◽  
Habiba Bougherara
Keyword(s):  
Mechanical Performance ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Femoral Shaft ◽  
Delayed Union ◽  
Fracture Site ◽  
Long Bone ◽  
Fe Model ◽  
Non Union ◽  
Shaft Fractures

Background: Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the above mentioned complications. Methods: In this study, a new hybrid concept for nails made of carbon fibers/ fl ax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Results: Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23 N ( P b 0.05), and the mean stress in the vicinity of fracture by 2.11 MPa ( P b 0.05) at 45% gait cycle, while only 0.33 mm and 0.39 mm ( P b 0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Interpretation: Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.

scholarly journals Role of PRP injection in delayed union and non union of long bone fractures

2020 ◽  
Vol 6 (1) ◽  
pp. 35-40
Author(s):  
Apser Khan ◽  
◽  
Suresh Kumar Kaushik ◽  
Mrigank Mathur ◽  
Milan Jaiswal ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Long Bone Fractures

scholarly journals Local Platelet-rich plasma (PRP) injection for the treatment of Delayed Union after Internal Fixation in Fractures of Long Bones

2020 ◽  
Vol 23 (1) ◽  
pp. 30-36
Author(s):  
Tanup Prasai ◽  
Sashmit Sharma ◽  
Kiran Prasad Rijal ◽  
Krishna Raj Khanal
Keyword(s):  
Internal Fixation ◽  
Bone Fractures ◽  
Platelet Rich Plasma ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Medical College ◽  
Long Bone Fractures ◽  
Usual Solution ◽  
Without Bone Graft

Introduction: Long bone fractures are among the most common orthopaedic injuries encountered. A fracture that fails to progress to union despite appropriate fixation and absence of complications presents a treatment dilemma to the surgeon. The usual solution of re-fixation with or without bone graft constitutes repeat exposure to surgery and its risks, as well as added morbidity and cost. Recent advances in molecular biology suggest Platelet rich plasma (PRP) may have bone forming potential. This study was done to determine whether PRP has any beneficial role in patients with delayed healing of long bone fractures. Methods: A prospective interventional study was done on patients arriving at the department of orthopaedic surgery of Kathmandu Medical College with delayed union of long bone fractures after internal fixation between January 2014 and January 2017. Patients were treated with local injection of group-matched PRP directly into the fracture gap and were followed-up for six months to check for radiological signs of fracture union. Results: A total of 10 fractures were included in 10 patients that involved four humeri, three tibiae, and three femora. Eight out of the 10 fractures united at a median time of three months after the injection. Two had non-union that required revision surgery. Conclusion: Local Platelet rich plasma injection may constitute a ‘nothing to lose, everything to gain’ intermediate option before a decision for major reoperation on such patients is made.

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