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Objective:To evaluate the treatment of infected nonunion after internal fixation of subtrochanteric fracture with a reconstruction stent of external fixation.Methods:A retrospective study was conducted to analyze the data of 5 male patients with infected nonunion after internal fixation of subtrochanteric fracture who had been treated and completely followed up at The Great Wall Orthopaedics and Hand Surgery Hospital from January 2017 to October 2022. The patients were (30.0±13.5) years old. Seinsheimer fracture types: ⅢA (1 case), ⅢB (1 case), Ⅳ (2 cases), and Ⅴ (1 case); original internal fixation: intramedullary system (4 cases) and plate fixation (1 case); the Cierny-Mader anatomical classification: type Ⅳ (diffuse type) for all. After complete debridement at stage one, 2 or 3 hydroxyapatite (HA) coated screws were placed at both fracture ends from the lateral side of the femur for unilateral reconstruction external fixation. Next, a hybrid external fixation scaffold was added with a 1/3 ring at the sagittal position and 1 or 2 HA screws in 4 cases while unilateral reconstruction external fixation was constructed at both sides by inserting 2 HA screws into both fracture ends from the anterior femur at the sagittal position in 1 case. Antibiotic bone cement was used to fill bone defects of (3.8±1.8) cm. At 6 to 8 weeks after debridement when infection did not recur, antibiotic bone cement was removed before autogenous iliac bone grafting was performed in 3 patients and osteotomy bone transport in 2 patients. Infection control, bone union time, time for removal of external fixation stent, complications, Sanders hip function score and Paley bone outcome score were recorded.Results:The 5 patients were followed up for (23.4±8.1) months after surgery. Infection at the fracture ends was controlled after 1 time of debridement in 3 patients and after 2 times of debridement in 2 patients. The loosening HA screws were replaced twice due to infection at the proximal nail tract, and autologous bone grafting was performed at the opposite fracture ends in 1 case; no complications occurred in the other 4 cases. Bony union was achieved at the extended segment and fracture ends in all patients. The time for imaging union after bone reconstruction was (10.2±3.4) months. The time for wearing a stent of external fixation was (18.0±4.5) months. There was no recurrent infection or lingering infection. According to the Sanders hip function score at the last follow-up, 4 cases were excellent and 1 case was good; according to the Paley bone outcome score, the curative effect was excellent in all.Conclusion:Application of a reconstruction stent of external fixation combined with antibiotic bone cement can control infection at the first stage and conduct bone reconstruction at the second stage to successfully treat the infected nonunion and preserve the hip function after internal fixation of subtrochanteric fracture.
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OBJECTIVE@#To explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation.@*METHODS@#The clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation.@*RESULTS@#All patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation ( t=12.851, P<0.001; t=-14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair.@*CONCLUSION@#Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.
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Male , Humans , Female , Adult , Fractures, Bone/surgery , Bone Wires , Scaphoid Bone/injuries , Retrospective Studies , Fracture Fixation, Internal/methods , Fractures, Ununited/surgery , Wrist Injuries/surgery , Bone Screws , Hand Injuries , Treatment OutcomeABSTRACT
Objective:To discuss the clinical efficacy of modified Bushen Huoxuetang combined with autologous bone grafting and locking compression plate （LCP） in treating nonunion of long bone fractures， and the effect on microcirculation， osteogenic differentiation factor and bone metabolism index. Method:A total of 70 patients were randomly divided into control group and observation group by random number table， with 35 cases in each group. Patients in both groups received LCP. Patients in control group got Dieda Shenggu granule， 10 g/time， 1 time/day. Patients in observation group got Bushen Huoxuetang， 1 dose/day. The course of treatment lasted for 3 months， and 3-month follow-up data were recorded. On a weekly basis， the main symptoms， such as pain， tenderness， longitudinal percussion pain and swelling were checked， and the time of disappearing of main symptoms and signs were compared. On a weekly basis， a X-ray examination was performed for callus formation and fracture line， and the fracture healing time was recorded. Before and after treatment， Fugl-Meyer （FMA） was scored， and levels of fibrinogen （FIB）， whole blood viscosity （BV） （high shear， low shear）， plasma viscosity （PV）， platelet aggregation rate （PAR）， <italic>D</italic>-Dimer （<italic>D</italic>-D）， bone morphogenetic protein-2 （BMP-2）， BMP-7， insulin-like growth factor-1 （IGF-1）， vascular endothelial growth factor （VEGF）， transforming growth factor-<italic>β</italic><sub>1</sub> （TGF-<italic>β</italic><sub>1</sub>）， osteocalcin （BGP）， osteoprotegerin （OPG）， procollagen type Ⅰ N-terminal propeptideserum amino pro peptide （PINP）， serum type 1 collagen cross-linked C-terminal peptide （S-CTX） and serum tartrate resistant acid phosphatase （TRACP） of type I procollagen were detected， and the safety was evaluated. Result:Disappearance time of symptoms and signs and fracture healing time in observation group were all lower than those in control group （<italic>P</italic><0.01）. At the third month after treatment， and during the three-month follow-up， scores of callus and FMA （upper and lower limbs） in observation group were all higher than those in control group （<italic>P</italic><0.01）. Levels of <italic>D</italic>-D， FIB， PAR， BV and PV （high-cut and low-cut）， BMP-2， BMP-7， IGF-1， VEGF， TGF-<italic>β</italic><sub>1</sub>， S-CTX and TRACP were all lower than those in control group （<italic>P</italic><0.01）， whereas levels of BGP， OPG and PINP were higher than those in control group （<italic>P</italic><0.01）. The curative effect of fracture healing was better than that of control group （<italic>Z</italic>=1.977， <italic>P</italic><0.05）. And the limb function recovery was superior to that in control group （<italic>Z</italic>=1.970， <italic>P</italic><0.05）. Conclusion:Based on autogenous bone and LCP， modified Bushen Huoxuetang can promote the fracture healing， shorten the course of disease， and promote the recovery of limb function， with a good clinical efficacy. It can improve microcirculation， promote the expression of osteogenic differentiation factor， regulate bone metabolism， and play a role in promoting fracture healing， with a safety in clinical use.
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@#Hoffa fractures are rare and difficult fractures to manage. Hoffa fracture involves a coronal plane fracture of posterior femoral condyle. Non-union in Hoffa fracture is further difficult to manage. The surgical management for such nonunion includes open reduction with recon/LCP plate or screw fixation with bone grafting. The problem with plates is the difficulty in contouring the plates according to the shape of posterior femoral condyles. We describe a new technique with 2 L shaped neutralisation plates placed in a circular fashion. This technique provides a more rigid construct and gives better holding strength of screws in Hoffa fragment. This enhances union and mobilisation can be started early.
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@#Introduction: Scaphoid fractures are most often treated with a single headless compression screw. However, intercarpal Kirschner wire (K-wire) might be added to improve stability and fracture outcomes. This study will determine if there is a difference in treatment outcome (union rate and time to union) between scaphoid fracture fixations using a single headless compression screw with and without augmentation using a intracarpal intramedullary K-wire. Material and Methods: We conducted a retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15 years period from December 2000 to December 2015. Only patients who underwent open surgery with bone grafting were included. They were divided into a group treated with a single screw fixation, and another group treated with screw and K-wire fixations. Results: Forty-four (58.7%) patients had single screw fixation and 31 (41.3%) had screw augmented with K-wire fixation. The overall union rate was 88.0%, with an overall mean time to union of 5.3 months. There was no difference in union rate (p=0.84) and time to union (p=0.66) between the single screw group and combined screw and K-wire group. Univariate analysis found that older age (t=-2.11, p=0.04) had a significant effect on union rate. Regression model showed that age had a significant effect on months to union. Conclusion: In open fixation of scaphoid fractures with compression screw and bone grafting, union rate and time to union is comparable whether or not screw fixation was augmented with an intracarpal K-wire. There was no increased risk of complications associated with augmented screw. Age of patient affected time to union and union rate.
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BACKGROUND: Nonunion is a common clinical complication in orthopedics, which seriously impacts the physical and mental health and quality of life of patients. In recent years, a large number of studies have found that icariin plays a significant role in promoting fracture healing and treating bone defects. Bone nonunion and fracture healing coexist, and the research on the mechanism of fracture healing actually focuses on the treatment of bone nonunion. OBJECTIVE: To review the research progress in the molecular mechanism of icariin in the treatment of bone nonunion. METHODS: The first author used “icariin, bone nonunion, bone marrow mesenchymal stem cells, periosteal cell, osteoblasts, osteoclast” as key words in English and Chinese to search PubMed, CNKI, WanFang and VIP databases. A total of 542 articles were retrieved and screened manually according to the selection criteria and exclusion criteria. Finally, 44 articles were included for result analysis. RESULTS AND CONCLUSION: Icariin can effectively promote fracture healing and treat bone nonunion by promoting the proliferation and differentiation of bone marrow mesenchymal stem cells and periosteal cells, promoting the proliferation and maturation of osteoblasts and inhibiting the osteoclast effect of osteoclasts. However, most of the experiments are still in the basic experimental research, and there is still a need for a large number of clinical studies as well as studies on related proteins and genes, to provide a new idea for the clinical use of Chinese herbs in the treatment of bone nonunion.
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Severe pelvic fractures are often accompanied with injuries to abdominal and pelvic organs and nerves and vessels as well.Timely operations for pelvic fractures may be delayed due to urgent management of serious and life-threatening injuries,rendering the fractures obsolete.Patients with severe obsolete pelvic fracture often sustain severe pain,unstable pelvis,neurovascular injuries and organ dysfunction associated with pelvic malunion and malalignment which can only be treated by surgery.This paper reviews the literature and summarizes clinical manifestations of the fracture,indications for surgery,surgical treatment algorithms and difficulties encountered during operation,with an aim to provide useful information for management of obsolete pelvic fractures.
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ABSTRACT Scaphoid fractures are the most common fractures of the carpal bones, corresponding to 60%. Of these, 10% progress to nonunion; moreover, 3% can present necrosis of the proximal pole. There are various methods of treatment using vascularized and non-vascularized bone grafts. To evaluate and compare the rate of scaphoid consolidation with necrosis of the proximal pole using different surgical techniques. The authors conducted a review of the literature using the following databases: PubMed and BIREME/LILACS, where 13 case series were selected (ten with use of vascularized bone grafts and three of non-vascularized bone grafts), according to inclusion and exclusion criteria. In most cases VBGs were used, especially those based on the 1,2 intercompartmental supraretinacular artery, due to greater reproducibility in performing the surgical technique.
RESUMO INTRODUÇÃO: As fraturas do escafoide são as mais comuns dos ossos do carpo, correspondem a 60%. Dessas, 10% evoluem para não consolidação; além disso, 3% podem apresentar necrose do polo proximal. Existem vários métodos de tratamento com enxertos ósseos, vascularizados (EOV) e não vascularizados (EONV). OBJETIVO: Avaliar e comparar as taxas de consolidação do escafoide com necrose do polo proximal com diferentes técnicas cirúrgicas. MATERIAL E MÉTODOS: Fez-se uma revisão na literatura nas bases de dados PubMed e Bireme/Lilacs, das quais foram selecionadas 13 séries de casos (dez com uso de EOV e três EONV), de acordo com os critérios de inclusão e exclusão. CONCLUSÃO: Enxertos ósseos vascularizados foram usados na maioria dos casos, principalmente naqueles baseados na artéria intercompartimental suprarretinacular 1 e 2, devido à maior reprodutibilidade na técnica cirúrgica.
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Osteonecrosis , Bone Transplantation , Scaphoid BoneABSTRACT
ABSTRACT: The aim of this study was to evaluate the effect of osteoprogenitor cells derived from mesenchymal stem cells from adipose tissue (OC-AD-MSCs), and differentiated into osteoblasts, in the treatment of critical bone defects in dogs. Adipose tissue derived mesenchymal stem cells (AD-MSCs) were subjected to osteogenic differentiation for 21 days and used in the treatment of bone defects in dogs radius. Either three experimental groups were bone defects treated with OC-AD-MSCs (OC), defects filled with autogenous bone (Control- C +), or empty defects (Control- C -). Bone regeneration was assessed by radiology, densitometry, and histomorphometry. The area of new bone formation was higher in the OC group compared to the control group (C-) on postoperative day 15. Defects treated with OC-AD-MSCs showed greater neovascularization than the other two groups at 90 days. We concluded that treatment with OC-AD-MSCs increased the area of new bone formation 15 days after surgery; however, it didn’t complete the bone union in critical bone defects in the radius of dogs at 90 days.
RESUMO: O objetivo deste estudo foi avaliar o efeito das células osteoprogenitoras derivadas de células tronco mesenquimais do tecido adiposo (CO-CTM-AD) no tratamento de defeitos ósseos críticos de cães. As células tronco mesenquimais do tecido adiposo (CTM-AD) foram submetidas à diferenciação osteogênica por 21 dias e usadas no tratamento de defeitos ósseos em rádios de cães. Foram constituídos três grupos experimentais: defeitos ósseos tratados com CO-CTM-AD (OC), defeitos preenchidos com osso autógeno (C+) e defeitos não preenchidos (C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos. A área de neoformação óssea foi maior no grupo OC em relação ao grupo C- no 15o dia de pós-operatório. Os defeitos tratados com CO-CTM-AD mostraram maior neovascularização que os demais grupos aos 90 dias de avaliação. Conclui-se que o tratamento com CO-CTM-AD aumentou a área de osso neoformado no 15o dia de pós-operatório, mas não foi suficiente para que houvesse a completa união óssea em defeitos ósseos críticos no rádio de cães aos 90 dias.
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Objective To investigate the safety and short-term clinical outcomes of percutaneous targeted positioning bone cement augmentation treatment for osteoporotic compression fracture nonunion. Methods A total of 32 cases of osteoporotic vertebral compression fracture nonunion, with clinical course of more than 6 months between September 2009 and September 2012 were selected. Under local anesthesia and radiological monitoring, targeted positioning puncture was carried out to inject bone cement to strengthen the lesions of nonunion. Visual analogue scale (VAS), activities of daily living (ADL) and radiographic results were compared among preoperative 1 day and postoperative 1 day, 3 months, 6 months, and 12 months. Results The operation was successfully completed in 34 vertebrae of the 32 cases. Postoperative radiographic observation found no cement leakage. As compared to preoperative level, the VAS scores significantly deceased at postoperative 1 day, 3 months, 6 months, and 12 months (P0. 05). Conclusion Percutaneous targeted positioning bone cement augmentation treatment for osteoporotic compression fracture nonunion is safe and effective.
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Objective To explore the clinical effects of Jiawei Bazhen in treatment of fracture nonunion in children .Methods 60 cases of patients with fracture nonunion from December 2014 to June 2015 in Weinan Maternity and Child Health Care Hospital were divided into experimental group and control group according to random number table, 30 cases in each group.The control group were treated by Shangke Jiegu tablet combined with staphylococcal enterotoxin C injection, and the experimental group were treated by Jiawei Bazhen combined with staphylococcal enterotoxin C injection, with a consecutive treatment of 6 weeks.The efficacy, arthritis symptom score, serum bone morphogenetic protein-7(BMP-7) and vascular endothelial growth factor( VEGF) were compared between two groups.Results The total effective rate in experimental group were higher than that in control group (χ2 =6.667,P0.05).Conclusion Jiawei Bazhen could improve the clinical symptoms, increase the levels of BMP-7 and VEGF, and promote the bone fracture's concresc in children with fracture nonunion, with fewer adverse reactions, which has distinct clinical curative effect.
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PURPOSE: The purpose of this study is to analyze the result of secondary total hip arthroplasty (THA) after primary internal fixation failure in femoral neck fracture patients and compare the results with primary THA for femoral neck fracture. MATERIALS AND METHODS: Among the femoral neck fracture patients, we analyzed clininal and radiologic results of those who underwent secondary THA after internal fixation failure and those who underwent THA as early treatment. Cases with patients over age 40 years and with at least two year of follow-up period were used for analysis. Periopertive conditions of patients were evaluated by using surgery time, bleeding amounts and period to start gait using walker or crutch after surgery. Clinical results were assessed by using Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index, and radiologic results were derived by observing follow-up simpe X-ray. RESULTS: The group of secondary THA had longer surgery time, more bleeding amount and longer period to start gait. But between the two groups, there was no difference of clinical and radiologic result at final follwing up. Both of two group had excellent clinical and radiological results. CONCLUSION: THA after internal fixation showed excellent clinical and radiologic results that was comparable to compare with primary THA.
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Humans , Arthroplasty, Replacement, Hip , Bleeding Time , Femoral Neck Fractures , Femur Neck , Follow-Up Studies , Gait , Hemorrhage , Hip , Ontario , Osteoarthritis , WalkersABSTRACT
Extraction of broken implant is a challenging task for orthopaedic surgeons. Many times it requires innovative ideas or some unusual methods, all of which has not been listed in literature. We hereby report such a case of 40-year-old male who presented with severe limping and history of previously treated right femur fracture. The radiographs showed an intramedullary nail which was segmentally broken. Femur nail was broken at the non-united fracture and below the fracture at the level of distal interlocking screw. We successfully removed a broken implant by using such one innovative -close retrograde method. The segments of broken nail were removed through knee arthrotomy without opening the fracture site. Non-union was treated by exchange nailing without bone grafting and patient recovered well on follow up. To our best of knowledge very few cases of extraction of segmentally fractured nail have been reported in literature until now.
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[Objective]To investigate a minimally invasive,safe and effective method for treating the nonunion of tibia fracture with Bastianti external fixators.[Method]Bastianti external fixators were used to treat nonunion tibia fracture with axial force followed by functional exercises in early stage.[Result]All cases showed tibia fracture union in 4~12 months after operation.According to the criterion of treatment effects,35 cases were as excellent,7 as good,and 1 as poor.[Conclusion]It is a good method that nonunion of tibia fracture was treated with Bastianti external fixators for maintaining pain-free joint activity and joint functional recovery in early stage.
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[Objective]To discuss the experience with locking compression plates fixation combining with autoallergic cancellous bone and Illizarov technique in the management of chronic fracture nonunion,and to further investigate the reason of fracture nonunion and assess the safety and the efficacy of this procedure.[Method]A retrospective analysis was made including 87 consecutive patients with fracture nonunion treated at our hospital with locking compression plates fixation combining with autoallergic cancellous bone(80 cases) and Illizarov technique(7 cases) from January 2002 to July 2007.Patients were evaluated for radiographic bony fusion,complications and clinical outcome.[Result]Mean follow-up period was 14.7 months.Bony union was achieved in all cases after a mean time of 6.8 months after operation.Joint function was improved after operation in 70 patients.No major complications related to the procedure or hardware failure occurred.[Conclusion]Medical factors are main etiopathogenisis of chronic fracture nonunion after operation.Locking compression plates combining with autoallergic cancellous bone and Illizarov technique are safe and effective procedure for the treatment of fracture nonunion.
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Objective To investigate the therapeutic effect of vascular pedicle bone graft and compound bone matrical gelatin (Co BMG) in treatment of nonunion of femoral neck fracture . Methods 28 cases of femoral neck fracture who had been treated with operation and traction and observed for 6 to 9 months suffered from nonunion. The 28 cases of nonunion were treated by vascular pedicle bone graft and compound bone matrical gelatin. The progress of bone healing, complications such as necrosis of femoral head, and joint function were followed up after operation. Results All the 28 cases healed. The function of joint was evaluated according to Jacobs criteria. It was excellent in 19 cases, fine in 7 cases, and poor in 2 cases. Conclusion The vascular pedicle bone graft combined with BMG is the effective choice for treatment of nonunion of femoral neck fracture in adolescents and adults, because it has the double effects of bone grafting and bone induction.