metaphyseal fracture
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2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Xu Zhang ◽  
Bin Liu ◽  
Quan Wang ◽  
Hongtao Shang

Objectives: To explore the curative effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) technology combined with locking compression plates (LCP) guided by C-arm X-ray machine in the treatment of tibial metaphyseal fracture and its impact on the surgical indexes and postoperative complications. Methods: The present study was a retrospective analysis focusing on the clinical data of 104 cases of tibial metaphyseal fracture who were treated surgically in our hospital from February 2019 to February 2021. According to different surgical methods, patients who were treated by using MIPPO technology combined with LCP guided by C-arm X-ray machine were divided into the observation group (n=54), while those who underwent traditional open reduction and internal fixation were classified into the control group (n=50). Further comparison was made on the differences of the curative effect, surgical index (operation time, intraoperative blood loss, incision length, and healing time) and postoperative complications between the two groups. In addition, the differences in ankle function, knee function and quality of life [Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36)] were evaluated between the two groups before treatment and 6 months after treatment. Results: The clinical curative effect and total efficacy of the observation group were better than those of the control group (All p<0.05). The operation time, intraoperative blood loss, incision length, and healing time were lower in the observation group when compared to those of the control group (All p<0.05). The total incidence of postoperative complications was also lower in the observation group than that in the control group (p<0.05). In addition, the scores of ankle function, knee function and MOS SF-36 in both groups were higher after 6 months of treatment than those before treatment; besides, the inter-group comparison showed that the scores of ankle function, knee function and MOS SF-36 in the observation group were higher than those in the control group (All p<0.05). Conclusion: MIPPO technology combined with LCP guided by C-arm X-ray machine has a significant curative effect on the treatment of tibial metaphyseal fracture. It can significantly improve the surgical index, reduce postoperative complications, and have an obvious effect on postoperative recovery of ankle function, knee joint function and quality of life. doi: https://doi.org/10.12669/pjms.38.3.4757 How to cite this:Zhang X, Liu B, Wang Q, Shang H. Minimally Invasive Percutaneous Plate Osteosynthesis technique combined with locking compression plates guided by C-Arm X-Ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4757 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.


Author(s):  
Meisam Jafari Kafiabadi ◽  
Mehrdad Sadighi ◽  
Amir Sabaghzadeh ◽  
Farsad Biglari ◽  
Saber Barazandeh Rad ◽  
...  

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children. Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature. Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.


2021 ◽  
Vol 4 (3) ◽  

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score <60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.


Biomechanics ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 29-42
Author(s):  
Lucas Engelhardt ◽  
Frank Niemeyer ◽  
Patrik Christen ◽  
Ralph Müller ◽  
Kerstin Stock ◽  
...  

Simulating diaphyseal fracture healing via numerical models has been investigated for a long time. It is apparent from in vivo studies that metaphyseal fracture healing should follow similar biomechanical rules although the speed and healing pattern might differ. To investigate this hypothesis, a pre-existing, well-established diaphyseal fracture healing model was extended to study metaphyseal bone healing. Clinical data of distal radius fractures were compared to corresponding geometrically patient-specific fracture healing simulations. The numerical model, was able to predict a realistic fracture healing process in a wide variety of radius geometries. Endochondral and mainly intramembranous ossification was predicted in the fractured area without callus formation. The model, therefore, appears appropriate to study metaphyseal bone healing under differing mechanical conditions and metaphyseal fractures in different bones and fracture types. Nevertheless, the outlined model was conducted in a simplified rotational symmetric case. Further studies may extend the model to a three-dimensional representation to investigate complex fracture shapes. This will help to optimize clinical treatments of radial fractures, medical implant design and foster biomechanical research in metaphyseal fracture healing.


2021 ◽  
Vol 10 (1) ◽  
pp. 41-50
Author(s):  
Ronald Man Yeung Wong ◽  
Victoria Man Huen Choy ◽  
Jie Li ◽  
Tsz Kiu Li ◽  
Yu Ning Chim ◽  
...  

Aims Fibrinolysis plays a key transition step from haematoma formation to angiogenesis and fracture healing. Low-magnitude high-frequency vibration (LMHFV) is a non-invasive biophysical modality proven to enhance fibrinolytic factors. This study investigates the effect of LMHFV on fibrinolysis in a clinically relevant animal model to accelerate osteoporotic fracture healing. Methods A total of 144 rats were randomized to four groups: sham control; sham and LMHFV; ovariectomized (OVX); and ovariectomized and LMHFV (OVX-VT). Fibrinolytic potential was evaluated by quantifying fibrin, tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) along with healing outcomes at three days, one week, two weeks, and six weeks post-fracture. Results All rats achieved healing, and x-ray relative radiopacity for OVX-VT was significantly higher compared to OVX at week 2. Martius Scarlet Blue (MSB) staining revealed a significant decrease of fibrin content in the callus in OVX-VT compared with OVX on day 3 (p = 0.020). Mean tPA from muscle was significantly higher for OVX-VT compared to OVX (p = 0.020) on day 3. Mechanical testing revealed the mean energy to failure was significantly higher for OVX-VT at 37.6 N mm (SD 8.4) and 71.9 N mm (SD 30.7) compared with OVX at 5.76 N mm (SD 7.1) (p = 0.010) and 17.7 N mm (SD 11.5) (p = 0.030) at week 2 and week 6, respectively. Conclusion Metaphyseal fracture healing is enhanced by LMHFV, and one of the important molecular pathways it acts on is fibrinolysis. LMHFV is a promising intervention for osteoporotic metaphyseal fracture healing. The improved mechanical properties, acceleration of fracture healing, and safety justify its role into translation to future clinical studies. Cite this article: Bone Joint Res 2021;10(1):41–50.


2020 ◽  
Vol 40 ◽  
pp. 172-188
Author(s):  
M Haffner-Luntzer ◽  
◽  
A Ignatius

An estimated 2 million osteoporotic fractures occur annually in the US, resulting in a dramatic reduction in quality of life for affected patients and a high economic burden for society. Osteoporotic fractures are frequently located in metaphyseal bone regions. They are often associated with healing complications, because of the reduced healing capacity of the diseased bone tissue, the poor primary stability of the fracture fixation in the fragile bone, and the high frequency of comorbidities in these patients. Therefore, osteoporotic fractures require optimised treatment strategies to ensure proper bone healing. Preclinical animal models can help understanding of the underlying mechanisms and development of new therapies. However, whereas diaphyseal fracture models are widely available, appropriate animal models for metaphyseal fracture healing are scarce, although essential for translational research. This review covers large and small animal models for metaphyseal fracture healing. General requirements for suitable animal models are presented, as well as advantages and disadvantages of the current models. Furthermore, differences and similarities between metaphyseal and diaphyseal bone fracture healing are discussed. Both large- and small-animal models are available for studying metaphyseal fracture healing, which mainly differ in fracture location and geometry as well as stabilisation techniques. Most common used fracture sites are distal femur and proximal tibia. Each model found in the literature has certain advantages and disadvantages; however, many lack standardisation resulting in a high variability or poor mimicking of the clinical situation. Therefore, further refinement ofanimal models is needed especially to study osteoporotic metaphyseal fracture healing.


Author(s):  
Naveed Ali Shair ◽  
Abdullah Tariq ◽  
Muhammad Shakeel ◽  
Muhammad Kashif ◽  
Ejaz Ahmad ◽  
...  

Background: Metacarpal fractures are considered a frequent orthopedic injury seen commonly in emergency units. Objectibe of thestudy was to compare the outcome of internal fixation procedure of miniplate versus cross kirschner wires (k-wires) for displaced metacarpal metaphyseal fractures.Methods: In this experimental prospective study, 100 patients with metacarpal metaphyseal fracture were considered. internal fixation was done by miniplate in one group and cross k wires in other group. Outcomes in terms of radiological union were compared between both groups. The data was analyzed by using SPSS for windows (version 26.0).Results: Mean age of the patients was 38.70±13.61 years. Male to female ratio of the patients was 1.2:1. The radiological success was noted in 76 (76.0%) patients. Statistically insignificant difference was found between the study groups in terms of radiological success of the patients (p=0.6396). K wire fixation was recorded to have significantly shorter duration of operation time in comparison to miniplate fixation (p=0.0001).Conclusions: The internal fixation procedure of both miniplate and k wire are equally effective in terms of radiological success for management displaced metacarpal metaphysis fractures. As compared to miniplate fixation, K wire fixation was found to have significantly shorter duration of operation time.


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