Medicine › Epidemiology

Bone fractures and treatments

Works Count: 102252

Wikipedia

Description

This cluster of papers covers the epidemiology, classification, treatment, and complications of bone fractures, with a focus on fracture healing, internal fixation techniques, nonunion, infection prevention, biomechanics, pediatric fractures, and soft tissue management. It provides insights into the molecular, spatial, and temporal aspects of fracture healing and the impact of factors such as smoking and inflammation. The cluster also explores limb reconstruction techniques and the economic burden associated with nonunions.

Keywords

Fracture Epidemiology; Bone Healing; Fracture Classification; Internal Fixation; Nonunion; Infection Prevention; Biomechanics; Pediatric Fractures; Soft Tissue Management; Limb Reconstruction

Skeletal Tissue Mechanics

2015-01-01

R. Bruce Martin , David B. Burr , Neil A. Sharkey +1 more

Physical properties of tissue : a comprehensive reference book

1990-01-01

Francis Duck

[Reconstruction of the long bones by the induced membrane and spongy autograft].

2000-06-01

Alain‐Charles Masquelet , Franck Fitoussi , Thierry Bégué +1 more

The influence of induced micromovement upon the healing of experimental tibial fractures

1985-08-01

A.E. Goodship , J. Kenwright

Although it has been well established that fracture healing is influenced by the mechanical environment, the optimal parameters have not yet been established. In two groups of sheep an experimental … Although it has been well established that fracture healing is influenced by the mechanical environment, the optimal parameters have not yet been established. In two groups of sheep an experimental tibial diaphysial fracture was created, and stabilised using external skeletal fixation. In one group rigid fixation was maintained throughout fracture healing; in the other group controlled axial micromovement, with a loading regime known to be osteogenic in intact bones, was applied for a short period daily. A significant improvement in healing was associated with the application of controlled micromovement. Data from these experiments provide the basis for improving the conditions for fracture healing and may assist in the prevention of delayed union.

OSTEOGENIC ACTIVITY OF THE FOURTEEN TYPES OF HUMAN BONE MORPHOGENETIC PROTEINS (BMPS)

2003-08-01

Hongwei Cheng , Wei Jiang , Frank M. Phillips +7 more

Background: Bone morphogenic proteins (BMPs) are known to promote osteogenesis, and clinical trials are currently underway to evaluate the ability of certain BMPs to promote fracture-healing and spinal fusion. The … Background: Bone morphogenic proteins (BMPs) are known to promote osteogenesis, and clinical trials are currently underway to evaluate the ability of certain BMPs to promote fracture-healing and spinal fusion. The optimal BMPs to be used in different clinical applications have not been elucidated, and a comprehensive evaluation of the relative osteogenic activity of different BMPs is lacking. Methods: To identify the BMPs that may possess the most osteoinductive activity, we analyzed the osteogenic activity of BMPs in mesenchymal progenitor and osteoblastic cells. Recombinant adenoviruses expressing fourteen human BMPs (BMP-2 to BMP-15) were constructed to infect pluripotent mesenchymal progenitor C3H10T1/2 cells, preosteoblastic C2C12 cells, and osteoblastic TE-85 cells. Osteogenic activity was determined by measuring the induction of alkaline phosphatase, osteocalcin, and matrix mineralization upon BMP stimulation. Results: BMP-2, 6, and 9 significantly induced alkaline phosphatase activity in pluripotential C3H10T1/2 cells, while BMP-2, 4, 6, 7, and 9 significantly induced alkaline phosphatase activity in preosteoblastic C2C12 cells. In TE-85 osteoblastic cells, most BMPs (except BMP-3 and 12) were able to induce alkaline phosphatase activity. The results of alkaline phosphatase histochemical staining assays were consistent with those of alkaline phosphatase colorimetric assays. Furthermore, BMP-2, 6, and 9 (as well as BMP-4 and, to a lesser extent, BMP-7) significantly induced osteocalcin expression in C3H10T1/2 cells. In C2C12 cells, osteocalcin expression was strongly induced by BMP-2, 4, 6, 7, and 9. Mineralized nodules were readily detected in C3H10T1/2 cells infected with BMP-2, 6, and 9 (and, to a lesser extent, those infected with BMP-4 and 7). Conclusions: A comprehensive analysis of the osteogenic activity of fourteen types of BMPs in osteoblastic progenitor cells was conducted. Our results suggest an osteogenic hierarchical model in which BMP-2, 6, and 9 may play an important role in inducing osteoblast differentiation of mesenchymal stem cells. In contrast, most BMPs are able to stimulate osteogenesis in mature osteoblasts. Clinical Relevance: These findings have implications for the development of effective formulas for bone-healing and spinal fusion. The efficacy of osteogenesis may depend not only on the type of BMP or the combination of BMPs that is used but also on the cell types that are present.

Production of a standard closed fracture in laboratory animal bone

1984-01-01

Frank Bonnarens , Thomas A. Einhorn

Abstract To develop a technique for the production of a standard closed experimental fracture, a new apparatus was designed and tested on 40 male Sprague‐Dawley rats. First, the femur was … Abstract To develop a technique for the production of a standard closed experimental fracture, a new apparatus was designed and tested on 40 male Sprague‐Dawley rats. First, the femur was treated with an intramedullary Steinmann pin. The femoral diaphysis was then fractured by means of a blunt guillotine driven by a dropped weight. Radiographically, this technique resulted in a highly reproducible transverse fracture. There was minimal comminution and minimal angulation of the intramedullary pin. Histologically, there was minimal soft tissue damage. Mechanical testing showed that all fractures healed. Pin removal was accomplished with ease and without disturbance of the healed fracture site. The apparatus is simple to use and inexpensive to build. Through its use, a highly reproducible closed fracture model is established.

The frequency and epidemiology of hand and forearm fractures in the United States

2001-09-01

Kevin C. Chung , Sandra V. Spilson

Fracture healing: mechanisms and interventions

2014-09-30

Thomas A. Einhorn , Louis C. Gerstenfeld

Bone regeneration: current concepts and future directions

2011-05-31

Rozalia Dimitriou , Elena Jones , Dennis McGonagle +1 more

Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there … Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis.

View PDF Chat

Clinical Application of the Tension-Stress Effect for Limb Lengthening

1990-01-01

Gavriil A. Ilizarov

For 40 years, the author has been developing a system of orthopedics, traumatology, and limb lengthening using a circular transfixion-wire external skeletal fixator, often in combination with biomechanic methods of … For 40 years, the author has been developing a system of orthopedics, traumatology, and limb lengthening using a circular transfixion-wire external skeletal fixator, often in combination with biomechanic methods of stimulating the formation of new osseous tissue within a widening osteotomy distraction site. The factors important for neoosteogenesis after osteotomy include: maximum preservation of extraosseous and medullary blood supply; stable external fixation; a delay prior to distraction; a distraction rate of 1 mm per day in frequent small steps; a period of stable neutral fixation after lengthening; and physiologic use of the elongating limb. For a successful fixator application, the apparatus must be applied with consideration given to the number, size, and location of the rings, the placement and tension on the wires, the technique of wire insertion, the effect of soft-tissue transfixion on limb use, and the prevention of bone and joint deformities caused by countertension in soft tissues. Clinical application of the author's techniques permits stature increase in certain forms of dwarfism, correction of deformities and limb-length inequalities, and stump elongation. For many of these applications, motorized distraction can provide continuous limb lengthening while the apparatus is on the patient.

Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique

1990-01-01

Dror Paley

Difficulties that occur during limb lengthening were subclassified into problems, obstacles, and complications. Problems represented difficulties that required no operative intervention to resolve, while obstacles represented difficulties that required an … Difficulties that occur during limb lengthening were subclassified into problems, obstacles, and complications. Problems represented difficulties that required no operative intervention to resolve, while obstacles represented difficulties that required an operative intervention. All intraoperative injuries were considered true complications, and all problems during limb lengthening that were not resolved before the end of treatment were considered true complications. The difficulties that occurred during limb lengthening include muscle contractures, joint luxation, axial deviation, neurologic injury, vascular injury, premature consolidation, delayed consolidation, nonunion, pin site problems, and hardware failure. Late complications are those of loss of length, late bowing, and refracture. Joint stiffness may also be a permanent residual complication. Pain and difficulty sleeping are other problems that arise during limb lengthening, especially in the more extensive cases. Forty-six patients had 60 limb segments lengthened between 1.0 and 16.0 cm, with a mean of 5.6 cm. The average treatment time was approximately one month per centimeter for single-level lengthenings with no deformity and 1.2 months per centimeter with deformity correction. The lengthening index for double-level lengthening was 0.57 month per centimeter with no deformity and 0.90 month per centimeter with correction of deformity. In adults, the lengthening index was 1.7 months per centimeter for single-level and 1.1 months per centimeter for double-level lengthening. There were 35 problems that had to be resolved in the outpatient clinic. There were 11 obstacles that required additional operative intervention to resolve. There were 27 true complications, of which 17 were considered minor and ten were considered major complications. Of the major complications, three interfered with achieving the original goals of treatment. All three required further operative intervention to achieve the original goal. These were nonunion in one and late bowing in two. Despite these problems, obstacles, and complications, the original goals of surgery were achieved in 57 of the 60 limb segments treated. Patient satisfaction was achieved in 94% of 46 cases.

Regulation of bone mass by mechanical strain magnitude

1985-07-01

Clinton T. Rubin , Lance E. Lanyon

Fracture healing under healthy and inflammatory conditions

2012-01-31

L. Claes , Stefan Recknagel , Anita Ignatius

The biology of fracture healing

2011-04-18

Richard Marsell , Thomas A. Einhorn

View PDF Chat

The Critical Size Defect as an Experimental Model for Craniomandibulofacial Nonunions

1986-04-01

John P. Schmitz , Jeffrey O. Hollinger

Little consistency has been manifest among investigators in choosing an appropriate experimental model for maxillofacial bone research. In an effort to develop a protocol for the experimental analysis of maxillofacial … Little consistency has been manifest among investigators in choosing an appropriate experimental model for maxillofacial bone research. In an effort to develop a protocol for the experimental analysis of maxillofacial nonunions, previous studies using calvarial and mandibular defects as models were reviewed. The creation of nonunions in animals within the calvaria and mandible was size dependent. Defects of a size that will not heal during the lifetime of the animal may be termed critical size defects (CSDs). A rationale was postulated for testing bone repair materials (BRMs) using CSDs in a hierarchy of animal models. This rationale suggests that testing should be initiated in the calvaria of the rat and rabbit, followed by testing in the mandibles of dogs and monkeys. While calvarial CSDs have been established in the rat, rabbit, and dog, further research is necessary to determine the CSD in the calvaria of the monkey, as well as the mandibles of dogs and monkeys.

Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations.

1950-05-01

N. Lauge-Hansen

EXACT knowledge of the mechanism, pathologic anatomy, genetic roentgenologic diagnosis and genetic reduction of fractures of the ankle is to be attained by combined experimental-surgical and experimental-roentgenologic investigations. 1 In … EXACT knowledge of the mechanism, pathologic anatomy, genetic roentgenologic diagnosis and genetic reduction of fractures of the ankle is to be attained by combined experimental-surgical and experimental-roentgenologic investigations. 1 In this study the mechanism of fracture was determined by fracturing, the pathologic anatomy was ascertained by dissection, the genetic roentgenologic diagnosis was established by roentgen examination and the genetic reduction technic of the fractures was found by reduction maneuvers, which will be dealt with in a later paper, Clinical Use of Genetic Roentgenologic Diagnosis and Genetic Reduction. In the experimental-surgical investigations free movability of the ankle joint is necessary in order to place the foot in the different positions which are to be considered. Experiments on cadavers were abandoned because of rigor mortis, which limits the movability of the foot and the ankle joint. The experiments have therefore been carried out exclusively on extremities which were amputated at the femur

Age and bone mass as predictors of fracture in a prospective study.

1988-06-01

Siu L. Hui , Charles W. Slemenda , C. Conrad Johnston

To study the effect of bone mass on the risk of fracture, we followed 521 Caucasian women over an average of 6.5 yr and took repeated bone mass measurements at … To study the effect of bone mass on the risk of fracture, we followed 521 Caucasian women over an average of 6.5 yr and took repeated bone mass measurements at the radius. We observed 138 nonspinal fractures in 3,388 person-yr. The person-years of follow-up and the incident fractures were cross-classified by age and bone mass. The incidence of fracture was then fitted to a log-linear model in age and bone mass. It was found that incidence of fracture increased with both increasing age and decreasing radius bone mass. When subsets of fractures were examined it was found that age was a stronger predictor of hip fractures, whereas midshaft radius bone mass was a stronger predictor of fractures at the distal forearm. We concluded that bone mass is a useful predictor of fractures but that other age-related factors associated with fractures need to be identified.

View PDF Chat

Fracture healing: The diamond concept

2007-09-01

Peter V. Giannoudis , Thomas A. Einhorn , David Marsh

Isolated allogeneic bone marrow-derived mesenchymal cells engraft and stimulate growth in children with osteogenesis imperfecta: Implications for cell therapy of bone

2002-06-25

Edwin M. Horwitz , Patricia L. Gordon , Winston K. K. Koo +5 more

Treatment with isolated allogeneic mesenchymal cells has the potential to enhance the therapeutic effects of conventional bone marrow transplantation in patients with genetic disorders affecting mesenchymal tissues, including bone, cartilage, … Treatment with isolated allogeneic mesenchymal cells has the potential to enhance the therapeutic effects of conventional bone marrow transplantation in patients with genetic disorders affecting mesenchymal tissues, including bone, cartilage, and muscle. To demonstrate the feasibility of mesenchymal cell therapy and to gain insight into the transplant biology of these cells, we used gene-marked, donor marrow-derived mesenchymal cells to treat six children who had undergone standard bone marrow transplantation for severe osteogenesis imperfecta. Each child received two infusions of the allogeneic cells. Five of six patients showed engraftment in one or more sites, including bone, skin, and marrow stroma, and had an acceleration of growth velocity during the first 6 mo postinfusion. This improvement ranged from 60% to 94% (median, 70%) of the predicted median values for age- and sex-matched unaffected children, compared with 0% to 40% (median, 20%) over the 6 mo immediately preceding the infusions. There was no clinically significant toxicity except for an urticarial rash in one patient just after the second infusion. Failure to detect engraftment of cells expressing the neomycin phosphotransferase marker gene suggested the potential for immune attack against therapeutic cells expressing a foreign protein. Thus, allogeneic mesenchymal cells offer feasible posttransplantation therapy for osteogenesis imperfecta and likely other disorders originating in mesenchymal precursors.

View PDF Chat

Mechanobiology of Skeletal Regeneration

1998-10-01

Dennis R. Carter , G. S. Beaupr� , Nicholas J. Giori +1 more

Skeletal regeneration is accomplished by a cascade of biologic processes that may include differentiation of pluripotential tissue, endochondral ossification, and bone remodeling. It has been shown that all these processes … Skeletal regeneration is accomplished by a cascade of biologic processes that may include differentiation of pluripotential tissue, endochondral ossification, and bone remodeling. It has been shown that all these processes are influenced strongly by the local tissue mechanical loading history. This article reviews some of the mechanobiologic principles that are thought to guide the differentiation of mesenchymal tissue into bone, cartilage, or fibrous tissue during the initial phase of regeneration. Cyclic motion and the associated shear stresses cause cell proliferation and the production of a large callus in the early phases of fracture healing. For intermittently imposed loading in the regenerating tissue: (1) direct intramembranous bone formation is permitted in areas of low stress and strain; (2) low to moderate magnitudes of tensile strain and hydrostatic tensile stress may stimulate intramembranous ossification; (3) poor vascularity can promote chondrogenesis in an otherwise osteogenic environment; (4) hydrostatic compressive stress is a stimulus for chondrogenesis; (5) high tensile strain is a stimulus for the net production of fibrous tissue; and (6) tensile strain with a superimposed hydrostatic compressive stress will stimulate the development of fibrocartilage. Finite element models are used to show that the patterns of tissue differentiation observed in fracture healing and distraction osteogenesis can be predicted from these fundamental mechanobiologic concepts. In areas of cartilage formation, subsequent endochondral ossification normally will proceed, but it can be inhibited by intermittent hydrostatic compressive stress and accelerated by octahedral shear stress (or strain). Later, bone remodeling at these sites can be expected to follow the same mechanobiologic adaptation rules as normal bone.

Bone remodeling during fracture repair: The cellular picture

2008-07-28

Aaron Schindeler , Michelle M. McDonald , Paul B. Bokko +1 more

Biomechanics of Locked Plates and Screws

2004-08-30

Kenneth A. Egol , Erik N. Kubiak , Eric Fulkerson +2 more

To review the biomechanical principles that guide fracture fixation with plates and screws; specifically to compare and contrast the function and roles of conventional unlocked plates to locked plates in … To review the biomechanical principles that guide fracture fixation with plates and screws; specifically to compare and contrast the function and roles of conventional unlocked plates to locked plates in fracture fixation. We review basic plate and screw function, discuss the design rationale for the new implants, and examine the biomechanical evidence that supports the use of such implants.Systematic review of the per reviewed English language orthopaedic literature listed on PubMed (National Library of Medicine online service).Papers selected for this review were drawn from peer review orthopaedic journals. All selected papers specifically discussed plate and screw biomechanics with regard to fracture fixation. PubMed search terms were: plates and screws, biomechanics, locked plates, PC-Fix, LISS, LCP, MIPO, and fracture fixation.The following topics are discussed: plate and screw function-neutralization plates and buttress plates, bridge plates; fracture stability-specifically how this effects gap strain and fracture union, conventional plate biomechanics, and locking plate biomechanics.Locked plates and conventional plates rely on completely different mechanical principles to provide fracture fixation and in so doing they provide different biological environments for healing. Locked plates may increasingly be indicated for indirect fracture reduction, diaphyseal/metaphyseal fractures in osteoporotic bone, bridging severely comminuted fractures, and the plating of fractures where anatomical constraints prevent plating on the tension side of the bone. Conventional plates may continue to be the fixation method of choice for periarticular fractures which demand perfect anatomical reduction and to certain types of nonunions which require increased stability for union.

Osseointegration and its experimental background

1983-09-01

Per‐Ingvar Brånemark

Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound.

1994-01-01

James D. Heckman , John P. Ryaby , Jennifer E. McCabe +2 more

Sixty-seven closed or grade-I open fractures of the tibial shaft were examined in a prospective, randomized, double-blind evaluation of use of a new ultrasound stimulating device as an adjunct to … Sixty-seven closed or grade-I open fractures of the tibial shaft were examined in a prospective, randomized, double-blind evaluation of use of a new ultrasound stimulating device as an adjunct to conventional treatment with a cast. Thirty-three fractures were treated with the active device and thirty-four, with a placebo control device. At the end of the treatment, there was a statistically significant decrease in the time to clinical healing (86 +/- 5.8 days in the active-treatment group compared with 114 +/- 10.4 days in the control group) (p = 0.01) and also a significant decrease in the time to over-all (clinical and radiographic) healing (96 +/- 4.9 days in the active-treatment group compared with 154 +/- 13.7 days in the control group) (p = 0.0001). The patients' compliance with the use of the device was excellent, and there were no serious complications related to its use. This study confirms earlier animal and clinical studies that demonstrated the efficacy of low-intensity ultrasound stimulation in the acceleration of the normal fracture-repair process.

Problems in the Management of Type III (Severe) Open Fractures

1984-08-01

Ramon B. Gustilo , Rex M. Mendoza , David N. Williams

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue … Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976-1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

Osteogenic Protein-1 (Bone Morphogenetic Protein-7) in the Treatment of Tibial Nonunions

2001-01-01

Gary E. Friedlaender , Clayton R. Perry , J. Dean Cole +7 more

The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was … The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was evaluated in a clinical trial conducted under a Food and Drug Administration approved Investigational Device Exemption to establish both the safety and efficacy of this BMP in the treatment of tibial nonunions. The study also compared the clinical and radiographic results with this osteogenic molecule and those achieved with fresh autogenous bone.One hundred and twenty-two patients (with 124 tibial nonunions) were enrolled in a controlled, prospective, randomized, partially blinded, multi-center clinical trial between February, 1992, and August, 1996, and were followed at frequent intervals over 24 months. Each patient was treated by insertion of an intramedullary rod, accompanied by rhOP-1 in a type I collagen carrier or by fresh bone autograft. Assessment criteria included the severity of pain at the fracture site, the ability to walk with full weight-bearing, the need for surgical re-treatment of the nonunion during the course of this study, plain radiographic evaluation of healing, and physician satisfaction with the clinical course. In addition, adverse events were recorded, and sera were screened for antibodies to OP-1 and type-I collagen at each outpatient visit.At 9 months following the operative procedures (the primary end-point of this study), 81% of the OP-1-treated nonunions (n = 63) and 85% of those receiving autogenous bone (n = 61) were judged by clinical criteria to have been treated successfully (p = 0.524). By radiographic criteria, at this same time point, 75% of those in the OP-1-treated group and 84% of the autograft-treated patients had healed fractures (p = 0.218). These clinical results continued at similar levels of success throughout 2 years of observation, and there was no statistically significant difference in outcome between the two groups of patients at this point (p = 0.939). All patients experienced adverse events. Forty-four percent of patients in each treatment group had serious events, none of which were related to their bone grafts. More than 20% of patients treated with autografts had chronic donor site pain following the procedure.rhOP-1 (BMP-7), implanted with a type I collagen carrier, was a safe and effective treatment for tibial nonunions. This molecule provided clinical and radiographic results comparable with those achieved with bone autograft, without donor site morbidity.

Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.

1984-04-01

R A Winquist , Sigvard T. Hansen , D. Kay Clawson

Intramedullary nailing was performed on 520 femoral fractures in 500 patients. The series included eighty-six open fractures and 261 comminuted fractures. Closed intramedullary nailing was used in 497 femora and … Intramedullary nailing was performed on 520 femoral fractures in 500 patients. The series included eighty-six open fractures and 261 comminuted fractures. Closed intramedullary nailing was used in 497 femora and open intramedullary nailing with cerclage wiring, in twenty-three. The union rate was 99.1 per cent. The range of motion of the knee at follow-up averaged 130 degrees. Complications included four infections (0.9 per cent). Shortening of more than two centimeters occurred in ten patients (2.0 per cent) and malrotation of more than 20 degrees was observed in twelve patients (2.3 per cent). After prompt emergency measures had been taken, routine treatment included strong preoperative traction followed by accurate positioning of the patient on the operating table; selection of the correct insertion point for a properly sized, prebent, flexible, bullet-tipped nail; and accurate reduction of the fracture. Careful rehabilitation of the patient also contributed to the excellence of the results.

Fracture healing as a post‐natal developmental process: Molecular, spatial, and temporal aspects of its regulation

2003-02-26

Louis C. Gerstenfeld , Dennis M. Cullinane , George L. Barnes +2 more

Abstract Fracture healing is a specialized post‐natal repair process that recapitulates aspects of embryological skeletal development. While many of the molecular mechanisms that control cellular differentiation and growth during embryogenesis … Abstract Fracture healing is a specialized post‐natal repair process that recapitulates aspects of embryological skeletal development. While many of the molecular mechanisms that control cellular differentiation and growth during embryogenesis recur during fracture healing, these processes take place in a post‐natal environment that is unique and distinct from those which exist during embryogenesis. This Prospect Article will highlight a number of central biological processes that are believed to be crucial in the embryonic differentiation and growth of skeletal tissues and review the functional role of these processes during fracture healing. Specific aspects of fracture healing that will be considered in relation to embryological development are: (1) the anatomic structure of the fracture callus as it evolves during healing; (2) the origins of stem cells and morphogenetic signals that facilitate the repair process; (3) the role of the biomechanical environment in controlling cellular differentiation during repair; (4) the role of three key groups of soluble factors, pro‐inflammatory cytokines, the TGF‐β superfamily, and angiogenic factors, during repair; and (5) the relationship of the genetic components that control bone mass and remodeling to the mechanisms that control skeletal tissue repair in response to fracture. J. Cell. Biochem. 88: 873–884, 2003. © 2003 Wiley‐Liss, Inc.

The Concept of Induced Membrane for Reconstruction of Long Bone Defects

2009-11-19

Alain C. Masquelet , Thierry Bégué

Injuries Involving the Epiphyseal Plate

1963-04-01

Robert B. Salter , William R. Harris

Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada Division of Orthopaedic Surgery, Toronto General Hospital, Toronto, Ontario, Canada Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada Division of Orthopaedic Surgery, Toronto General Hospital, Toronto, Ontario, Canada

The biology of fracture healing in long bones

1978-05-01

B. McKibbin

View PDF Chat

The Tension-Stress Effect on the Genesis and Growth of Tissues

1989-01-01

Gavriil A. Ilizarov

To evaluate the optimum conditions for osteogenesis during limb lengthening and to study the changes in soft tissues undergoing elongation, a series of experiments were performed on the canine tibia. … To evaluate the optimum conditions for osteogenesis during limb lengthening and to study the changes in soft tissues undergoing elongation, a series of experiments were performed on the canine tibia. The experiments used the transfixionwire, Ilizarov circular external skeletal fixator in configurations of differing stability of fixation in combination with a second variable, i.e., preservation of the periosteum, bone marrow, and medullary blood supply. Both increased fixator stability, and maximum preservation of the periosseous and intraosseous soft tissues enhanced bone formation during limb lengthening. To assess the role that the direction of the elongation vector plays in osteogenesis, canine tibiae were widened rather than lengthened in a second series of experiments using an Ilizarov apparatus modified for lateral distraction. The new bone formed parallel to the tension vector even when perpendicular to the bone's mechanical axis. As in longitudinal lengthening, damage to the bone marrow inhibits osteogenesis occurring by the influence of a lateral tension-stress vector. In a third series of experiments, half- and full-circumference cortical defects were created in canine tibiae to study the osteogenic potential of the marrow. New bone formed rapidly, even when the marrow was separated From the surrounding periosseous soft tissues by a sheet of polyvinyl chloride, attesting to the importance of marrow element preservation during osteotomy for limb lengthening.

Enhancement of fracture-healing.

1995-06-01

Thomas A. Einhorn

PREVENTION OF INFECTION IN THE TREATMENT OF ONE THOUSAND AND TWENTY-FIVE OPEN FRACTURES OF LONG BONES

2002-04-01

Ramon B. Gustilo , John T. Anderson

In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed … In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed retrospectively, the infection rate was 12 per cent from 1955 to 1960 and 5 per cent from 1961 to 1968. In a prospective study from 1969 to 1973, 352 patients were managed as follows: débridement and copious irrigation, primary closure for Type I and II fractures and secondary closure for Type III fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type III open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study.

The development of mature gait.

1980-04-01

David H. Sutherland , Richard A. Olshen , Les Cooper +1 more

The development of mature gait. D Sutherland;R Olshen;L Cooper;S Woo; The Journal of Bone & Joint Surgery The development of mature gait. D Sutherland;R Olshen;L Cooper;S Woo; The Journal of Bone & Joint Surgery

Bone remodeling in response to in vivo fatigue microdamage

1985-01-01

David B. Burr , R. Bruce Martin , Mitchell B. Schaffler +1 more

THE ROLE OF GROWTH FACTORS IN THE REPAIR OF BONE

2002-06-01

Jay R. Lieberman , Aaron Daluiski , Thomas A. Einhorn

Jay R. Lieberman, MD; Department of Orthopaedic Surgery, UCLA Medical Center, CHS 76-134, 10833 Le Conte Avenue, Los Angeles, CA 90077 Aaron Daluiski, MD; Desert Orthopaedic Center, 3150 North Tenaya … Jay R. Lieberman, MD; Department of Orthopaedic Surgery, UCLA Medical Center, CHS 76-134, 10833 Le Conte Avenue, Los Angeles, CA 90077 Aaron Daluiski, MD; Desert Orthopaedic Center, 3150 North Tenaya Way, Suite 405, Las Vegas, NV 89128 Thomas A. Einhorn, MD; Doctors Office Building, Suite 808, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118-2393

Evolution of the internal fixation of long bone fractures: The scientific basis of biological internal fixation: choosing a new balance between stability and biology

2002-11-01

S. M. Perren

The advent of 'biological internal fixation' is an important development in the surgical management of fractures. Locked nailing has demonstrated that flexible fixation without precise reduction results in reliable healing. … The advent of 'biological internal fixation' is an important development in the surgical management of fractures. Locked nailing has demonstrated that flexible fixation without precise reduction results in reliable healing. While external fixators are mainly used today to provide temporary fixation in fractures after severe injury, the internal fixator offers flexible fixation, maintaining the advantages of the external fixator but allowing long-term treatment. The internal fixator resembles a plate but functions differently. It is based on pure splinting rather than compression. The resulting flexible stabilisation induces the formation of callus. With the use of locked threaded bolts, the application of the internal fixator foregoes the need of adaptation of the shape of the splint to that of the bone during surgery. Thus, it is possible to apply the internal fixator as a minimally invasive percutaneous osteosynthesis (MIPO). Minimal surgical trauma and flexible fixation allow prompt healing when the blood supply to bone is maintained or can be restored early. The scientific basis of the fixation and function of these new implants has been reviewed. The biomechanical aspects principally address the degree of instability which may be tolerated by fracture healing under different biological conditions. Fractures may heal spontaneously in spite of gross instability while minimal, even non-visible, instability may be deleterious for rigidly fixed small fracture gaps. The theory of strain offers an explanation for the maximum instability which will be tolerated and the minimal degree required for induction of callus formation. The biological aspects of damage to the blood supply, necrosis and temporary porosity explain the importance of avoiding extensive contact of the implant with bone. The phenomenon of bone loss and stress protection has a biological rather than a mechanical explanation. The same mechanism of necrosis-induced internal remodelling may explain the basic process of direct healing.

The Tension-Stress Effect on the Genesis and Growth of Tissues: Part II. The Influence of the Rate and Frequency of Distraction

2013-12-09

Gunasekaran Kumar , Badri Narayan

Percutaneous Autologous Bone-Marrow Grafting for Nonunions<sbt aid="1015500">Influence of the Number and Concentration of Progenitor Cells</sbt>

2005-07-01

Ph. Hernigou , Alexandre Poignard , F. Beaujean +1 more

Bone marrow aspirated from the iliac crest contains progenitor cells that can be used to obtain bone-healing of nonunions. However, there is little available information regarding the number and concentration … Bone marrow aspirated from the iliac crest contains progenitor cells that can be used to obtain bone-healing of nonunions. However, there is little available information regarding the number and concentration of these cells that are necessary to obtain bone repair. The purpose of this study was to evaluate the number and concentration of progenitor cells that were transplanted for the treatment of nonunion, the callus volume obtained after the transplantation, and the clinical healing rate.Marrow was aspirated from both anterior iliac crests, concentrated on a cell separator, and then injected into sixty noninfected atrophic nonunions of the tibia. Each nonunion received a relatively constant volume of 20 cm(3) of concentrated bone marrow. The number of progenitor cells that was transplanted was estimated by counting the fibroblast colony-forming units. The volume of mineralized bone formation was determined by comparing preoperative computerized tomography scans with scans performed four months following the injection.The aspirates contained an average (and standard deviation) of 612 +/- 134 progenitors/cm(3) (range, 12 to 1224 progenitors/cm(3)) before concentration and an average of 2579 +/- 1121 progenitors/cm(3) (range, 60 to 6120 progenitors/cm(3)) after concentration. An average total of 51 x 10(3) fibroblast colony-forming units was injected into each nonunion. Bone union was obtained in fifty-three patients, and the bone marrow that had been injected into the nonunions of those patients contained >1500 progenitors/cm(3) and an average total of 54,962 +/- 17,431 progenitors. The concentration (634 +/- 187 progenitors/cm(3)) and the total number (19,324 +/- 6843) of progenitors injected into the nonunion sites of the seven patients in whom bone union was not obtained were both significantly lower (p = 0.001 and p < 0.01, respectively) than those in the patients who obtained bone union. The volume of the mineralized callus measured at four months on the computerized tomography scans of the patients who had union ranged from 0.8 to 5.3 cm(3) (mean, 3.1 cm(3)). There was a positive correlation between the volume of mineralized callus at four months and the number (p = 0.04) and concentration (p = 0.01) of fibroblast colony-forming units in the graft. There was a negative correlation between the time needed to obtain union and the concentration of fibroblast colony-forming units in the graft (p = 0.04).Percutaneous autologous bone-marrow grafting is an effective and safe method for the treatment of an atrophic tibial diaphyseal nonunion. However, its efficacy appears to be related to the number of progenitors in the graft, and the number of progenitors available in bone marrow aspirated from the iliac crest appears to be less than optimal in the absence of concentration.

EVOLUTION OF THE INTERNAL FIXATION OF LONG BONE FRACTURES

2002-11-01

S. M. Perren

Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones

1976-06-01

RB Gustilo , JT Anderson

In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed … In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed retrospectively, the infection rate was 12 per cent from 1955 to 1960 and 5 per cent from 1961 to 1968. In a prospective study from 1969 to 1973, 352 patients were managed as follows: debridement and copious irrigation, primary closure for Type I and II fractures and secondary closure for Type III fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type III open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study.

RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEIN-2 FOR TREATMENT OF OPEN TIBIAL FRACTURES

2002-12-01

S. Govender , Cristina Csimma , Harry K. Genant +1 more

Background: The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy … Background: The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy of the use of recombinant human bone morphogenetic protein-2 (rhBMP-2; dibotermin alfa) to accelerate healing of open tibial shaft fractures and to reduce the need for secondary intervention. Methods: In a prospective, randomized, controlled, single-blind study, 450 patients with an open tibial fracture were randomized to receive either the standard of care (intramedullary nail fixation and routine soft-tissue management [the control group]), the standard of care and an implant containing 0.75 mg/mL of rhBMP-2 (total dose of 6 mg), or the standard of care and an implant containing 1.50 mg/mL of rhBMP-2 (total dose of 12 mg). The rhBMP-2 implant (rhBMP-2 applied to an absorbable collagen sponge) was placed over the fracture at the time of definitive wound closure. Randomization was stratified by the severity of the open wound. The primary outcome measure was the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months postoperatively. Results: Four hundred and twenty-one (94%) of the patients were available for the twelve-month follow-up. The 1.50-mg/mL rhBMP-2 group had a 44% reduction in the risk of failure (i.e., secondary intervention because of delayed union; relative risk = 0.56; 95% confidence interval = 0.40 to 0.78; pairwise p = 0.0005), significantly fewer invasive interventions (e.g., bone-grafting and nail exchange; p = 0.0264), and significantly faster fracture-healing (p = 0.0022) than did the control patients. Significantly more patients treated with 1.50 mg/mL of rhBMP-2 had healing of the fracture at the postoperative visits from ten weeks through twelve months (p = 0.0008). Compared with the control patients, those treated with 1.50 mg/mL of rhBMP-2 also had significantly fewer hardware failures (p = 0.0174), fewer infections (in association with Gustilo-Anderson type-III injuries; p = 0.0219), and faster wound-healing (83% compared with 65% had wound-healing at six weeks; p =0.0010). Conclusions: The rhBMP-2 implant was safe and, when 1.50 mg/mL was used, significantly superior to the standard of care in reducing the frequency of secondary interventions and the overall invasiveness of the procedures, accelerating fracture and wound-healing, and reducing the infection rate in patients with an open fracture of the tibia.

Biomechanics

1993-01-01

Y. C. Fung

The Tension-Stress Effect on the Genesis and Growth of Tissues

1989-02-01

GAVRIIL A. ILIZAROV

To assess the influence of both the rate and the frequency of distraction on osteogenesis during limb elongation, a canine tibia was used with various combinations of distraction rates (0.5 … To assess the influence of both the rate and the frequency of distraction on osteogenesis during limb elongation, a canine tibia was used with various combinations of distraction rates (0.5 mm, 1.0 mm, or 2.0 mm per day) and distraction frequencies (one step per day, four steps per day, 60 steps per day). The distractions were performed after both open osteotomy and closed osteoclasis. Histomorphic and biochemical studies were conducted on the elongated osseous tissue, fascia, skeletal muscle, smooth muscle, blood vessels, nerves, and skin. It was determined that distraction at a rate of 0.5 mm per day often led to premature consolidation of the lengthening bone, while a distraction rate of 2.0 mm per day often resulted in undesirable changes within elongating tissues. A distraction rate of 1.0 mm per day led to the best results. It was also observed that the greater the distraction frequency, the better the outcome. With optimum preservation of periosseous tissues, bone marrow, and blood supply at the time of osteotomy, stability of external fixation, and 1.0 mm per day of distraction in four steps, osteogenesis within the distraction gap of an elongating bone takes place by the formation of a physislike structure, in which new bone forms in parallel columns extending in both directions from a central growth zone. The growth plate that forms under the influence of tension-stress has features of both physeal and intramembranous ossification, yet is neither; instead, the distraction regenerated bone is unique, providing numerous applications in clinical trau-matology, orthopedics, and other medical disciplines.

Skeletal Tissue Mechanics

1998-01-01

Robert Martin , David B. Burr , Neil A. Sharkey

The Comprehensive Classification of Fractures of Long Bones

1990-01-01

Maurice E. Müller , Peter Koch , Serge Nazarian +1 more

Fractures in adults

1984-01-01

Charles A. Rockwood , David P. Green

Effects of aquatic exercises on upper limb physical function after a humeral shaft fracture – a time series analysis

2025-06-25

Pedro Silva , Eduarda H Santos , Paola Cobbo +5 more | Human Movement

Purpose Humeral shaft fractures account for 1.2% of all fractures in adults. Regardless of the treatment approach, the consequences of immobility can lead to decreased functional capacity in these individuals. … Purpose Humeral shaft fractures account for 1.2% of all fractures in adults. Regardless of the treatment approach, the consequences of immobility can lead to decreased functional capacity in these individuals. Methods This case report describes a 46-year-old male patient with a fracture of the greater tubercle and diaphysis of the humerus in the left limb (non-dominant) treated with 15 aquatic exercise sessions and five land-based sessions. The Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) assessed physical function, Simulation Modeling Analysis (SMA) (autocorrelation, r, and significance) evaluated DASH measurements pre- and post-intervention, and the minimum clinically important difference (MCID) was reported. A MicroFet 2 HHD portable dynamometer measured muscle strength, while a manual goniometer assessed range of motion (ROM). Results The MCID was reached in the DASH questionnaire, with an 18.3% improvement in physical function. The data analysed by SMA showed autocorrelation = –0.78, r = –0.87, and p = 0.01. There was an improvement in the ROM in all shoulder and elbow movements and an increase in the strength of the shoulder and elbow flexor muscles. Conclusions Time series analysis with a slope of –2.25 each week predicted physical function. A score of zero on the DASH questionnaire indicated the absence of functional impairment and meant that the MCID was reached. Improvements in shoulder and elbow ROM and increased muscle strength were observed on the affected side.

Does Preoperative Joint Space Dimension Affect Accuracy in Splint-Based Lefort I Osteotomy?

2025-06-24

Man Yong Han , Michael Miloro | International Journal of Oral and Maxillofacial Surgery

A prospective comparative study of distal tibia and fibula fractures treated with tibial interlocking nailing with and without fibular plating

2025-06-24

Ananya Mishra , Vibhay Pareek , Mohit Yadav +2 more | International Journal of Research in Orthopaedics

Background: Distal both bone leg fractures present significant challenges in orthopedic surgery. The purpose of this study was to evaluate the functional and radiological outcomes of tibial interlocking nailing alone … Background: Distal both bone leg fractures present significant challenges in orthopedic surgery. The purpose of this study was to evaluate the functional and radiological outcomes of tibial interlocking nailing alone versus interlocking nail with supplementary fibular plating. Methods: A hospital-based, prospective interventional study was conducted on 72 patients, divided into two groups. Karlstrom-Olerud scoring and radiographic assessment were used to evaluate outcomes. SPSS software will be used for all statistical calculations. Results: Patients in the interlocking nail with fibular plating group demonstrated improved alignment values in varus/valgus angulation (p=0.00008) and anteroposterior angulation (p=0.00029), also Karlstrom Olerud score was significantly better in fibular plating group at 3 months (p=0.002). There was slightly earlier union time in fibular plating group than patients without fibular plating (14.86 and 15.55 respectively) and also there was higher rate of patients requiring secondary procedures in group without fibular plating (6) compared to group with fibular plating (2). Conclusion: Patients with fibular plating group demonstrated significantly improved alignment and functional scores, suggesting that supplementary fibular plating enhances stability and reduces malalignment.

Clinical, functional and radiological outcome of retrograde femoral nailing in femoral shaft fractures: an observational study

2025-06-24

S. Velmurugan , V. S. V. Kumar , M S +1 more | International Journal of Research in Orthopaedics

Background: Femoral shaft fractures require prompt and effective management to prevent long-term disability. Retrograde intramedullary nailing (RIMN) offers a reliable alternative to antegrade nailing, particularly when proximal access is limited. … Background: Femoral shaft fractures require prompt and effective management to prevent long-term disability. Retrograde intramedullary nailing (RIMN) offers a reliable alternative to antegrade nailing, particularly when proximal access is limited. This study evaluates the clinical, functional, and radiological outcomes of RIMN to inform optimal fracture management. Methods: An ambispective observational study was conducted at the Asian Orthopaedic Institute, SIMS Hospital, Chennai, from February 2023 to February 2024. A total of 38 patients with femoral shaft fractures treated using RIMN were included. Functional outcomes were assessed using the lower extremity functional scale (LEFS), pain using the Visual Analogue Scale (VAS), and radiological outcomes based on time to union. All patients were operated on by the same surgeon and followed for six months postoperatively. Results: The mean age was 42.3±0.9 years, with a female predominance (55%). Slip and fall was the most common cause (53%), and A1-type fractures were most frequent. The mean time to union was 14.5±4.4 weeks. LEFS scores improved from 23.76 to 63.29, VAS scores declined from 4.95 to 0.34, and knee ROM increased from 77.37° to 112.63° (p<0.001). One malunion was reported; no other complications occurred. No significant association was found between demographic variables and time to union. Conclusion: RIMN is a safe and effective treatment for femoral shaft fractures, enabling early mobilization and favourable clinical outcomes.

Distal tibia physeal fractures and premature growth arrest

2025-06-24

Mahdi Jaradat , Hider Mahmoud Al Soudi , Yousef Mohammad Eid Atoom +3 more | International Journal of Research in Orthopaedics

Background: Distal tibia children’s physeal fractures can cause growth complications, as premature physeal closure (PPC), which is radiographic growth plate closure compared to unaffected side. Methods: Retrospective analysis of 243 … Background: Distal tibia children’s physeal fractures can cause growth complications, as premature physeal closure (PPC), which is radiographic growth plate closure compared to unaffected side. Methods: Retrospective analysis of 243 patients, conducted to assess occurrence of physeal growth arrest. The study aims to identify factors associated with risk of PPC, investigate how common these complications are and to identify factors might predict their occurrence. Data of 243 children with distal tibial physeal fractures were reviewed in multiple military hospitals in Jordan between January 2018 and October 2023. Results: Average follow-up was 37 weeks. PPC occurred in 29 cases (12.1%). Majority of PPC cases (64%) associated with Salter-Harris II fractures (19 cases), 14% in Salter-Harris III (4), 14% in Salter-Harris IV (4 cases), 8% in triplane fractures (2 cases). No cases of physeal arrest found in Salter-Harris I or Tillaux fractures. Cox multivariate regression analysis revealed statistically significant associations between mechanism of injury and PPC, and between degree of initial displacement and PPC. Each millimeter of initial displacement increased relative risk of PPC by 1.15 (P < 0.01). Although trends suggested possible link between residual displacement after reduction or number of reduction attempts and PPC risk, these correlations were not significant. Conclusions: Recent studies reported higher PPC following distal tibial physeal fractures compared to this cohort. Significant predictors of PPC included extent of initial fracture displacement and mechanism of injury. While trends noted regarding residual displacement and number of reduction attempts, found not significant in predicting PPC.

Functional recovery and quality of life after surgical fixation of segmental femoral shaft fractures: a case series from India

2025-06-24

Haemanath Pandian , Silambarasi Nagasamy , Chockalingham Kasi +1 more | International Journal of Research in Orthopaedics

Segmental femoral shaft fractures, which are often a result of high-energy trauma, pose significant challenges in management and rehabilitation. This case series presents twelve male patients (mean age 40 years, … Segmental femoral shaft fractures, which are often a result of high-energy trauma, pose significant challenges in management and rehabilitation. This case series presents twelve male patients (mean age 40 years, range 28-52) with segmental femoral shaft fractures treated between October 2022 and March 2023 at tertiary care centers in Tamil Nadu, India. Surgical fixation methods included intramedullary interlocking nails (58.3%), locking plates (25%), and other constructs (16.7%), with all patients undergoing open reduction. Functional recovery and quality of life were assessed using WOMAC, EQ-5D-3L, and SMFA scores at 1, 3, and 6 months postoperatively. Significant improvements were observed across all measures, with mean WOMAC scores decreasing from 55.6 (±6.5) to 18.2 (±5.9), EQ-5D-3L scores improving from 0.62 (±0.10) to 0.91 (±0.06), and SMFA dysfunction index decreasing from 41.4 (±5.3) to 12.6 (±3.9) over six months. Radiological union was achieved in 33.3% of cases at 3 months and in all remaining eleven patients (one lost to mortality from associated injuries) by 6 months, with a mean union time of 23.7 weeks. This case series demonstrates that appropriate surgical fixation of segmental femoral shaft fractures can yield favorable functional outcomes and quality of life improvements, with complete radiological union achievable within six months in this challenging fracture pattern.

Comparing the outcome of fixation of supracondylar femur fractures using retrograde intramedullary nailing and distal femur locking compression plate

2025-06-24

Debanga Sarma Barua , Tirupati S. Shirdinayak , Mahmoodul Karim +1 more | International Journal of Research in Orthopaedics

Background: Supracondylar femur fractures typically occur as a result high energy trauma in young and in elderly after low energy trauma. Retrograde intramedullary nailing (RIMN) and distal femur locking compression … Background: Supracondylar femur fractures typically occur as a result high energy trauma in young and in elderly after low energy trauma. Retrograde intramedullary nailing (RIMN) and distal femur locking compression plate (DFLCP) are widely used for fixation distal femur fractures. This study was done to compare the clinicoradiological outcome of fixation of supracondylar femur fractures using RIMN and DFLCP. Methods: In our study with 26 patients fulfilling the criteria were enrolled and one group treated with RIMN while the other group treated with DFLCP and corresponding Functional and radiological assessment done on basis of Neer’s score. Results: Fractures occurred primarily as a result of RTA in young and self-fall in elderly. Fracture type AO33-A1 was seen more commonly in both groups. The mean duration of surgery, blood loss and bone union time in the RIMN group minutes was less than that the DFLCP group. All fractures in the RIMN group united while three cases of non-union in DFLCP group, with one case of delayed union, one case of periprosthetic implant fracture, and one case of knee joint arthrosis. Local soft tissue complications were more common among DFLCP group. Functional and radiological assessment on basis of Neer’s score was found to be better in RIMN group than the DFLCP group. Conclusions: RIMN is a better option in the operative treatment of supracondylar femur fractures found to be correct in terms of less soft tissue complications, shorter duration of surgery, less intraoperative blood loss, shorter duration of hospital stays, and fracture union.

Titanium Osteosynthesis Sequencing for Pediatric Mandibular Fracture – A Case Report and Literature Review

2025-06-24

K. Mousavi , Angela M. Arlen , E. Endrawan +1 more | International Journal of Oral and Maxillofacial Surgery

Interobserver Reliability of the Modified Radiographic Union Score (mRUST) for Tibial and Femoral Fractures

2025-06-24

Dominik Deppe , Mario Gabriele , Manuel Giovanni Mazzoleni +7 more | Journal of Orthopaedic Trauma

OBJECTIVES: To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (Femur, Tibia) treated with various modalities … OBJECTIVES: To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (Femur, Tibia) treated with various modalities (Nail, Plate). METHODS: Design : Retrospective analysis. Setting: Single center academic hospital in Germany. Patient Selection Criteria: Adult patients (≥18 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality. Outcome Measures and Comparisons: Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up timepoints based on clinical practice. To evaluate inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur/tibia), treatment type (plate/nail fixation), and treatment combinations across locations. RESULTS: A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18-84)) with 1,136 follow-up timepoints were analyzed. Overall inter-rater reliability for mRUST was good (ICC 0.77), consistent across fixation methods (nail/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70–0.74) and lowest for the posterior cortex (0.65–0.74). CONCLUSIONS: The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures. LEVEL OF EVIDENCE: I.

Enhancing Surgical Guides: The Role of Integrated Irrigation Ports for Fibula Flap Osteotomies

2025-06-24

C. Enfinger , Diego Caruso , Marina Morante Silva +2 more | International Journal of Oral and Maxillofacial Surgery

Reconstruction of a Post-Traumatic Mandibular Defect Using Patient-Specific Polycaprolactone Tricalcium Phosphate (PCL/TCP) Scaffold

2025-06-24

Sally Ng , Leonardo Saigo | International Journal of Oral and Maxillofacial Surgery

The incidence, prevalence, and health burden of forearm fractures in China from 1992 to 2021 and forecasts for 2036

2025-06-24

Yuan Zeng , Michael Z. Hu , Zhiming Zhang +4 more | Frontiers in Public Health

Background Forearm fractures (Fracture of radius and/or ulna) are common worldwide and constitute a significant public-health burden. There is limited epidemiological data on radius and/or ulna fractures in the Chinese … Background Forearm fractures (Fracture of radius and/or ulna) are common worldwide and constitute a significant public-health burden. There is limited epidemiological data on radius and/or ulna fractures in the Chinese population. Using data from the Global Burden of Disease (GBD) 2021 study, this research reports the epidemiology and disease burden of forearm fractures in China, as well as projected trends for the next 15 years. Methods Data on the incidence, prevalence, and years lived with disability (YLDs) for Fractures of the radius and ulna in mainland China from 1992 to 2021 were obtained from the 2021 GBD database. Joinpoint regression analysis was used to analyze epidemiological trends in incidence, prevalence, and age-standardized rates (ASIR, ASPR, ASYR) over the period from 1992 to 2021. The Bayesian Age-Period-Cohort (BAPC) model was employed to project trends in incidence and YLDs for radius and/or ulna fractures in mainland China from 2022 to 2036. Results In 2021, there were 5,790,636 radius and/or ulna fractures in China, with 2,724,178 in males and 3,066,459 in females. The age-standardized incidence rate (ASIR) for radius and/or ulna fractures was 404.52 per 100,000, with 375.83 in males and 430.87 in females. The age-standardized years of disability (ASYR) was 2.55 years per 100,000, with 2.22 years in males and 2.82 years in females. From 1990 to 2021, both the ASIR and ASYR increased, with an average annual percent change (EAPC) of 0.09. The incidence of radius and/or ulna fractures peaked in males at ages 30–34, and in females at ages 50–54 and 65–69. Joinpoint regression analysis revealed a decline in incidence and prevalence from 2001 to 2005, followed by a significant increase from 2011 to 2021. Projected data suggests that the ASIR for radius and/or ulna fractures in males will rise from 369 per 100,000 to 374 per 100,000 from 2022 to 2029. This will be followed by a slight decline from 373 per 100,000 in 2030 to 368 per 100,000 in 2036, while the rate in females is expected to steadily increase from 427 per 100,000 in 2022 to 502 per 100,000 in 2036. Conclusion In 2021, an estimated 5,790,636 radius and/or ulna fractures occurred in China. Prevalence and disability rates were higher among women than among men. After a decline between 2001 and 2005, the incidence, prevalence, and disability burden of these fractures rose sharply from 2011 to 2021. Projections indicate that incidence in men will fall slightly after 2030, whereas it will continue to rise in women. These findings provide critical evidence for shaping public-health policy, designing fracture-prevention programmes, and allocating healthcare resources in China.

Innovative approach to distraction osteogenesis using a novel external fixator design. In vivo experimental rabbit model

2025-06-24

Fathia Slimi , Amir Bahri , Mœz Trigui +7 more | European Journal of Orthopaedic Surgery & Traumatology

Functional outcome in adults treated for both bone forearm fractures with intramedullary square nails

2025-06-24

Vidisha Kulkarni , Utkarsh Vishwakarma , Sunil Kulkarni | International Journal of Research in Orthopaedics

Background: The forearm fractures are considered intraarticular due to functional characteristics and spatial orientation. These fractures require anatomic reduction to maintain axial and rotational stability and preserve bone length with … Background: The forearm fractures are considered intraarticular due to functional characteristics and spatial orientation. These fractures require anatomic reduction to maintain axial and rotational stability and preserve bone length with absolute stability for adequate healing to restore function. Open reduction and internal fixation is accepted as the treatment of choice for both bone forearm fractures according to many studies. However, it can result in complications like extensive soft tissue damage, evacuation of fracture hematoma, periosteal damage, radioulnar synostosis, neurovascular injury, compartment syndrome, delayed union, non-union, infection, refracture after implant removal. Intramedullary nailing is an alternative technique to avoid the above problems, with the advantages of minimal incision, no periosteal stripping, faster healing and biologic fixation. This study evaluates the functional outcome in adults treated for both bone forearm fractures with intramedullary square nail fixation at our institute. Methods: 113 patients with closed both bone forearm fractures were treated with Intramedullary square nail fixation between January 2014 to December 2023. There were 54 (22A) type fractures, 44 (22B) type fractures, 15 (22C) type fractures. Functional outcome was assessed based on Anderson’s criteria. Results: 105 patients had excellent to satisfactory results while fixation in 8 patients resulted in failures based on Anderson’s criteria. Conclusions: Intramedullary nailing is a simple, safe and effective method of alternative fixation of both bone forearm fractures that is associated with closed reduction, early union, biologic fixation, low infection rate, small cosmetic scars, less blood loss, shorter operating time, and less risk of compartment syndrome.

Fat embolism syndrome before surgical treatment of open tibial and fibular shaft fracture: a case report

2025-06-24

Kamal Khalil , Samah Ali Ibrahim , Nada Ayman Yakout | International Journal of Research in Orthopaedics

A 26-year-old male with no significant medical history sustained open fractures of the left tibia and fibula following a workplace accident. Initially alert and stable, he developed sudden neurological deterioration … A 26-year-old male with no significant medical history sustained open fractures of the left tibia and fibula following a workplace accident. Initially alert and stable, he developed sudden neurological deterioration (GCS 9/15) 10 hours post-injury, without respiratory compromise or cutaneous signs. CT was unremarkable; diffusion-weighted MRI revealed widespread acute cerebral infarcts. No intracardiac shunt was found on echocardiography. Supportive care led to gradual neurological improvement, and successful surgical fixation followed. Isolated cerebral fat embolism can precede orthopedic intervention and present without classic signs. Early neuroimaging and high clinical vigilance are crucial for prompt diagnosis and management.

On the relationship between torsion and axial deformations of the lower extremities

2025-06-23

A. S. Barinov , A.A. Vorobyev , О.А. Каплунов +2 more | Operativnaâ hirurgiâ i kliničeskaâ anatomiâ (Pirogovskij naučnyj žurnal)

Background. Axial deformities of the lower extremities with the apex of deformation at the level of the metaepiphyses of the lower leg and the appearance of the limbs with such … Background. Axial deformities of the lower extremities with the apex of deformation at the level of the metaepiphyses of the lower leg and the appearance of the limbs with such deformities can be associated with various factors such as the angle of antetorsion and anteversion of the thigh, torsion of the lower leg, angle of extension in the knee joints and foot position, the severity of muscles and subcutaneous fat. Objective. The purpose of this work is to identify the anatomical relationships of torsion and axial deformities of the lower extremities and their effect on the appearance of the limbs. Material and methods. The clinical material of this study was a pool of 105 patients of both sexes aged 16 to 59 years, who became chronologically the last (from 2021 to 2024) in the long-term experience of correcting axial deformities of the proximal metaepiphysis of both legs in more than 980 patients. Results. It has been demonstrated that the appearance of the lower extremities depends on many factors, and when correcting axial deformities of the limbs, it is necessary to take into account that both varus and valgus deformities of the lower extremities at the knee joint level are rarely isolated in one plane, and most often represent multi-plane anatomical and functional changes involving the entire lower limb from the hip joint up to the foot. An important factor affecting the appearance of the lower extremities is, in addition to the shape of the bones, the distribution of soft tissues, primarily muscles and subcutaneous fat. Conclusion. As a conclusion, it is important to note that the correction of such deformations requires an integrated approach that takes into account the multidimensional changes of the entire lower limb. In this case, it is necessary to take into account not only the anatomical features of bones and joints, but also the distribution of soft tissues such as muscles and subcutaneous fat.

Overcoming the detrimental impact of volumetric muscle loss on segmental fracture healing via the induced membrane technique

2025-06-23

Andrew Clark , Michael S. Valerio , Jonathan Kulwatno +4 more | Bone and Joint Research

Aims Open fractures pose a substantial treatment challenge, with adjacent muscle loss being a major complication. The induced membrane (IM) technique has shown promise in treating complicated fractures. The aim … Aims Open fractures pose a substantial treatment challenge, with adjacent muscle loss being a major complication. The induced membrane (IM) technique has shown promise in treating complicated fractures. The aim of this study is to investigate the impact of adjacent muscle trauma on segmental fracture healing using recombinant human bone morphogenetic protein-2 (rhBMP-2) via the IM technique. Methods Skeletally mature male rats (n = 10 to 11 per group) underwent unilateral 3 mm segmental bone defects (SBD) of the tibial diaphysis or a composite tissue injury (CTI), which included a SBD along with volumetric muscle loss (VML). A polymethyl methacrylate (PMMA) spacer was formed within the SBD of each rat. After a four-week period, the PMMA spacer was removed, and the defect was treated with a rhBMP2-impregnated collagen sponge. Longitudinal micro-CT (µCT) imaging was conducted at baseline (Day 0) and at weeks 2, 4, 8, and 12 post-spacer removal to monitor fracture healing progress. At the 12-week postoperative mark, a comprehensive analysis was conducted, including endpoint µCT analysis, evaluation of neuromuscular function, tibia torsional testing, and histological examination. Results Longitudinal µCT scans revealed no differences in bone formation or bone mineral density (BMD) at any timepoint between the SBD and CTI groups. High-resolution µCT analysis at the endpoint also showed no variations in bone quality. Torsion testing confirmed that VML did not affect bone strength. Notably, CTI animals exhibited an irreversible reduction in muscle mass and neuromuscular function, which was not observed in the SBD group. Conclusion Introducing the additional challenge of VML alongside SBD did not hinder the effectiveness of the induced membrane technique in healing a critical-sized defect. Cite this article: Bone Joint Res 2025;14(6):568–577.

A retrospective review of outcomes in open tibial fractures following the implementation of BAPRAS/BOA guidelines

2025-06-23

Ariella J Smith , Alexis J. Zimbulis , Vincent V.G. An +4 more | European Journal of Orthopaedic Surgery & Traumatology

Short Stature and Brachydactyly in an 8-year-old Girl with Congenital Hypothyroidism

2025-06-23

| American Academy of Pediatrics eBooks

Gravity-Based Minimal Invasive Plate Osteosynthesis for Proximal Tibia Fractures: A Novel Reduction Technique

2025-06-22

Michael Abdou , Mohammad Khak , Mohammad Javad Shariyate | SurgiColl

Minimally Invasive Plate Osteosynthesis (MIPO) is widely utilized in treating extra-articular proximal tibia fractures due to its advantages in preserving periosteal blood supply, reducing pain, and promoting early functional recovery. … Minimally Invasive Plate Osteosynthesis (MIPO) is widely utilized in treating extra-articular proximal tibia fractures due to its advantages in preserving periosteal blood supply, reducing pain, and promoting early functional recovery. Traditional techniques, such as external fixators and manual traction, often involve extended surgical times, increased risk of infection, and additional costs. This study introduces a novel gravity-based reduction technique for extra-articular proximal tibial fractures to enhance the efficiency and safety of MIPO procedures. We evaluated this technique in a cohort of three male patients (aged 26, 34, and 56) with extra-articular comminuted proximal tibial fractures, all resulting from motorcycle accidents. Patients were positioned supine on a conventional operating table, with the affected limb suspended vertically, allowing gravity-assisted reduction. The average surgical time was 35 ± 8 minutes. All patients achieved complete bone union within 24 weeks, with no intraoperative or postoperative complications, and returned to work in less than 10 days. This gravity-based reduction technique demonstrates promising results in reducing operative time and complications, suggesting it may be a valuable alternative to traditional methods. However, further studies with larger sample sizes are needed to validate these findings and assess long-term outcomes.

Altered long-term patient-perceived outcome following lateral tibial plateau fractures – A matched register-based cohort study of 762 patients with a mean of 11 years of follow-up

2025-06-21

Peter Larsen , Rasmus Elsøe | The Knee

While several studies have examined lateral tibial plateau fracture (LTPF) outcomes, long-term follow-up data (exceeding 10 years) remain limited. We aim to compare the long-term patient-reported outcomes following LTPF to … While several studies have examined lateral tibial plateau fracture (LTPF) outcomes, long-term follow-up data (exceeding 10 years) remain limited. We aim to compare the long-term patient-reported outcomes following LTPF to that of an age- and gender-matched group without an LTPF. The study design was a national matched cohort study, including all patients admitted with an LTPF in Denmark between January 1, 1996, and December 31, 2017. The primary outcome measure was The Knee Injury Osteoarthritis Outcome Score (KOOS). The match group consisted of Danish citizens without LTPFs matched 1:10 to the LTPF group on age and gender. Total 1621 patients with a LTPF were included. Of these, 762 (47 %) responded to the survey invitation. The mean age of respondents was 61.5 years, and 65 % were women-the mean follow-up time since fracture was 11.2 years, ranging between 6.1 and 26.0 years. The match group was comprised of 16,210 citizens. Of these, 5050 (31 %) responded to the survey invitation. The mean age of respondents was 63.3 years, and 72 % were women. Patients with LTPFs reported significantly lower KOOS subscale scores compared to the match group. The differences in KOOS subscale scores ranged from a mean of 7.2 in activities of daily living (ADL) to 20.4 in sport and recreational activities (Sport/Rec). Results suggested than LTPFs are associated with considerable long-term patients-perceived knee complaints compared to that of an age- and gender-matched population without a lateral tibial plateau fracture.

Microsurgical Reconstruction of Extensive Lower Limb Defects: Latissimus Dorsi Free Flap for Circumferential Soft Tissue Loss Following High-Energy Trauma

2025-06-21

Edoardo Filigheddu , Federico Ziani , Giovanni Arrica +4 more | Journal of Clinical Medicine

Background/Objectives: High-energy trauma to the lower limb often results in extensive soft tissue loss with exposure of critical structures, posing a serious threat to limb viability. Early and effective coverage … Background/Objectives: High-energy trauma to the lower limb often results in extensive soft tissue loss with exposure of critical structures, posing a serious threat to limb viability. Early and effective coverage is crucial to prevent infection, promote bone healing, and preserve function. This report presents the use of a latissimus dorsi free flap for circumferential soft tissue reconstruction following a severe crush injury. Methods: We describe the case of a young female patient who sustained a high-energy crush trauma with a comminuted, displaced fracture of the middle and distal third of the tibia and complete circumferential soft tissue loss. Due to the extent and location of the defect, a latissimus dorsi free flap was selected for reconstruction. The surgical technique, microsurgical anastomosis, postoperative care, and rehabilitation protocol are detailed. Results: The latissimus dorsi flap provided reliable coverage of the entire defect, protected the underlying bone and hardware, and promoted wound healing. No major complications were observed. Functional recovery was satisfactory, with progressive weight-bearing and joint mobility achieved during follow-up. Conclusions: In complex lower limb injuries with extensive soft tissue damage, free flap transfer remains a key strategy for limb salvage. The latissimus dorsi flap, due to its size, reliability, and versatility, represents a valuable option for circumferential coverage and restoration of limb function following high-energy trauma.

Manejo secuencial de las fracturas abiertas

2025-06-20

Braulio Zuñiga Aleman , Daniel Leiva Rojas , Jorge Suarez Gordillo | Revista Ciencia y Salud Integrando conocimientos

Las fracturas abiertas son una gran problemática a nivel mundial, debido a que afectan principalmente a la población económicamente activa. Esto tiene un gran impacto a nivel social y económico … Las fracturas abiertas son una gran problemática a nivel mundial, debido a que afectan principalmente a la población económicamente activa. Esto tiene un gran impacto a nivel social y económico de una comunidad al afectar directamente a una población económicamente activa causando incapacidades prolongadas, y, en ocasiones, secuelas funcionales importantes en la vida de la persona. Es por esto que saber su manejo inicial y tratamiento definitivo cobra vital importancia. El objetivo principal de este artículo de revisión es valorar la presentación clínica característica, los métodos diagnósticos, estudios complementarios, los diferentes abordajes terapéuticos y las principales complicaciones de esta patología. Un aborde adecuado de las fracturas expuestas puede tener un gran impacto en la morbimortalidad y secuelas funcionales de cada paciente.

There’s Moore II it: assessing outcomes following tibial plateau fracture dislocations

2025-06-20

Alexander Lashgari , Benjamin Padon , Abhishek Ganta +2 more | European Journal of Orthopaedic Surgery & Traumatology

The Interplay of Angiogenesis and Osteogenesis in Non‐Stabilized Incomplete Tibial Fractures: A Temporal Study in Rats

2025-06-20

Kyung Wook Kim , Andrew Padalhin , Hyun Seok Ryu +7 more | Journal of Orthopaedic Research®

ABSTRACT Prior research on angiogenesis and osteogenesis during bone fracture healing has primarily focused on stabilized models, often within controlled environments. However, the dynamic interplay of these processes in the … ABSTRACT Prior research on angiogenesis and osteogenesis during bone fracture healing has primarily focused on stabilized models, often within controlled environments. However, the dynamic interplay of these processes in the context of long bone fractures without scaffolds or external factors remains poorly understood. This study investigated the temporal dynamics of angiogenesis and osteogenesis in a non‐stabilized incomplete transverse tibia bone fracture model. Multi‐modal observation approach was carried out using micro‐CT analysis of bone mineral density, histological assessment of fracture healing, and confocal microscopy for visualization and co‐localization of key angiogenic (CD31, endomucin) and osteogenic (collagen 1, osteocalcin, PDGFRB) markers. Our findings revealed a dynamic and interdependent relationship between these processes. H type blood vessels persisted throughout the healing process, and significant correlations were observed between the expression of angiogenic and osteogenic markers. The role of hypoxia, a critical regulator of both processes, was investigated by analyzing HIF1‐α expression. Increased expression of SLIT3, a guidance molecule, was also observed at later stages of healing, suggesting its potential involvement in vascular remodeling. These findings provide crucial insights into the molecular mechanisms underlying bone fracture repair in the absence of additional supporting external elements such as scaffolds or stabilizers. By elucidating the temporal dynamics of these key processes, we identify potential targets for therapeutic interventions aimed at accelerating and optimizing bone regeneration. Consideration of these interactions can lead to the development of effective clinical strategies for enhancing bone healing in non‐stabilized incomplete fractures.

A finite element study for tibial fractures: analyze the biomechanical condition of the tibial fracture area to provide guidance for subsequent treatment

2025-06-20

Ke-rui Zhang , Bin Luo , Jiangping Tu +7 more | Frontiers in Bioengineering and Biotechnology

Introduction Distal tibial fractures are common fracture sites and usually require surgical treatment to achieve anatomical reduction. Intramedullary nails (IMN) are widely used in orthopedics for stabilizing fractured bones and … Introduction Distal tibial fractures are common fracture sites and usually require surgical treatment to achieve anatomical reduction. Intramedullary nails (IMN) are widely used in orthopedics for stabilizing fractured bones and treating limb deformities. The process of postoperative bone healing is of great significance for patient rehabilitation and can guide subsequent treatment methods. However, the current radiographic techniques used to determine the degree of fusion, such as X-ray, need to be improved in accuracy and have some radiation effects. Several studies suggested that the mechanical load on the fracture area could reflect the bone healing process and evaluated the stability of fracture area. The aim of this study is to investigate the biomechanical changes in the fracture area during bone healing and IMN, and to prepare for the subsequent placement of intelligent stress and displacement sensors based on the changes in stress and displacement, in order to provide guidance for the treatment and rehabilitation of postoperative fractures. Methods Finite element (FE) models representing different healing stages of tibial fractures were developed. All conditions were applied to simulate the stress and strain of the IMN fixation system under normal tibial stress. Results The stress at the fracture area on the IMN gradually decreases, while the stress on the callus gradually increases until reaching a stable state at the 12th week after surgery. And the deformation value and the displacement value of the callus decrease and stabilize over time. Based on the changes in stress at the fracture area of the IMN and the displacement value of the callus, we can place a stress sensor at the fracture area of the IMN and a displacement sensor at the callus area. Conclusion This study utilized FE analysis to evaluate stress, deformation and displacement between the IMN and bone during the healing process of tibial fractures in four stages. By combining these aspects, the degree of bone healing can be assessed. This research enables orthopedic doctors to monitor the progression of fracture healing without relying solely on imaging examinations. Furthermore, it aids in guiding patients to undergo appropriate rehabilitation training for better recovery.

Extended anterolateral versus Frosch approach for type II tibial plateau fractures involving the posterolateral column: A retrospective case series study

2025-06-20

Jiakai Zhang , Yi Zheng , Junlong Wu +1 more | Medicine

This study aimed to compare the extended anterolateral approach and the Frosch approach for treating type II tibial plateau fractures (based on the Schatzker classification system) involving the posterolateral column. … This study aimed to compare the extended anterolateral approach and the Frosch approach for treating type II tibial plateau fractures (based on the Schatzker classification system) involving the posterolateral column. A retrospective study was undertaken to compare general patient characteristics, intraoperative and postoperative outcomes, the Hospital for Special Surgery score, Rasmussen radiology score, tibial plateau angle, and posterior slope angle immediately after surgery and at a 1-year follow-up, between the 2 surgical approaches utilized between 2016 and 2020. Fifty-two patients with Schatzker type II fractures from Ningbo No. 2 Hospital were enrolled. No significant demographic differences existed between the 2 surgical groups. The Frosch approach group had slightly longer operative times but better hospital for special surgery knee scores and Rasmussen radiology scores than the extended anterolateral approach group. Both approaches achieved good outcomes for simple posterolateral fractures. For complex fractures, the Frosch approach may enabled more accurate reduction and superior biomechanical stability.

Approach to Femoral Shaft Nonunions: Diagnosis and Management

2025-06-20

Elizabeth P. Wellings , James A. Blair | Journal of the American Academy of Orthopaedic Surgeons

Despite the high union rate of femoral shaft fractures treated with intramedullary nailing (90% to 100%), the annual incidence of femoral shaft nonunion ranges from 2% to 6%. Although less … Despite the high union rate of femoral shaft fractures treated with intramedullary nailing (90% to 100%), the annual incidence of femoral shaft nonunion ranges from 2% to 6%. Although less common than tibial nonunions, femoral shaft nonunions remain a clinical problem in orthopaedic surgery. Proper treatment begins with appropriate diagnosis, workup, and identification of risk factors followed by a multidisciplinary approach to treatment. This article provides current evidence-based guidance for providers on the diagnosis and management of femoral shaft nonunions.

Hydroxylated fullerene promotes fracture healing in ovariectomized combined type 2 diabetic mice

2025-06-19

Yunpeng Hu , Linjie Feng , Jie Li +7 more | Journal of Orthopaedic Surgery and Research

Functional Outcomes of Bicolumnar Plating in Schatzker Type V and VI Proximal Tibial Fractures: A Prospective Study

2025-06-19

Ajayguru Senthurvelan , Ashok Nayak , Ravikumar Biradar +4 more | Cureus

Early stage prediction of bone regeneration using FEA and cell differentiation algorithms with 3D-printed PLA and PCL scaffolds: modeling and application to dorsal double-plating in distal radius fractures

2025-06-19

Hsuan Chih Liu , Ya-Han Chan , Shao-Fu Huang +3 more | 3D Printing in Medicine

This study introduces an advanced framework that integrates biphasic cell differentiation bone remodeling theory with finite element (FE) analysis and multi-remodeling simulation to evaluate the performance of 3D-printed biodegradable scaffolds … This study introduces an advanced framework that integrates biphasic cell differentiation bone remodeling theory with finite element (FE) analysis and multi-remodeling simulation to evaluate the performance of 3D-printed biodegradable scaffolds for bone defect repair. The program incorporates a time-dependent cell differentiation stimulus (S), accounting for fluid-phase shear stress and solid-phase shear strain, to dynamically predict bone cell behavior. The study focuses on polylactic acid (PLA) and polycaprolactone (PCL) scaffolds with diamond (DU) and random (YM) lattice designs, applied to a dorsal double-plating (DDP) fixation model for distal radius fractures. Material testing reveals that PLA provides higher rigidity and strength, while PCL offers superior ductility. Mechanical strength tests confirm the superior performance of DU lattice structures under compression, shear, and torsion forces. The bone remodeling program, applied to 36 model combinations of fracture gaps, materials, and lattice designs, computes the total percentage of cell differentiation (TPCD), identifying scaffold material as the key factor, with PLA significantly enhancing TPCD values. Biomechanical analysis after 50 remodeling iterations in a 5.4 mm fracture gap shows that the PLA + DU scaffold reduces displacement by 35%/39%/75%, bone stress by 19%/16%/67%, and fixation plate stress by 77%/66%/93% under axial/bending/torsion loads, respectively, compared to the PCL + YM scaffold. This study highlights the critical role of dynamic remodeling programs in optimizing scaffold material properties and lattice architectures, establishing a robust platform for patient-specific bone repair solutions in regenerative medicine.

Development and Evaluation of a Novel Mixed Reality-Based Surgical Navigation System for Distal Locking of Intramedullary Nails

2025-06-19

Fei Lyu , Puxun Tu , Xingguang Tao +1 more | Electronics

Intramedullary nailing (IMN) is the gold standard for fixing mid-shaft fractures of long bones, but distal locking remains a challenging procedure. This study aims to develop and evaluate a novel … Intramedullary nailing (IMN) is the gold standard for fixing mid-shaft fractures of long bones, but distal locking remains a challenging procedure. This study aims to develop and evaluate a novel mixed reality (MR)-based surgical navigation system for distal locking of IMN through phantom experiments. Twelve bone models closely replicating the mechanical properties, anatomy, and density of human tibial bone were utilized. Six orthopedic surgeons participated in the phantom experiments using both MR and traditional electromagnetic (EM) navigation systems. Effectiveness was evaluated using postoperative fluoroscopic imaging and the time taken for distal locking. Compared to the EM navigation system, the MR system significantly reduced distal locking time (81.54 ± 6.06 vs. 132.67 ± 6.45 s per screw) and achieved a higher success rate (23/24 vs. 21/24 screws accurately placed), but the difference in terms of success rate is not statistically significant. The MR-based navigation system for distal locking of IMN is time-efficient, accurate, and shows high potential for enhancing surgical precision in orthopedic procedures.

Reinforced locking screws with enhanced head and neck junction: improving biomechanical stability in opening-wedge high tibial osteotomy applications

2025-06-19

Kyung-Wook Nha , Hyungsuh Kim , Kyoung-Tak Kang +2 more | Journal of Orthopaedic Surgery and Research

Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close

2025-06-18

Yohan Jang , Roman M. Natoli , Gregory J. Della Rocca +7 more | Journal of Bone and Joint Surgery

Background: Initial surgical management of Gustilo-Anderson type-I to IIIA open fractures varies from surgical fixation of the fracture with immediate closure of the traumatic wound to various combinations of staged … Background: Initial surgical management of Gustilo-Anderson type-I to IIIA open fractures varies from surgical fixation of the fracture with immediate closure of the traumatic wound to various combinations of staged fracture and wound management. The decision to choose staged management has historically been based on wound contamination and the severity of the open fracture. The purpose of this study was to compare the rates of surgical site infection (SSI), wound complication, nonunion, and 1-year reoperation between patients with type-I to IIIA open fractures who underwent fix-and-close treatment and those who underwent planned, staged treatment. Methods: This is a secondary analysis of participants who were enrolled in the Aqueous-PREP and PREPARE-Open studies, excluding those with type-IIIB and IIIC open fractures. Participants were divided into fix-and-close or planned, staged groups and were matched using propensity scores that were computed with multiple variables, including patient and injury characteristics. Associations between treatment type and outcomes were analyzed. Results: A total of 3,170 participants (staged, 872: 70% White, 20% Black, and 10% other or unknown race; fix-and-close, 2,298: 62% White, 21% Black, and 17% other) with Gustilo-Anderson type-I to IIIA open fractures were identified. Eight hundred and thirty-six participants who underwent planned, staged treatment were propensity score-matched to 836 participants who underwent fix-and-close treatment. Staged treatment was significantly associated with increased odds of deep SSI within 90 days (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.15 to 3.47]; p = 0.01) and reoperation specifically for infection within 1 year (OR, 1.47 [95% CI, 1.06 to 2.04]; p = 0.02) but was not associated with increased odds of wound dehiscence (OR, 0.85 [95% CI, 0.49 to 1.49]; p = 0.57), wound necrosis or failure of the wound to heal (OR, 1.37 [95% CI, 0.83 to 2.25]; p = 0.21), reoperation requiring any free or local flap coverage (OR, 0.96 [95% CI, 0.55 to 1.68]; p = 0.89), or reoperation for delayed union or nonunion (OR, 1.30 [95% CI, 0.92 to 1.83]; p = 0.14). Conclusions: Fix-and-close treatment of open fractures of type IIIA and lower was associated with decreased odds of deep SSI within 90 days and reoperation for infection within 1 year without an increased risk of wound complications or nonunion and may be considered even in fractures with embedded contamination provided that adequate debridement is performed. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Early routine radiographic follow-up at 2–3 weeks for operatively treated tibia, fibula or ankle fractures does not contribute to identification of complications: A two center case series of 628 patients

2025-06-18

Derek van Duuren , Robert Wágner , Jacob S. Borgida +7 more | Injury

Three-dimensional biomechanical analysis of flexible intramedullary nailing constructs in length-unstable pediatric femur fractures

2025-06-18

Emmanouil Grigoriou , Emil Varas‐Rodríguez , M. Bryant Transtrum +3 more | Journal of Pediatric Orthopaedics B

Flexible intramedullary nail fixation of pediatric femoral shaft fractures offers advantages such as shorter hospital stays, faster return to function, and less associated costs when compared with traction and casting. … Flexible intramedullary nail fixation of pediatric femoral shaft fractures offers advantages such as shorter hospital stays, faster return to function, and less associated costs when compared with traction and casting. This study compared the biomechanical performance of three configurations: 2CS, 2CL, and 3CL. Thirty synthetic femur models with identical, length-unstable, spiral fractures were tested using a three-dimensional camera system to assess real-time micromotion. Three groups were analyzed: (a) 2CS – two 3.5 mm C- and S-shaped nails inserted anterograde, (b) 2CL – one ‘C’ and one ‘S’ shaped 3.5 mm titanium nail-inserted retrograde from a single lateral entry, (c) 3CL – two ‘C’ shaped 3.5 mm titanium nails inserted medially and laterally with a third ‘C’ shaped 2.5 mm nail placed retrograde from an anterolateral site. Torsional loading, cyclical loading, and load-to-failure tests were conducted. The 3CL configuration demonstrated superior biomechanical performance. It exhibited the highest torsional stiffness [0.67 ± 0.06 Nm/° for external rotation (ER), 0.404 = ± 0.06 Nm/° for internal rotation (IR); P = 0.002], least displacement (0.05 ± 0.02 vs. 0.30 ± 0.02 mm for 2CL and 0.57 ± 0.05 mm for 2CS; P = 0.012), and required the highest load-to-failure (162 ± 83 vs. 106 4 ± 75 N for 2CL and 790 ± 34 N for 2CS; P = 0.016).The 3CL configuration provided superior strength and stability across all tests, supporting its role in the fixation of length-unstable pediatric femoral fractures.

Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures

2025-06-18

Augustine M. Saiz , Christina A. Stennett , Nicholas M. Romeo +7 more | Journal of Bone and Joint Surgery

Background: External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of … Background: External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures. Methods: This is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures. Wilcoxon rank-sum and Fisher exact tests were used to assess if temporary external fixation use varied between hospital clusters. Mixed-effects logistic regression models controlling for hospital cluster and participant characteristics estimated the associations between temporary external fixation and SSI or unplanned reoperation. Results: There were 2,438 patients with an open lower-extremity fracture identified, with 568 (23.3%) undergoing temporary external fixation. There were 34 participating hospitals with a median external fixation rate of 21.5%. Hospitals with higher temporary external fixation use had a higher number of surgeons treating patients with fracture (p = 0.02). There was no difference in SSI at 90 days (odds ratio [OR], 1.16 [95% confidence interval (CI), 0.82 to 1.66]; p = 0.40) or 1 year (OR, 1.30 [95% CI, 0.97 to 1.75]; p = 0.08) between patients who did and did not undergo temporary external fixation. Patients who underwent temporary external fixation were more likely to have unplanned reoperations within 1 year (OR, 1.40 [95% CI, 0.96 to 1.79]; p = 0.05). Conclusions: More temporary external fixation for open lower-extremity fractures was performed at hospitals with more surgeons treating fractures. There was no difference in SSI at 90 days or 1 year between patients who did and did not undergo temporary external fixation. Temporary external fixation tended to be used in more critically ill patients and patients with more severe fractures but was not associated with increased unplanned reoperations at 90 days or at 1 year. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Outcomes Associated with Choice of Prophylactic Antibiotics in Open Fractures

2025-06-18

Carol A. Lin , Tim Kobes , Eric Kholodovsky +7 more | Journal of Bone and Joint Surgery

Background: The ideal antibiotic prophylaxis for open fractures is unknown. We evaluated outcomes following different antibiotic prophylaxis regimens for open fractures. Methods: This is a secondary analysis of data from … Background: The ideal antibiotic prophylaxis for open fractures is unknown. We evaluated outcomes following different antibiotic prophylaxis regimens for open fractures. Methods: This is a secondary analysis of data from PREP-IT. Prophylactic antibiotics were defined as any intravenous antibiotic given on the day of admission. The outcomes were surgical site infection (SSI) within 90 days and reoperation within 1 year. Logistic regression and an instrumental variable analysis that leveraged site-level variation accounted for confounding. Subgroup variation was evaluated by stratifying by Gustilo-Anderson classification (Types I and II versus III). Results: Of the 3,331 included participants, the mean age was 45 ± 18 years, 63% were male, 73% were White, 21% were Black, 2% were Asian, and 10% were Hispanic. Cefazolin monotherapy (58% of patients), ceftriaxone monotherapy (10%), and cefazolin plus gentamicin (6%) were the most common regimens. In the instrumental variable analysis, the odds of infection did not significantly differ with ceftriaxone use (odds ratio [OR], 1.24; 95% confidence interval [CI], 0.70 to 2.20; p = 0.45) or cefazolin plus gentamicin use (OR, 0.25; 95% CI, 0.03 to 2.04; p = 0.20) compared with cefazolin monotherapy. There were no significant differences between the regimens with respect to infection when stratified by Gustilo-Anderson type. However, we did observe a nearly 3-fold increase in the odds of infection with ceftriaxone use compared with cefazolin monotherapy (OR, 2.73; 95% CI, 0.96 to 7.79; p = 0.06) in Type-I and II fractures, and a 75% decrease in the odds of infection with cefazolin plus gentamicin use (OR, 0.25; 95% CI, 0.03 to 2.02; p = 0.19) compared with cefazolin monotherapy in Type-III fractures. Conclusions: Among patients with open fractures, antibiotic prophylaxis with ceftriaxone monotherapy did not provide significant benefits compared with cefazolin monotherapy in preventing infection in Type-I and II fractures. The findings suggest that cefazolin plus gentamicin might reduce the odds of infection in Type-III fractures compared with cefazolin monotherapy, but this difference was not statistically significant. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Multidisciplinary Approaches to Limb Salvage in Traumatic Extremity Injuries From Emergency Triage to Definitive Vascular, Orthopedic, and Reconstructive Surgery: A Systematic Review

2025-06-17

N. Youssouf , Haroon Khan , Awad Mohamed +7 more | Cureus

Can metaphyseal variations in the distal femurs and proximal tibias be distinguished from classic metaphyseal lesions?

2025-06-17

Boaz Karmazyn , Christopher L. Newman , Megan B. Marine +7 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background: </bold>Classic metaphyseal lesions (CMLs) are considered specific for child abuse, but the reliability of radiologists in distinguishing CMLs from metaphyseal variations is unclear. <bold>Objective: </bold>To evaluate whether radiologists … <title>Abstract</title> <bold>Background: </bold>Classic metaphyseal lesions (CMLs) are considered specific for child abuse, but the reliability of radiologists in distinguishing CMLs from metaphyseal variations is unclear. <bold>Objective: </bold>To evaluate whether radiologists can differentiate between CMLs and metaphyseal variations in the knees. <bold>Materials and Methods: </bold>We performed a<bold> </bold>retrospective review of distal femur and proximal tibia radiographs in children under two years of age who underwent skeletal surveys for suspected child abuse. The CML group included children diagnosed with abuse and reported CMLs. The metaphyseal variation group included children not diagnosed with abuse, with reported metaphyseal variations and either no fractures or an isolated skull fracture. Radiographs were trimmed to exclude other injuries. Four pediatric and four general radiologists reviewed anonymized studies and categorized each case as CML, metaphyseal variation, normal, or indeterminate, with confidence levels (high, moderate, low). We analyzed diagnoses with moderate or high confidence. Interobserver agreement was assessed using kappa statistics. <bold>Results: </bold>There were 48 children with CMLs (40 initial, 38 follow-up) and 27 with metaphyseal variations (20 initial, 12 follow-up). Metaphyseal fragmentation was the most common variation, identified in 259 of 356 femurs (72.8%) and 69 of 83 tibias (83.1%). Fragmentations were most frequently located in the posterior or medial metaphysis, or both, in 257 of 259 femurs (99.2%) (257/259) and 68 of 69 tibias (98.6%). In the CML group, 34 of 115 initial CML diagnoses (29.4%) were read on follow-up as either metaphyseal variation (n=17) or normal (n=17). In contrast, in the metaphyseal variation group, only one follow-up case was diagnosed as a CML; the remainder were diagnosed as metaphyseal variation (n=22) or normal (n=2). Diagnostic performance for CML demonstrated high specificity (90.7%) and positive predictive value (94.9%), with moderate accuracy (76.1%), sensitivity (70.2%), and negative predictive value (55.2%). Interobserver agreement was substantial, with a mean kappa of 0.61. <bold>Conclusion</bold>: Radiologists demonstrated substantial agreement and high specificity in distinguishing CMLs from metaphyseal variations. Metaphyseal fragmentation was the most common variation and was uncommonly diagnosed as CML on follow-up.

Modified T-plate internal fixation in the treatment of medial malleolus fractures of the distal tibia in the elderly

2025-06-16

Xipeng Wang , Kun Nie , Jiangtao Liu +1 more | Frontiers in Surgery

Objective This study aimed to compare the clinical efficacy of modified T-plate internal fixation vs. conventional cannulated lag screws in treating medial malleolus fractures of the distal tibia in elderly … Objective This study aimed to compare the clinical efficacy of modified T-plate internal fixation vs. conventional cannulated lag screws in treating medial malleolus fractures of the distal tibia in elderly patients, with a focus on surgical outcomes, functional recovery, and complication profiles. Methods A prospective cohort analysis was conducted on a sample of 46 elderly patients (aged ≥ 60 years) with isolated medial malleolus fractures treated at a single orthopedic center between April 2020 and December 2022. Patients were allocated to either modified T-plate internal fixation ( n = 23) or cannulated lag screw internal fixation ( n = 23). The postoperative conditions, including operative time, blood loss, and complications, as well as the long-term rehabilitation outcomes, such as AOFAS ankle and hindfoot score at 3, 6, and 12 months, were systematically compared. Results The modified T-plate group exhibited significantly superior early functional recovery, with higher AOFAS ankle and hindfoot score at 3 months (63.5 ± 8.0 vs. 55.3 ± 13.3, P = 0.015) and 6 months (74.6 ± 8.9 vs. 67.8 ± 12.5, P = 0.041), though operative time was longer (85.6 ± 12.3 vs. 72.4 ± 10.8 min, P &lt; 0.001). No significant differences were observed in intraoperative blood loss (120.5 ± 25.6 vs. 115.8 ± 22.4 ml, P = 0.511), overall complication rates (8.7% vs. 17.4%, P = 0.381), or long-term outcomes of AOFAS ankle and hindfoot score at 12 month (89.0 ± 8.7 vs. 87.9 ± 7.6, P = 0.628). Both groups demonstrated comparable safety profiles, with no severe complications during a mean 14.4-month follow-up. Conclusion Modified T-plate fixation has been shown to facilitate early functional rehabilitation in elderly patients with distal tibial medial malleolus fractures. Although this method requires marginally longer operative time, it offers equivalent long-term outcomes and safety to traditional lag screws internal fixation. Notably, it is particularly advantageous for osteoporotic patients, as it addresses the challenges posed by bone fragility and compromised healing capacity.

Hoffa Fractures: Current Understanding and Surgical Treatment Strategies

2025-06-16

Ashok S. Gavaskar , Vaibhav Bagaria , Abhay Elhence +1 more | Journal of the American Academy of Orthopaedic Surgeons

Coronal fractures of the distal femur, although uncommon in isolation, represent a distinct fracture pattern different from other distal femur fracture subtypes. Popularly known as the Hoffa fractures, these injuries … Coronal fractures of the distal femur, although uncommon in isolation, represent a distinct fracture pattern different from other distal femur fracture subtypes. Popularly known as the Hoffa fractures, these injuries are characterized by obliquely oriented fracture lines in the coronal plane with or without articular comminution. These partial articular fractures are commonly seen on the lateral condyle as a result of translational shearing forces on the posterior femoral condyle with the knee in flexion. These fractures were often missed before the advent of routine use of CT scans because they appear subtle on plain radiographs. The frequent presence of major and more proximal associated skeletal injuries is another reason that these fractures may be missed in the initial evaluation. Hoffa fractures, being articular injuries, need anatomical reduction and a stable fixation to facilitate early knee motion and prevent arthrofibrosis. Surgical treatment of these fractures needs a careful understanding of various fracture patterns, presence of comminution, articular impaction, fragment size, and location to choose the optimal surgical approach, reduction, and fixation techniques. This review will outline strategies for surgical management of Hoffa fractures and discuss outcomes and complications based on published evidence.

Clinical and Functional Outcomes of Percutaneous Locking Plate as an External Fixator in Extra-Articular Proximal Tibia Fractures

2025-06-16

Imran Manzoor , Rizwan Khan Lodhi , Muhammad Moeen +3 more | Journal of University College of Medicine and Dentistry

Objective: To evaluate the clinical and functional outcomes of using a percutaneous locking plate as an external fixator in extra-articular proximal tibia fractures, with particular emphasis on pain reduction, fracture … Objective: To evaluate the clinical and functional outcomes of using a percutaneous locking plate as an external fixator in extra-articular proximal tibia fractures, with particular emphasis on pain reduction, fracture union, and progressive recovery of knee range of motion (ROM). Methodology: This prospective interventional study was conducted in the Department of Orthopedic Surgery at Hayat Memorial Hospital, affiliated with Continental Medical College, Lahore, over a 12-week period from January to March, 2025. A total of 30 patients, aged 18 to 75 years, with open extra-articular proximal tibia fractures were included using consecutive non-probability sampling. Fracture stabilization was performed using a 12- or 19-hole locking compression plate applied externally. Pain was assessed at 1, 3, 6, and 12 weeks postoperatively using the Wong-Baker Faces Pain Rating Scale, while ROM was measured using a goniometer. Radiographic evaluation for union was conducted at the same intervals. Data were analyzed using SPSS version 23, with p < 0.05 considered statistically significant. Results: The study included 30 patients (mean age 43.5 ± 12.2 years; 21 males and 9 females). Average pain scores showed a statistically significant decline from 6.0 in the 1st week to 1.5 by the 12th week (p < 0.05). ROM also improved progressively: at the 1st week, most patients were limited to 30°–60°, whereas by the 12th week, the majority (n=23) achieved near-normal ROM (120°–135°). Radiographic union was observed in all patients by the end of 12 weeks. Conclusion: Percutaneous application of a locking compression plate as an external fixator appears to be an effective treatment option for extra-articular proximal tibia fractures. It offers stable fixation, reduces pain significantly, and facilitates early functional recovery in terms of knee mobility.

Clinical and radiological outcomes of magnetically controlled intramedullary lengthening nails in adolescents and young adults: a retrospective cohort study

2025-06-16

Mehmet Ali Talmaç , Melih Cıvan , Ergün Mendeş | Journal of Orthopaedic Surgery and Research

Magnetically controlled intramedullary lengthening nails offer a fully internal approach to limb lengthening, avoiding complications associated with external fixators such as pin site infections and soft tissue transfixation. While their … Magnetically controlled intramedullary lengthening nails offer a fully internal approach to limb lengthening, avoiding complications associated with external fixators such as pin site infections and soft tissue transfixation. While their use in adults is well-documented, evidence regarding their safety and efficacy in adolescents and young adults remains limited. This retrospective cohort study evaluated the clinical and radiological outcomes of 24 limb lengthening procedures performed in 18 adolescent and young adult patients between 2022 and 2024 using PRECICE® intramedullary lengthening nails. Patients aged ≤ 18 years with a minimum of 9 months follow-up were included. Lengthening parameters, regenerate morphology, complication rates, and inter-group comparisons were analyzed. A total of 24 long bone segments (femur, tibia, and humerus) underwent lengthening in 19 sessions. The mean follow-up period was 18.8 months. The average length gained was 45.7 ± 10.5 mm, with a distraction rate of 1.0 ± 0.1 mm/day. Complications requiring return to the operating room occurred in 16% of cases, while 5.3% had minor unresolved issues at treatment completion. Radiographic analysis revealed favorable regenerate morphology, and no case showed regenerate insufficiency. Statistical comparison revealed a significantly higher distraction rate in femoral versus tibial lengthenings (p = 0.036). Fully internal limb lengthening using magnetically controlled nails is a safe and effective option for adolescents and young adults, with a low rate of complications and high-quality regenerate formation. These findings support broader adoption of internal lengthening in younger patients, particularly in centers with trained teams and appropriate patient selection.

The Effect of a Simple and Reproducible Marking Technique on Enhancing Radiation Safety in Surgical Fixation of Proximal Femur Fractures

2025-06-16

Muhammad Junaid Khan , Ahmed Juanroyee , Hassan Janan +2 more | Cureus

Retrograde Intramedullary Nailing vs. Lateral Locking Plate Fixation for Distal Femur Fractures: Which Technique is Superior?

2025-06-16

İsmail Güzel , Tarık Altunkılıç , Bünyamin Arı +1 more | Orthopedic Reviews

Objective Distal femur fractures are challenging to treat, especially in elderly osteoporotic patients. Retrograde intramedullary nailing (RIMN) and lateral locking plate (LP) fixation are commonly used surgical methods for these … Objective Distal femur fractures are challenging to treat, especially in elderly osteoporotic patients. Retrograde intramedullary nailing (RIMN) and lateral locking plate (LP) fixation are commonly used surgical methods for these fractures. This study aimed to compare the clinical and radiological outcomes of these two techniques. Methods In this retrospective study, a total of 72 patients with distal femur fractures classified according to the AO/OTA system and treated surgically were included. Patients were divided into two groups: RIMN (n=36) and LP (n=36). Demographic data, fracture classification, surgical method, operative time, intraoperative blood loss, early weight-bearing status, knee range of motion, union time, and complication rates were evaluated. Additionally, union rate, infection, implant failure, and reoperation requirement were compared. A power analysis was conducted assuming 70% power to detect a clinically significant difference. Statistical analyses included T-test, Mann-Whitney U test, Chi-square test, and Fisher’s exact test. Kaplan-Meier analysis was used to assess union time. A p-value <0.05 was considered statistically significant. Results The union rate was 86.1% in the RIMN group and 75.0% in the LP group. The average union time was 15.4 weeks for RIMN and 17.2 weeks for LP. Knee range of motion was significantly better in the RIMN group (115.2° vs. 110.4°, p=0.03). Early weight-bearing was achieved in 61.1% of RIMN patients and 44.4% of LP patients (p=0.11). The overall complication rate was 16.7% in the RIMN group and 25.0% in the LP group. Infection rates were 5.6% and 8.3%, respectively. Implant failure was observed in 5.6% of patients in both groups. Reoperation was required in 8.3% of RIMN and 13.9% of LP patients. Conclusion Our findings suggest that RIMN may offer advantages over LP in terms of higher union rates, shorter union time, and better functional outcomes, particularly in osteoporotic patients. However, both techniques demonstrated acceptable complication rates, and treatment choice should be tailored to the fracture pattern and patient characteristics. Further prospective, randomized studies are needed to support these findings.

BioBone – A prospective, blinded, multicenter validation study of the CD8 + terminal differentiated effector memory cells (CD8 + TEMRA cells) as prognostic biomarker for disturbed fracture healing – study design

2025-06-16

Simon Reinke , Andrea Bauer , Michael Dahne +7 more | Journal of Orthopaedic Surgery and Research

Abstract Aims The BioBone consortium aims to validate circulating CD8 + TEMRA cells as a prognostic biomarker for predicting impaired fracture healing outcomes in a prospective, blinded, multicenter clinical study. … Abstract Aims The BioBone consortium aims to validate circulating CD8 + TEMRA cells as a prognostic biomarker for predicting impaired fracture healing outcomes in a prospective, blinded, multicenter clinical study. The primary performance parameters are the pre-operative identification of at least 30% of patients who ultimately experience impaired healing at the first clinical endpoint, with a specificity greater than 90% to minimize the false-positive rate. Methods BioBone is a prospective, blinded, multicenter biomarker validation study designed to assess the prognostic value of circulating CD8 + TEMRA cells in fracture healing. A total of 640 patients aged 18 to 80 years with fractures of the humeral diaphysis, radial and/or ulnar diaphysis, femoral neck, trochanteric femur, femoral diaphysis, distal femur, proximal tibia, tibial diaphysis and distal tibia will be enrolled. The study is powered to validate the target assay performance and accounting for 6–7 potential confounders at an expected incidence of 10% impaired healing. Biomarker levels will be measured pre- and post-operatively using flow cytometry (FC) and patients will be monitored for one year. The primary endpoint is fracture healing status at 17–19 weeks (normal healing or delayed healing), while the secondary endpoint evaluates healing at nine months (delayed healing or pseudarthrosis). Fracture consolidation will be assessed through radiographs or computed tomography (CT) scans in conjunction with clinical assessments such as range of motion and weight-bearing capacity. Key outcome measures include radiographic analysis (RUST/RUSH scores), functional and patient-reported outcomes (e.g. weight bearing ability, range of motion, and the SF-36 questionnaire), as well as socioeconomic parameters (e.g. work capacity, rehabilitation needs, mobility). The predictive performance (sensitivity, specificity, NPV, PPV) of the biomarker will be determined in a prospective, double-blinded analysis, where CD8 + TEMRA blood levels are measured prior to surgical treatment and healing status at clinical endpoints is assessed by independent observers. Additional immunological examination and in vitro analysis of blood and fracture hematoma samples will further investigate the mechanism of action of CD8 + TEMRA cells in impaired human bone regeneration. Conclusion The BioBone study will validate the suitability of CD8 + TEMRA cells as a prognostic marker for impaired fracture healing and their integration into routine clinical practice. The results could have a global impact by incorporating immune-based prognostic tools into clinical workflows, paving the way for precision medicine approaches in trauma care. The BioBone study is funded by the German Federal Ministry of Education and Research (BMBF).

Type IV Monteggia Fracture in a Puma Cub (Puma concolor) - Surgical Treatment

2025-06-15

Beatriz Pereira Solani , Natália Santos de Carvalho , Erika Frühvald +2 more | ACTA SCIENTIAE VETERINARIAE

Background: Monteggia fracture is an injury characterized by a bone discontinuity affecting the ulna associated with radial head dislocation. This type of fracture has been rarely reported in human and … Background: Monteggia fracture is an injury characterized by a bone discontinuity affecting the ulna associated with radial head dislocation. This type of fracture has been rarely reported in human and veterinary literature and even more rarely in studies on wild animals. Herein, we report the case of a puma cub (Puma concolor); also known as cougar) with functional weakness of the right forelimb following an automobile trauma who was diagnosed with type IV Monteggia fracture. The cub underwent osteosynthesis of the radius and ulna, which was associated with reduction of humeroradial dislocation, to achieve functional recovery of the injured limb until its reintroduction into the wild. Case: A traumatized puma cub was treated for lameness and functional weakness of the right forelimb. The nature of the trauma is unknown, but probably secondary to vehicle collision. Following intramuscular chemical sedation with ketamine and xylazine, a physical examination was conducted, revealing that the cub was a young male with permanent incisors and deciduous canines. Radiographic examination revealed fractures in both ulna and radius, along with right humeroradial dislocation, which is a characteristic feature of type IV Monteggia fracture. The cub underwent surgical osteosynthesis associated with correction of the dislocation. Osteosynthesis was performed using locking neutralization plates on both radius and ulna. In addition, a figure-of-8 antirotational suture was performed with steel wire over the head of the radius and condyle of the humerus to reduce the radial head dislocation. After surgery, the animal appeared comfortable, with weight bearing of the operated limb. Bone healing of the fractures was verified within 75 days. It was recommended that the implants should be removed before reintroducing the animal into the wild. Discussion: Monteggia fractures are an uncommon type of fracture, with only a few reports published in veterinary literature. Despite the lack of information, especially in wild animals. This type of fracture has been reported to be caused by direct high-energy, for example, automobile trauma or falls. Monteggia fractures are difficult to be identified by physical examination, and radiographic examination with at least 2 orthogonal projections is defined as the "gold standard" of diagnosis. These fractures must be treated surgically as early as possible to avoid excessive surgical manipulation and complications. Complications include swelling of the limb, muscle contraction, and inflammation of the soft tissues. The surgical technique may vary depending on the surgeon's preference and patient's characteristics. Furthermore, when bone fragments can be anatomically reconstructed and maintained in position, rigid stabilization methods should be used, such as locking plates. In the feline analyzed in this report, osteosynthesis of the radius and ulna combined with the antirotational suture enabled bone healing and functional recovery of the limb. The osteosynthesis associated to the antirotational suture contributed to the maintenance of the joint congruence, which is extremely important for maintaining an acceptable joint function. Early surgical intervention and appropriate handling of the animal contributed to its successful recovery and reintroduction into the wild. The implants used in the osteosynthesis of the radius and ulna were removed before the animal was released, due to the non-biodegradability of the materials. Keywords: felidae, wild animal medicine, radius and ulna, humeroradial subluxation, osteosynthesis.