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Salem KH 《International orthopaedics》2012,36(7):1471-1477
Purpose
Unreamed nails have revolutionised the treatment of tibial shaft fractures. Many authors, however, have reported increasing bone healing complications with these implants. Unfortunately, few studies have addressed the factors affecting bone healing after unreamed tibial nailing.Methods
One-hundred and sixty tibial fractures in 158 patients (mean age 39.5 years) fixed using unreamed nails were reviewed. There were 78 AO type-A, 65 type-B and 17 type-C fractures (115 closed and 45 open fractures). Twelve patient, injury and surgery variables were analysed for their influence on fracture healing.Results
Union occurred in all fractures after a mean time of 24.3 weeks. Additional surgery to achieve union, apart from dynamisation, was done in nine (6%) cases. The most important variables affecting healing were the mechanism of trauma (p = 0.005), fracture site gap (p = 0.01), degree of comminution (p = 0.0003), associated soft tissue injuries (p = 0.02) and the time to dynamisation (p = 0.0001).Conclusions
High-energy trauma and fracture comminution have a negative impact on bone union and require close follow-up. It is essential to avoid distraction over three millimetres with unreamed nailing. Dynamisation is advised within ten weeks in axially stable fractures to encourage bone healing and avoid failure of the locking screws. 相似文献2.
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David Metcalfe Craig J. Hickson Lesley McKee Xavier L. Griffin 《Journal of orthopaedics and traumatology》2015,16(4):275-285
Background
It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures.Materials and methods
A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses.Results
Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25–5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups.Conclusion
Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.Level of evidence
II. 相似文献6.
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Laurens J. van Baardewijk Jacob van der Ende Suzanne Lissenberg-Thunnissen Loes M. Romijn Lukas J. A. C. Hawinkels Cornelis F. M. Sier Inger B. Schipper 《International orthopaedics》2013,37(3):523-527
Objective
Despite adequate treatment 5–30 % of bone fracture patients experience delayed union. During normal fracture union, bone morphogenetic proteins (BMPs) induce healing through a sequential cascade of events. Improved fracture healing after BMP-2 or -7 supplementation in patients with impaired fracture union suggests a deficiency of one or more of these factors. We postulated that low levels of circulating BMPs may result in delayed bone healing. The aim of this study was to quantify differences in levels of circulating BMP-2, -4, -6, -7, and −9 in patients that have demonstrated normal or delayed fracture healing.Patients and methods
Blood samples were collected from an unselected cohort of 65 patients that had been treated for a diaphyseal tibia or femur fracture. Patients were divided into a group with fracture healing within nine months after injury and a group with delayed fracture union. BMP plasma concentrations were quantified using ELISAs and compared between these two groups.Results
Circulating plasma levels of BMP-2, -4, -6, and -7 did not differ between 34 patients with normal fracture healing and 31 patients with delayed fracture healing. Also the median BMP-9 plasma levels were not statistically different between the two groups of patients. However, the distribution in the patients with normal union showed a wider range (72–2496 pg/ml) compared with the delayed union group (120–816 pg/ml).Conclusion
In general, circulating BMP concentrations are not statistically different between patients who demonstrated normal or delayed fracture healing. High circulating BMP-9 levels seem to be associated with faster fracture healing, but are apparently not decisive. 相似文献9.
Maximilian Petri Ali Namazian Florian Wilke Max Ettinger Timo Stübig Stephan Brand Frank Bengel Christian Krettek Georg Berding Michael Jagodzinski 《International orthopaedics》2013,37(11):2231-2237
Purpose
Treating segmental long-bone defects remains a major challenge. For defects >3 cm, segmental transport represents the gold standard, even though the method is time consuming and afflicted with several complications. The aim of this study was to evaluate healing of such defects after grafting an osteogenic scaffold previously seeded with stem cell concentrate.Methods
We evaluated five patients with segmental long-bone defects (3–14 cm) treated with bone marrow aspirate concentrates (BMAC) seeded onto a bovine xenogenous scaffold. The healing process was monitored by X-rays and positron emission tomography–computed tomography (PET-CT) three months after surgery.Results
Centrifugation led to a concentration of leukocytes by factor 8.1 ± 7.5. Full weight bearing was achieved 11.3 ± 5.0 weeks after surgery. PET analysis showed an increased influx of fluoride by factor 8.3 ± 6.4 compared with the contralateral side (p < 0.01). Bone density in the cortical area was 75 ± 16 % of the contralateral side (p < 0.03). The patient with the largest defect sustained an implant failure in the distal femur and finally accomplished therapy by segmental transport. He also had the lowest uptake of fluoride of the patient collective (2.2-fold increase).Conclusion
Stem cell concentrates can be an alternative to segmental bone transport. Further studies are needed to compare this method with autologous bone grafting and segmental transport. 相似文献10.
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Abd R. Muhamad Joana M. Freitas James D. Bomar Jerry Dwek Harish S. Hosalkar 《Journal of children's orthopaedics》2012,6(5):391-396
Background
Assessment of lower extremity (LE) torsional profile using computed tomography (CT) imaging is a well-recognized imaging method that supplements the clinical examination. Magnetic resonance imaging (MRI) is another advanced imaging modality that can be used as an alternative, since there are many growing concerns of radiation exposure with traditional CT studies, particularly in the skeletally immature population.Methods
Sixty-two patients between the ages of 7 and 19 years were included. Thirty-four had CT and 28 had MRI for assessment of LE torsional profile. All patients had clinical evidence of torsional malalignment. CT and MR images were randomized and de-identified. Two observers measured femoral anteversion and tibial torsion based on previously published methodologies. This exercise was repeated 2 weeks later and the data were tabulated and statistical analysis was performed. Radiation exposure for the patients studied by CT was estimated.Results
The mean age of the patients was 14.4 years (range 9.5–18.9 years) and 13.8 years (range 7.3–18.9 years) for the CT and MRI groups, respectively. Inter-observer reliability for both CT and MRI studies were excellent. The intra-class correlation coefficient (ICC) for femoral anteversion and tibial torsion studied by CT and MRI for both observers at both times were excellent. The radiation exposure for CT examination averaged 0.3–0.5 mSv, compared to none with the MRI method.Conclusions
MRI provides a reproducible method for assessing the torsional profile in children and adolescents using similar anatomic landmarks for measurements as those used on CT torsional profile. In circumstances where MRI methods are readily available (and affordable), the CT torsional profile can be replaced with MRI methods, in the current era of growing concerns of radiation hazards and increasing awareness about radiation safety.Level of evidence
Diagnostic Level III. 相似文献13.
Malin Wijeratna Kimberley Anne Bailey Alistair Pace Graham Tytherleigh-Strong Lee Van Rensburg Matthew Kent 《International orthopaedics》2012,36(12):2507-2512
Purpose
This study describes a case series of 15 patients with radial head fractures who underwent radial head excision using an arthroscopic technique.Methods
Over a four year period, 15 patients (average age 49.6 years) who had sustained a radial head or radial neck fracture underwent an arthroscopic excision of the radial head. Four patients had an unreconstructable comminuted fracture (early group; EG) and 11 patients had pain and loss of motion with an associated non- or malunion (late group; LG).Results
The mean time to surgery following injury was three weeks (one to five) for the EG and 27 weeks (eight–58) for the LG. The average visual analogue scale (VAS) was 1.7 (zero to four), and the average Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score was 24.7 (16–44). At final follow-up, average supination was 62.0° (range 45–75°) and pronation was 63.3° (range 45–75°). There were no complications.Conclusion
This series demonstrates that arthroscopic excision of fractures of the radial head and neck is reliable, reproducible and safe, with similar results to open excision. There may also be additional benefits in the short term with regards to speed of healing and rehabilitation. 相似文献14.
Background
Periprosthetic supracondylar fractures of the femur after total knee arthroplasty are not common but are usually difficult to treat due to the advanced age of patients and frequently accompanying osteoporosis. Retrograde intramedullary nailing can be effective in promoting healing of these fractures by providing sufficient stability, but the number of beneficiaries is small due to its limited applicability and the postoperative function has rarely been assessed. This study evaluated the efficacy of retrograde intramedullary nailing for the treatment of periprosthetic supracondylar fractures of the femur using the clinical outcomes.Methods
Between January 2000 and May 2006, 9 patients (10 knees) with periprosthetic supracondylar fractures of the femur underwent retrograde intramedullary nailing. An open reduction and additional fixation using a shape memory alloy ring were used in 3 of them in whom a closed reduction was not successful. The clinical and radiographic findings were reviewed retrospectively in 7 patients (8 knees), excluding 2 who were unavailable for a follow-up assessment due to death. The mean follow-up period was 39 months (range, 24 to 82 months). The union and alignment of the fracture were assessed radiographically. The postoperative function was evaluated using Sanders'' criteria.Results
Radiographic union was obtained in all patients after an average of 13 weeks (range, 12 to 15 weeks) postoperatively. No postoperative infection, heterotopic ossification and component loosening were observed. After union, the coronal alignment averaged 0.1° valgus (range, 3.6° varus to 2.6° valgus) and the mean sagittal alignment was 1.9° of extension (range, 0.9° of flexion to 6.3° of extension). The mean range of motion was 103° (range, 90° to 120°) postoperatively. At the last follow up, there were 1 excellent, 5 good and 2 fair results according to Sanders'' criteria.Conclusions
With retrograde intramedullary nailing, excellent fracture union and good functional recovery were obtained in patients with periprosthetic supracondylar fractures. 相似文献15.
Joon Soon Kang Ye Yeon Won Jong Oh Kim Byeong Woo Min Kee Haeng Lee Kwan Kyu Park Joo Hyun Song Young Tae Kim Geon Ho Kim 《International orthopaedics》2014,38(6):1247-1253
Purpose
Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies.Methods
We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture.Results
The mean age of cases was 71.4 ± 8.8 (range, 43–89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12–79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was −1.9 ± 1.4 (range, −4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one–204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039).Conclusions
The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures. 相似文献16.
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Ayman El-Sayed Khalil Mostafa Ahmed Ayoub 《Journal of orthopaedics and traumatology》2012,13(4):179-188
Background
Multiplanar complex C3-type unstable distal femoral fractures present many challenges in terms of approach and fixation. This prospective study investigates a possible solution to these problems through double plating with autogenous bone grafting via a modified Olerud extensile approach.Materials and methods
Twelve patients with closed C3-type injuries were included; eight of them were male, and their mean age was 33.5 years (range 22–44 years). Mechanism of injury was road traffic accident (RTA) in nine patients and fall from height in the other three cases. Eight cases were operated during the first week and four cases during the second week after injury. Mean follow-up was 13.7 months (range 11–18 months).Results
Mean radiological healing time was 18.3 weeks (range 12-28 weeks), and all cases had good radiological healing without recorded nonunion or malunion. Clinically, two cases (16.7 %) had excellent results, five cases (41.7 %) had good results, three cases (25 %) had fair results, and two cases (16.7 %) had poor results. No cases developed skin necrosis, deep infection, bone collapse, or implant failure. However, two cases (16.7 %) had limited knee flexion to 90° and required subsequent quadricepsplasty.Conclusions
Use of this modified highly invasive approach facilitated anatomical reconstruction of C3-type complex distal femoral fractures with lower expected complication rate and acceptable clinical outcome, especially offering good reconstruction of the suprapatellar pouch area. It can be considered as a standby solution for managing these difficult injuries. 相似文献19.
Ching-Hou Ma Shang-Won Yu Yuan-Kun Tu Cheng-Yo Yen James Jih-Hsi Yeh Chin-Hsien Wu 《Acta orthopaedica》2010,81(3):382-386
Background and purpose
Based on reported success with staged treatment of distal tibial fractures, we designed a 2-stage protocol including external/internal locked plating. We retrospectively assessed the outcome of open distal tibial fractures treated according to this protocol.Patients and methods
From March 2006 through July 2008, 16 patients who sustained open distal tibial fractures were treated by a two-stage protocol. The first stage consisted of low-profile, locked plates for temporary external fixation after debridement and anatomic reduction, followed by soft tissue reconstruction. The second stage consisted of locked plates for definitive internal fixation, using minimally invasive percutaneous osteosynthesis. All fractures were followed for median 2 (1–3) years.Results
The reduction was classified as being good in 15 patients and fair in 1 patient. All fractures united at a median of 6 (6–12) months. At the latest follow-up, 7 patients had excellent and 9 had good Iowa ankle scores; ankle motion ranged from a median of 10 (5–20) degrees of dorsiflexion to 40 (20–60) degrees of plantar flexion.Interpretation
We believe that the 2-stage external/internal locked plating technique is an effective procedure for treatment of open distal tibial fractures in patients who need a long period of external fixation. We achieved good reduction with immediate ankle-sparing stable fixation. Soft tissue reconstruction and subsequent definitive fixation led to union of all fractures with good function. 相似文献20.
Narender Kumar Magu Paritosh Gogna Amanpreet Singh Rohit Singla Rajesh Rohilla Amit Batra Reetadyuti Mukhopadhyay 《Journal of orthopaedics and traumatology》2014,15(3):173-179