scholarly journals Clinical effects of dynamic stabilization with far cortical locking system in the treatment of simple distal-third tibia fractures: A cohort study

2020 ◽  
Author(s):  
Jing Peng ◽  
Jun Fan ◽  
Yang Li ◽  
Xiaotao Long ◽  
Shiyang Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fracture Healing ◽  
Operative Time ◽  
Callus Formation ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Control Group ◽  
Fracture Union ◽  
Locked Plating ◽  
Tibia Fractures

Abstract Background: Locked plating constructs provided rigid fixation and may suppress callus formation at the fracture site, while far cortical locking (FCL) constructs have been shown to reduce the stiffness, thereby promoting fracture healing. A few publications have demonstrated that FCL construct increased axial dynamization and improved fracture healing. However, it is unclear whether the FCL construct was superior over locked plating construct for treating simple tibia fractures. Thus, we aimed to compare the clinical effect of FCL construct and locked plating construct for these fracture types.Methods: We retrospectively analyzed 18 patients treated with locked plating (control group) and 22 patients treated with the FCL construct (FCL group) from January 2016 to January 2018; the simple distal-third tibia fractures were included (AO/OTA classification: 42A1-A3 or 43A1). Patients were followed up regularly at 1, 2, 3, 6, and 12 months postoperatively, and data from clinical and radiological examinations were obtained. Patients’ demographics, operative time, time to radiological fracture union, time to full weight bearing, callus index, radiographic union score in tibia (RUST), and surgery-related complications were analyzed between the two groups.Results: The baseline patients’ demographics were similar between the two groups (P>0.05). There were no significant differences in of the operative time, time to radiological fracture union, or time to full weight bearing (P>0.05). However, the median callus index was 1.15 (IQR=1.08–1.25) in the FCL group and 1.09 (IQR=1.00–1.14) in the control group, showing a significant difference between the two groups (Z=-2.35, P<0.05), and the RUST was significantly higher at 2 months postoperatively (6.50±0.92 vs 7.59±1.37, P =0.006). Seven out of 18 patients in the control group and 2 out of 22 patients in the FCL group had no callus formation (callus index=1.0). All patients ultimately healed, and the complication rates were similar between the two groups.Conclusions : The FCL construct could promote fracture healing and was superior to locked bridge plating, as it did not lead to more surgery-related complications. Level of Evidence : Ⅲ, retrospective cohort study

scholarly journals Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 691
Author(s):  
Jan Barcik ◽  
Devakara R. Epari
Keyword(s):  
Fracture Healing ◽  
Bone Healing ◽  
Mechanical Stimulation ◽  
Callus Formation ◽  
Weight Bearing ◽  
Healing Process ◽  
Healing Time ◽  
Mechanical Environment ◽  
Clinically Significant ◽  
The Impact

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

2016 ◽  
Vol 2 (4) ◽  
pp. 291 ◽  
Author(s):  
Shafeed T. P. ◽  
Bijo Paul
Keyword(s):  
Tissue Injury ◽  
Weight Bearing ◽  
Soft Tissue Injury ◽  
Femoral Fractures ◽  
Early Mobilization ◽  
Type A ◽  
Full Weight Bearing ◽  
Supracondylar Fractures ◽  
Range Of Movement ◽  
Locked Plating

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.</span></p><p class="abstract"><strong>Methods:</strong> 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients &lt;50 was 103 degree and for patients&gt;50 ROM was 98.66 degree. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.</span></p>

scholarly journals Functional and radiological outcome of expert tibia nailing in proximal tibia fractures

2018 ◽  
Vol 5 (1) ◽  
pp. 50
Author(s):  
Rahul Kadam ◽  
Ashutosh Ajit Jadhav ◽  
Abhay Chaallani ◽  
Preetam Singh Dagar ◽  
Jehangir Malcom Pestonji
Keyword(s):  
Proximal Tibia ◽  
Weight Bearing ◽  
Proximal Part ◽  
Tibia Fracture ◽  
Full Weight Bearing ◽  
Proximal Tibia Fracture ◽  
Tibia Fractures ◽  
Good Treatment Option ◽  
Proximal Tibia Fractures ◽  
Radiological Union

<p class="abstract"><strong>Background:</strong> Previously treatment of choice for proximal tibia fracture was internal fixation by plate. Presently, expert tibia nail is widely used in treating proximal tibia fracture. Expert tibia nailing system has features like multi directional locking options in the distal and proximal part of the nail, in addition to the standard static and dynamic locking options present in IMIL Nail. Purpose of study is to evaluate the outcome of expert tibia nail in proximal tibia fracture.</p><p class="abstract"><strong>Methods:</strong> We retrospectively, reviewed thirty patients having proximal tibia fracture with age more than 18 years treated with expert tibia nail and were followed up averagely for 12 months between May2016 to May2018. All patients were compared in terms of intraoperative and postoperative parameters and functionally assessed using the Johner and Wruchs criteria at 3 weeks, 3 months, 6 months and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome was measured by Johner and Wruhs criteria of 30 patients showed 20 excellent, 8 good, 2 patients had fair results. Average time unprotected full weight bearing walking was 7.2 weeks. Average time taken for radiological union was 18.2 weeks.</p><p class="abstract"><strong>Conclusions:</strong> Expert tibial Interlocking Nail is good treatment option for proximal tibia fracture.</p>

scholarly journals Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

2015 ◽  
Vol 9 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Izzet Bingol ◽  
Nadir Yalcin ◽  
Vedat Bicici ◽  
Tolga Tulunay ◽  
Kaan Yuksel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Callus Formation ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Cohort Analysis ◽  
Tibial Fractures ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

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 Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110243
Author(s):  
Cheng Ren ◽  
Ming Li ◽  
Liang Sun ◽  
Zhong Li ◽  
Yibo Xu ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Cochrane Library ◽  
Full Weight Bearing ◽  
Locked Plating ◽  
Fixation Group ◽  
Proximal Tibial Fractures

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

scholarly journals Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Ye Zhao ◽  
Yong-hui Liu ◽  
Shu-ge Mao ◽  
Xin-xin Zhang
Keyword(s):  
3D Printing ◽  
Fracture Healing ◽  
Hip Joint ◽  
Weight Bearing ◽  
Control Group ◽  
Intertrochanteric Fractures ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Comprehensive Rehabilitation ◽  
Experimental Group

Objectives: To observe the clinical value of 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in elderly patients with intertrochanteric fractures. Methods: Sixty elderly patients with intertrochanteric fractures of the femur who were treated in our hospital from January 2018 to January 2020 were selected and randomly divided into two groups. In the experimental group, 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation was used for treatment. While in the control group, traditional open reduction and dynamic hip screw internal fixation combined with postoperative conventional treatment was utilized. The duration of surgery, intraoperative blood loss, postoperative hospital stay, weight bearing time, fracture healing time and other surgical indicators were recorded respectively, and hip joint function recovery was evaluated prior to and 2 weeks after surgery. All patients were followed up for six months to observe the occurrence of complications within half a year, including deep vein thrombosis, incision infection, avascular necrosis of femoral head, hip joint stiffness, delayed fracture healing, etc. Subsequently, the differences in postoperative complications between the two groups were compared and analyzed. Results: The operation time, blood loss, postoperative hospital stay, weight bearing time and fracture healing time of the experimental group were better than those of the control group, and the difference was statistically significant (p<0.05). After treatment, the hip joint function of the experimental group was significantly improved compared with the control group, with a statistically significant difference(p=0.03). The incidence of operative complications in the experimental group was 10% (3/30) within six months postoperatively, significantly lower than the 33% (10/30) in the control group, with statistical significance (p=0.03). Conclusion: 3D printing with early rehab proved to be effective treatment in our study. Such a combined treatment has the advantages of precise operative reduction, fast postoperative recovery, and certain safety and effectiveness. doi: https://doi.org/10.12669/pjms.37.3.3988 How to cite this:Zhao Y, Liu YH, Mao SG, Zhang XX. Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pseudarthrosis in fibrous dysplasia treated with bone morphogenetic protein

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 377-379
Author(s):  
Johannes Beckmann ◽  
Franz Kock ◽  
Markus Tingart ◽  
Juergen Goetz ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Fibrous Dysplasia ◽  
Callus Formation ◽  
Weight Bearing ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Underlying Disease ◽  
The Body ◽  
Full Weight Bearing ◽  
Morphogenetic Protein

AbstractWe present a case of pseudarthrosis in a patient suffering from polyostotic fibrous dysplasia of the right part of the body that was successfully treated with bone morphogenetic protein. Pseudarthrosis occurred after proximal femoral shaft fracture due to a motorcycle accident initially treated by intramedullary nailing. After revision, the patient was treated by pseudarthrosis debridement and grafting of bone morphogenetic protein-7/osteogenic protein-1, resulting in callus formation that allowed indolent full weight-bearing after 6 weeks. The underlying disease as well as the described treatment is discussed.

Coned hemipelvis reconstruction for osteoporotic acetabular fractures in frail elderly patients

2020 ◽  
Vol 102-B (2) ◽  
pp. 155-161 ◽  
Author(s):  
Samuel E. McMahon ◽  
Owen J. Diamond ◽  
Laurence A. Cusick
Keyword(s):  
Frail Elderly ◽  
Posterior Approach ◽  
Operative Time ◽  
Weight Bearing ◽  
High Energy ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Surgical Options ◽  
The Mean ◽  
One Year

Aims Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. Methods We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). Results The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d’Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. Conclusion The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155–161.

scholarly journals Comparative efficacy and safety profile for the treatment of humeral bone cysts in children: curettage and mixed bone grafting either with or without elastic intramedullary nailing

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xuan Wang ◽  
Jiuhui Han ◽  
Yazhou Li ◽  
Yuchang Liu ◽  
Junzhong Luo
Keyword(s):  
Intramedullary Nailing ◽  
Safety Profile ◽  
Bone Grafting ◽  
Weight Bearing ◽  
Bone Cyst ◽  
Operation Time ◽  
Full Weight Bearing ◽  
Control Group ◽  
Pain Level ◽  
Elastic Intramedullary Nailing

Abstract Purpose The primary aim of our study was to evaluate the comparative efficacy and safety profile of curettage and mixed bone grafting without instrument or with elastic intramedullary nailing in the treatment of humeral bone cyst in children. Methods Our retrospective study included a total of 48 children harboring humeral bone cyst in our hospital from August 2012 to February 2019. The patients enrolled were divided into elastic nailing group with the application of elastic intramedullary nailing (n = 25) and control group without using instrument (n = 23) during the management of curettage and mixed bone grafting. The following medical outcomes of the two groups were monitored and recorded: the amount of intraoperative blood loss, operation time and postoperative full weight-bearing time, in addition to postoperative clinical effects after 1 year, the function and pain level of shoulder joint before and 1, 3, 6, 9, 12, and 16 months after operation. Follow-up radiographic outcomes were reviewed to observe bone healing, local recurrence and internal fixation loosening, and other postoperative complications. Results The clinical curative effect of the elastic nailing group was higher than that of the control group 16 months after operation (96.00% > 73.91%, P < 0.05). The intraoperative blood loss and postoperative full weight-bearing time in the elastic nailing group were less than those in the control group (P < 0.05), but the operation time was statistically insignificant between the two groups (P > 0.05). Before operation, the shoulder joint function of the two groups was comparable (P > 0.05), while the function showed remarkably better outcome in the elastic nailing group than control group 1 to 16 months after operation (P < 0.05). Before operation, the pain level of the two groups was comparable (P > 0.05), while 1 to 16 months after operation, the pain level of the elastic nailing group was significantly lower than that of the control group (P < 0.05). Patients in both groups were followed up for 16 months. Mixed bone grafting fusion was indicated by imaging CT and X-ray during the follow-up period, with an average fusion time of 11.3 ± 1.2 months (range, 8–16 months). Three months after operation, there was 1 case of incomplete pathological fracture in the control group, while no related complications occurred in the elastic nailing group. Moreover, no tumor recurrence was observed in the two groups. The two groups were comparable in terms of the incidence of complications (P > 0.05). Conclusion Children with humeral cyst treated with curettage and mixed bone grafting with the additional use of elastic intramedullary nailing exerted superior results to those without using instrument as there are beneficial outcomes and safety profile and no complications.

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