Open Tibial Fractures in Children

Since the last edition of this book the total number of published articles on the management of open fractures of the tibia in children has trebled. This allows for a further evaluation of similarities and differences in the management of open fractures in children, adolescents and adults. The principles evolving from the evidence published thus far indicate there are greater similarities than there are differences. Early antibiotic administration is important as is the simultaneous delivery of combined orthoplastic care. The techniques of soft tissue reconstruction are similar to those used in adults. Fracture stabilisation will need to factor in the presence of a physis. Bone loss after injury or excision (debridement) is replaced using the same techniques as in adults; an exception is the young (under 6 years of age) child with a small (less than 3 cm) defect that may restitute spontaneously from periosteal callus.

BONE HEALING PATTERNS OF INTERLOCKED INTRAMEDULLARY NAIL-FIXATED FEMORAL SHAFT FRACTURES: AGE-MATCHED RADIOGRAPHIC PRESENTATION OF UNION PATTERN

Design: Study on the union pattern of femoral shaft fractures after interlocked intramedullary fixation. Objective: To assess the fracture healing pattern — the so-called callus types — and its formation speed, and age influence. Setting: Orthopedic and traumatic services. Material and methods: Among all the healed femoral shaft fractures, 10 patients at least in each decade from late teens to eighth decade who were regularly followed radiographically with a certain interval upto complete fracture union were chosen. Results: All the fractures healed primarily with external periosteal callus which was followed sometimes later by intercortical uniting callus with disappearance of fracture line. Conclusion: All the nailed femoral shaft fractures healed primarily by periosteal bridging callus irrespective of age, fracture type, and use of interlocking screws, though some less external callus formation after sixth decade was observed.

Nomenclature, classification, and documentation of catastrophic fractures and associated preexisting injuries in racehorses

Racehorses are susceptible to bone fractures when damage from repetitive, high-magnitude loads incurred during training and racing exceed concurrent damage removal and replacement, resulting in transient periods of focal osteoporosis and bone weakening. Clinically, these events correspond to cortical stress fractures and subchondral bone stress remodeling. Evidence of these preexisting lesions include periosteal callus, endosteal callus, and intracortical focal hyperemia for cortical stress fractures; and subchondral focal hyperemia located superficial to sclerotic compacted trabecular bone tissue for subchondral stress remodeling. These findings must be in direct physical association with an acute fracture to infer that the abnormalities precipitated complete bone fracture. Recognition of preexisting lesions must be conveyed in the autopsy report to the racehorse industry audience because this is the mechanism for education of racehorse trainers, veterinarians, and owners. Standardized anatomic nomenclature, fracture classification, and documentation of gross autopsy findings specific to catastrophic bone fractures in racehorses provides information to empower changes in management of racehorses for the detection and management of mild injuries and prevention of catastrophic fractures.

New biological method of internal fixation of the femur

One of the main goals in fracture treatment is preservation of both intramedular and periosteal vascularisation. The aim of this paper is to show a new method of internal fixation which accomplishes these goals. The paper presents the results of clinical application of Mitkovic Internal Fixator, new self-dynamisable device, which provides fixation of the femur using minimally invasive technique. This device has been investigated experimentally on 60 animals. It has been applied to 267 patients. Here is presented a series of 92 fixations of femoral diaphyses after fresh fractures and after unsuccessful treatment using other methods. Follow-up was 3.1 years (2 to 7 years). Bone healing was achieved in all patients within 3.5 months (2.7-9 months) with big amount of periosteal callus formation. There were no complications in all patients seen. It can be concluded that this method and device meet biological and biomechanical requirements for safe fracture treatment.