Fractures of Tibia Diaphysis Managed with Internal Fixation by Elastic Nails: An Alternative Approach

Background: Intramedullary nailing techniques specially using elastic nails like Enders nail are a good treatment option, owing to their cost effectiveness, less use of fluroscopy and ease of procedure with short learning curve. This study is aimed to bring evidence to the hypothesis that Ender nails can be used successfully in tibia shaft fractures under certain indications. Due to the economic nature and easy procedure, we aimed specifically to demonstrate that elastic IM nailing, esp. Ender nails can be a good alternative to interlock nailing for select cases of diaphyseal fractures. The study aims at evaluating outcome of Enders nail in diaphyseal tibia fractures. Material and Methods: This study was carried on in the Department of Orthopaedics, tertiary care hospital during the period of April 2019 to March 2020. It is a prospective type of study. Patients were evaluated based on functionality and radiology, post-surgery. Results: A total of 30 patients of tibial shaft fractures were selected and managed with closed reduction and internal fixation with Enders nail. Male to female ratio was 4:1. 24 (80%) patients sustained injury from motor vehicular accidents. 40% patients with open fracture and 60% closed fracture patients were involved. 60% if the patients showed clinic-radiological union in 12-14 weeks, while 50% of the patients achieved a post operative knee range of movement of 0 to 131-140 degrees. Conclusion: Closed reduction with internal fixation by Enders nail can be a good alternative for management of tibia diaphysis fractures, when performed after proper patient selection and patient counselling.

Relationship Between Periosteal Reaction and Medial Compartment Knee Osteoarthritis in Observation of Chinese Patients: A Retrospective Single-Centre Comparative Study

Background: The purpose of this study to evaluate the potential relationship between the periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the related risk factors for the development of periosteal reaction associated with medial compartment KOA.Methods: From January 2019 to December 2019, a total of 476 consecutive patients with medial compartment KOA were included and assessed in this retrospective comparative study. They were divided into two groups: periosteal reaction group and non-periosteal reaction group. Radiological parameters was measured for malalignment of the lower extremities in coronal plane. Intra-observer and inter-observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses was conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate binary logistical regression analysis were performed to determine the independent risk factors of radiographic parameters for periosteal reaction.Results: A total of 363 patients (726 knees) were selected for the study, including 91 males and 272 females, with an average age of 57.9±12.8 years (range, 18-82 years). The overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, the incidence of periosteal reaction significantly increased with age and K-L grade progressed (P＜0.05). Multivariate logistical regression analysis found that HKA and JICA were significantly correlated with the development of periosteal reaction adjacent to the lateral of proximal tibia diaphysis in medial compartment KOA (P＜0.05).Conclusions: Our observation of the reaction of periosteum may be an anatomical adaptation for medial compartment KOA. Patients with lower HKA and higher JICA are more likely to developing periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis.

EFFECTS OF DIABETES MELLITUS ON REPARATIVE OSTEOGENESIS

Introduction: Chronic hyperglycemia as the main link in DM pathogenesis leads to systemic vessels and nerves lesion with chronic bone complications development consequently. The aim: To evaluate influence of hyperglycemia on reparative osteogenesis after perforated tibial fracture in rats. Materials and methods: A total of 30 white adult rats were subdivided into two groups: 15 healthy rats in Group 1 (control) and 15 rats with alloxan induced hyperglycemia in Group 2 (investigated) and were carried out of experiment on the 10th, 20th and 30th day after the fracture. Hyperglycemia in rats was verificated as the postprandial glycemic rate ≥ 8,0 mmol/l. Tibia diaphysis fracture was modeled by a cylindrical defect with a diameter of 2 mm with portable frezer. Morphological evaluation. A complex morphological studies included histological, morphometric and immunohistochemical examination. Results: This is confirmed by an increase in MMP-9 expression in connective tissue, a decrease in TGF-β expression in all phases, an increase in the expression of CD3 and CD20 and a marked decrease in the expression of all vascular markers. During hyperglycemia, incomplete blood supply to the tissues occurs, necrosis of bone and soft tissues develop in the area of the fracture, the reparative reaction slows down considerably and manifests itself in the development of fibrous and, less commonly, cartilage tissue. Conclusions: In hyperglycemia rats, there was a delay in the callus formation, a decrease in proliferation and ossification, and a slowdown in the processes of angiogenesis.

Case Report: Aggressive Tibial Pseudarthrosis as Primary Symptom in Infant with Neurofibromatosis

Neurofibromatosis (NF1) is a rare genetic neurological disorder with over 30 distinct clinical manifestations, the top 3 of which include cafe-au-lait spotting, benign tumors and abnormal freckling. Pseudarthrosis (PA), also known as a false joint, is a rare subset of NF1 symptomology, characterized by bone fractures and nonunion caused by severe bowing of long bones. To date, it is invariably reported as secondary to NF1, commonly at 24 months of age. Here we describe a 4-month old infant who presented with PA as primary symptom, and in absence of an NF1 first-degree relative. Initial manifestation was guarding of the leg and increased irritability upon palpation of the knee, subsequent to light playful jostling. Physician examination revealed gross anterolateral bowing of the left leg. Radiography confirmed tibia-fibula bowing and pathologic transverse fracture at tibia diaphysis, characteristic of PA. Cafe-au-lait spots developed at 6 months subsequent to PA, but with number and size well below the National Institutes of Health criteria for NF1 diagnosis. At 14 months, exome sequencing established definitive NF1 diagnosis. Treatment involved PA takedown surgery. Although healing was seen after 2 months, complications emerged by 6 months. This case suggests that for primary PA without clear etiology, first-contact and consulting physicians should pay careful attention and be vigilant to timing of clinical onset and severity. Early, severe primary PA warrants accelerated NF1 exome sequencing, suggesting expansion of existing federal guidelines may be necessary to improve detection and prognosis of this rare, debilitating but readily managed condition.

Numerical Simulation of the Healing Process in the Tibia Diaphysis Fracture Fixed With External Fixation

The tibia diaphysis (shaft) fracture is one of the most common long bone fractures, and is usually treated with either the internal or the external fixations. How to choose a proper fixation type is still empirical and controversial. The objective of this study was to investigate whether the lateral external fixation (LEF) is suitable to treat the transverse and oblique tibia diaphysis fracture, from a mechanobiological perspective. The healing processes in the tibia fractures were simulated using the finite element method. The models of both the transverse and oblique (45°) tibia diaphysis fracture fixed with a LEF were built. A mechano-bioregulatory algorithm, which considered both the mechanobiological and biological environments, was developed to simulate the cell and tissue activities inside the callus. The results showed that both fractures healed in a typical secondary osteogenesis process. After 60 days, the regions of external callus and bone marrow were occupied with bone tissue. However, the mechanical stimulus in the inter-cortical region in the oblique fracture model with a less stiff LEF was greater than the stimulus in the transverse fracture model with the same LEF, indicating that the angled fracture was prone to generate greater instability. Moreover, increased osteogenic differentiation threshold only slightly affected the bone formation in the bridging areas, thus, had minor influences on the healing process. In conclusion, the lateral external fixation demonstrated satisfactory capacity in the treatment of the transverse and oblique tibia diaphysis fracture. The oblique fracture was more likely to be affected with a less stiff fixation.