ABSTRACT
PURPOSE:. To review the efficiency of the primary closed IM nail in 15 cases of distal tibial metaphyseal fractures. PATIENTS AND METHODS: From January 1997 to August 1998, 15 patients were treated by closed intramedullary nailing for distal metaphyseal tibial fracture. All operations were done on the fracture table in supine position, and any fracture extending into the ankle joint was stabilized by supplementary cannulated screw. RESULT: According to Robinson classification, there were 5 type I fractures (33%) , 6 type IIa fractures (40%) , 2 type IIb fractures (13%) , and 1 type IIc fracture (7%) . The mean distance between the distal end of fracture and tibial plafond was 2.3cm (range 0 to 4.5cm) . Three intraarticular fractures were stabilized by a supplementary cannulated screw. The mean score was 93.7 point ( excellent 7 cases, good 4 cases, fair 4 cases ) by Baird ankle scoring system There were no poor results. Fourteen patients (93%) went on to union at average of 18weeks (range 12-28weeks) . One type IIIa open fracture failed to unite and one patient had a valgus deformity of 7 degrees. Nonunion was succesfully treated by bone graft. There was no soft tissue necrosis or infection. CONCLUSION: In this study, we confirmed that IM nailing is one of the safe and effective methods for treating distal tibial metaphyseal fractures.
Subject(s)
Humans , Ankle , Ankle Joint , Classification , Congenital Abnormalities , Fracture Fixation, Intramedullary , Fractures, Open , Intra-Articular Fractures , Necrosis , Supine Position , Tibial Fractures , TransplantsABSTRACT
Fibronectin(FN) is a multifunctional glycoprotein with ARG-GLY-ASP(RGD) sequences that has been known as an important constituent of extracellular matrix in bone. 17-beta estradiol, bone active hormone has been reported to stimulate the in vitro production of several extracellular matrix proteins. Though it is known that estrogen withdrawal causes a significant diminition in PTH induced FN production, the hormonal regulation of FN production in bone has not been thoroughly studied. Especially the study using immunoelectron microscopy about FN production is rare. So, the author undertook tile present study to pursue the effect of estrogen on the distribution of fibronectin in the process of bone matrix formation with immunoelectron microscopy. Four to five weeks old female Sprague-Dawley rats, weighing about 150 gm, were used as experimental animals. It was grouped as ovariectomy group, sham operation group, ovarectomy with estrogen injection group, and normal control group. Each group was sacrificed at 1 week, 3 weeks and 5 weeks postoperatively. Ovaries were removed under the pentobarbital anesthesia, and for the estrogen injection group, 0.25 mg/kg of 17-beta estradiol was injected subcutaneously after oophorectomy. Immunoelectromicroscopic findings were as follows. 1 At the one week after operation, the distributions of gold particles, show the fibronectin reaction in osteoid, are similar in the control group, sham operation group, and ovariectomy with estrogen injection group at intermediate reactions, but it is severely decreased in the ovariectomy group as a weak reaction. 2. At there weeks after operation, the distributions of gold particle are similar in the control group, sham operation group and ovariectomy with estrogen injection group as intermediate reactions, but it is also decreased in the ovariectomy group as a weak reaction. 3 At the five weeks after operation, all the groups have similar distributions of gold particles as intermediate reaction. It is suggested that the estrogen secreted in ovary, partially effects on the fibronectin formation in the matrix of developing bone, and other factors stimulate and compensate the fibronectin formation with removal of ovaries.