Prophylactic Topical Gentamicin after Open Reduction and Internal Fixation of Long Bone Fractures in Orthopedics

This study demonstrates that long bone fracture treatment in food and fibre producing animals is in most cases successful. The greatest disadvantage of such treatment are the costs of the surgery and implants.

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

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v23i1.33523 ◽

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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Outcome of Open Long Bone Fractures in Dogs Stabilized with Linear External Skeletal Fixator

Indian Journal of Animal Research ◽

10.18805/ijar.b-4262 ◽

2021 ◽

Author(s):

Tejpal Singh ◽

Ashwani Kumar ◽

Rahul Kumar Udehiya ◽

Kirandeep Kaur Gill ◽

Tejinder Singh Rai ◽

...

Keyword(s):

Internal Fixation ◽

Open Fracture ◽

Bone Fractures ◽

Open Fractures ◽

Long Bone ◽

Type I ◽

Group Iii ◽

Long Bone Fractures ◽

Group I ◽

Tract Infections

Background: External skeletal fixator (ESF) has been recommended as biological method to stabilize open fracture as it does not involves the wound site, besides protecting adjacent soft tissue structures. Considering the advantages of ESF, this study was envisaged with an objective to study the outcome of open fractures of radius-ulna and tibia-fibula stabilized with linear ESF in dogs.Methods: This study included 17 dogs suffering from open long bone fractures of radius-ulna and tibia-fibula, divided into three groups; linear ESF type I or II (group I, n=8) and type III (group II, n=3). In group III (n=6), open fractures were initially treated using conservative methods i.e management of open wound till complete healing followed by delayed internal fixation using intramedullary pin or bone plating.Result: Majority of the open fractures of radius-ulna and tibia-fibula were transverse (64.71%), involving distal third diaphysis (47.06%) in heavy weight (54.55%), 1-3 year old (64.71%), non-descript (35.29%), male (88.23%) dogs due to automobile accidents (58.82%). Neutrophilic (81.47±4.45%) leukocytosis (24610±2461.88 per cumm) and elevated levels of alkaline phosphatase and creatine kinase were observed. Staphylococcus spp. was the common isolated bacteria sensitive to Gentamicin, Cefotaxime, Tobramycin, Amikacin and Neomycin. High per cent fractures (83.33%) in group III had acceptable functional outcome as compared to fractures treated with linear ESF (55.55%) in groups I and II. Osteomyelitis due to pin tract infections was the major complication (8/11; 72.7%) recorded in ESF groups (Group I and II) that lead to delayed and/or nonunion. Weight bearing score improved markedly after removal of the ESF frame. In conclusions, immediate fixation of the long bone fracture using linear ESF in the presence of open contaminated / infected wounds leads to unacceptable outcome. Poor animal compliance, pin tract discharge, osteomyelitis, delayed union and nonunion are major complications associated with linear ESF. Conservative management of the open fracture wound using standard treatment for 2-3 weeks till complete wound healing followed by internal fixation with intramedullary pin or bone plate is recommended for open long bone fractures in dogs.

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