Reliability and Usefulness of Radiographic Union Score (RUS) for Fracture Healing Assessment in Subtrochanteric Femoral Fractures

2020 ◽  
Vol 103 (11) ◽  
pp. 1148-1154
Keyword(s):  
Diagnostic Accuracy ◽  
Fracture Healing ◽  
Intraclass Correlation ◽  
Femoral Fractures ◽  
High Rate ◽  
Non Union ◽  
Keywords Hip Fracture ◽  
Keywords Hip ◽  
Healing Assessment ◽  
Radiographic Union

Background: The fracture healing assessment in subtrochanteric femoral fracture (SFF) is essential due to a high rate of implant failure and non-union. It requires an effective diagnostic tool for determining fracture union status. However, significant disagreement exists among clinicians for SFF union diagnosis, and no standardized method is available. Previous studies showed that radiographic union score (RUS) is reliable and highly correlated with fracture healing status. Objective: To evaluate the reliability and diagnostic accuracy of the RUS method for assessing the fracture healing status in the treatment of SFFs. Materials and Methods: The present study was a retrospective review study conducted on 44 SFFs. A panel of seven reviewers, which included five orthopedic surgeons and two musculoskeletal radiologists, assessed the radiographic healing of SFF based on both the RUS method and the physician impression method. The interobserver and intraobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Cohen’s kappa coefficient. The correlation and diagnostic accuracy between RUS and the clinical union were also evaluated. Results: The RUS method resulted in higher intraobserver and interobserver agreement compared to the physician impression method. Inter-rater agreements of the RUS method and physician impression method were moderate (ICC=0.60) and minimal (kappa=0.37), respectively. The RUS method had a higher correlation with clinical union outcome compared to the physician impression method in SFFs (AUC 0.908 versus 0.640). A RUS of 7 or more at 12 weeks had 88% sensitivity and 63% specificity for predicting clinical union outcome. Conclusion: The application of the RUS method is reliable for determining the fracture healing status in SFFs and has better correlation with clinical union than the physician impression method. The RUS method may also be useful for predicting clinical union in SFFs. These results support the use of the radiographic scoring system for fracture healing assessment in SFFs. Keywords: Hip fracture, Subtrochanteric fracture, Fracture healing assessment, Radiographic union, Clinical union, Physician impression

scholarly journals Teriparatide in fracture healing: Case series and review of literature

2022 ◽  
Vol 7 (2) ◽  
pp. 93-100
Author(s):  
S S Jha ◽  
Amit B Jain ◽  
Nilanj Dave ◽  
Alok Chaturvedi ◽  
Sandesh Warudkar
Keyword(s):  
Fracture Healing ◽  
Case Reports ◽  
Case Series ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Published Data ◽  
Mechanical Instability ◽  
Mineral Density ◽  
Non Union

Teriparatide (TPTD) (recombinant Parathyroid Hormone 1-34) is one of the pioneer osteo-anabolic agents approved for management of osteoporosis. Being an anabolic agent, it increases bone mineral density by inducing formation of new bone by the action on osteoblasts. As new bone formation is an important aspect of fracture healing as well, Teriparatide has long been a product of interest with respect to its effect on the process of fracture healing. Though fracture healing is not an approved indication for Teriparatide, there is quite a substantial amount of published data related to its effectiveness in fracture healing. With an intent to better understand the role of teriparatide in fracture, we share few case reports of successful fracture healing after giving Teriparatide and also review the published evidences of union taking place in difficult delayed union and non-union cases secondary to mechanical instability, inadequate fixation support or other reasons. This article thus, intended to summarize the accumulating preclinical and clinical evidence for role of TPTD in accelerating fracture healing in various conditions like conservative management of fractures, vertebral fractures, non-unions, delayed unions and atypical femoral fractures.

Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

2018 ◽  
Vol 29 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Amaia Ormaza ◽  
Javier Mosquera ◽  
Kattalin Iza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Fracture Healing ◽  
Femoral Fractures ◽  
Functional Results ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Harris Hip Score ◽  
Periprosthetic Femoral Fractures ◽  
The Mean

Introduction: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. Methods: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. Results: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66–88 years). The mean follow-up time was 5 years (range 2–12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34–87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. Discussion: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

scholarly journals Timing of Bisphosphonate Initiation After Fracture: What Does the Data Really Say?

2020 ◽  
Vol 11 ◽  
pp. 215145932098036
Author(s):  
David W. Barton ◽  
C. Taylor Smith ◽  
Amit S. Piple ◽  
Sterling A. Moskal ◽  
Jonathan J. Carmouche
Keyword(s):  
Fracture Healing ◽  
Clinical Studies ◽  
Osteoporosis Treatment ◽  
The Body ◽  
Non Union ◽  
Increased Risk ◽  
Level I ◽  
Timing Of Initiation ◽  
The Impact ◽  
Published Research

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic. Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review. Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

scholarly journals Validating scoring systems for fracture healing in infants and young children: pilot study

2021 ◽  
Author(s):  
Samuel Crompton ◽  
Fabrizio Messina ◽  
Gillian Klafkowski ◽  
Christine Hall ◽  
Amaka C. Offiah
Keyword(s):  
Pilot Study ◽  
Young Children ◽  
Fracture Healing ◽  
Callus Formation ◽  
Femoral Fractures ◽  
Scoring Systems ◽  
Power Calculation ◽  
Small Pilot Study ◽  
Fractures In Children ◽  
Infants And Young Children

Abstract Background Recent studies have analysed birth-related clavicular fractures to propose time frames for healing that could be applied to dating of all fractures in cases of suspected child abuse. Objective To assess differences in healing rates between femoral fractures and birth-related clavicular fractures in infants and young children. Materials and methods A retrospective 5-year pilot study of femoral fractures in children younger than 3 years of age was performed. Anonymised radiographs were independently scored by two radiologists for stages of fracture healing. In cases of reader disagreement, radiographs were independently scored by a third radiologist. Results In total, 74 radiographs (30 children) met the inclusion criteria. Fracture healing evolved over time with subperiosteal new bone formation (SPNBF) appearing first, followed by callus then remodelling. A power calculation for a single proportion, with a level of confidence of 95% and a margin of error of 5%, showed that in a definitive study, 359 radiographs would be required. Conclusion Although the overall pattern of healing is similar, in this small pilot study, the earliest times for SPNBF and callus formation in femoral fractures appeared to lag behind healing of birth-related clavicular fractures. Remodelling appeared earlier than remodelling of clavicular fractures. A power calculation has determined numbers of femoral radiographs (359) required for a definitive study.

scholarly journals Union rates and functional outcome of double plating of the femur: systematic review of the literature

2021 ◽  
Author(s):  
M. F. Lodde ◽  
M. J. Raschke ◽  
J. Stolberg-Stolberg ◽  
J. Everding ◽  
S. Rosslenbroich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fracture Healing ◽  
Functional Outcome ◽  
Femoral Fractures ◽  
Periprosthetic Fractures ◽  
Level Of Evidence ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Meta Analyses ◽  
Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

Clinical feasibility of fracture healing assessment through continuous monitoring of implant load

2020 ◽  
pp. 110188
Author(s):  
Manuela Ernst ◽  
Heiko Baumgartner ◽  
Stefan Döbele ◽  
Dankward Höntzsch ◽  
Tim Pohlemann ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Continuous Monitoring ◽  
Healing Assessment

scholarly journals Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

2018 ◽  
Vol 9 (7) ◽  
pp. 92-99 ◽  
Author(s):  
Jacob E Vaughn ◽  
Ronit V Shah ◽  
Tarek Samman ◽  
Jacob Stirton ◽  
Jiayong Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

scholarly journals Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

2018 ◽  
Vol 15 (12) ◽  
pp. 2845 ◽  
Author(s):  
Christina Ekegren ◽  
Elton Edwards ◽  
Richard de Steiger ◽  
Belinda Gabbe
Keyword(s):  
Fracture Healing ◽  
Hospital Admissions ◽  
Femoral Shaft ◽  
Hospital Length Of Stay ◽  
Long Bone ◽  
Future Research ◽  
Related Factors ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

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