Suplementación efectiva de vitamina D en pacientes con fractura tibial / Effective vitamin D supplementation in patients with tibial fracture

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

Comparison of such three in vitro inactivation methods as alcohol inactivation, irradiation inactivation, and liquid nitrogen inactivation for the treatment of femur osteosarcoma in children / 中华实用儿科临床杂志

Objective:To retrospectively analyze the clinical effects and complications of alcohol inactivation, irradiation inactivation, and liquid nitrogen inactivation in the treatment of femur osteosarcoma in children, in an attempt to provide a theoretical basis for clinical selection of in vitro inactivation methods of tumor bone segment. Methods:The clinical data of 93 children with femur osteosarcoma admitted to the Department of Bone and Soft Tissue, the Affi-liate Cancer Hospital of Zhengzhou University from January 2008 to December 2017 were retrospectively analyzed, and 40 children, including 21 males and 19 females, aged 8-18 (13.65±2.87) years, who were treated with in vitro inactivation and replantation of autogenous tumor bone segment, were screened.Among these children, there was alcohol inactivation in 15 cases, irradiation inactivation in 12 cases, and liquid nitrogen inactivation in 13 cases.A comparison was drawn on these 3 inactivation methods with respect to bone healing time, bone healing rate, tumor recurrence rate, infection rate, fracture or fixation failure rate, and revision rate. Results:All those 40 children were subject to valid medical followed-up, with the alcohol inactivation group for (102.60±16.55) months, the irradiation inactivation group for (59.33±6.39) months, and the liquid nitrogen inactivation for (36.85±6.49) months.The difference in follow-up time of 3 groups was statistically significant ( P<0.05). Compared with other 2 groups, the index of bone healing time, bone healing rate, infection rate and revision rate in the alcohol inactivation group were unfavorable, which showed a significant difference (all P<0.05); However, there was no significant difference in the recurrence rate, fracture rate or fixation failure rate compared with other 2 groups (all P>0.05); There was no significant difference in all above indexes between the irradiation group and the liquid nitrogen group (all P>0.05). Conclusions:Three in vitro inactivation methods for the treatment of tumor bone segment are safe and reliable.The alcohol inactivated bone has a long healing time and more complications.Both irradiation inactivation and liquid nitrogen inactivation are clinical options, but irradiation inactivation requires professional equipment, which may limit the clinical application.

Comparison of the effects of topical application of zoledronic acid and silver nanoparticles on osseointegration of immediate implant / 中国组织工程研究

BACKGROUND: Some studies have shown that topical application of zoledronic acid and topical application of silver nanoparticles can promote bone formation, but the difference between two methods has not been reported. OBJECTIVE: To investigate the effect of topical application of zoledronic acid versus topical application of silver nanoparticles on rabbit tooth extraction socket immediate implantation of titanium screw bonding. METHODS: Twenty-four New Zealand white rabbits were randomly divided into zoledronic acid and silver nanoparticles groups (n=12/group). After removing four incisors of the upper and lower jaws, the mixture of nanometer silver and nanometer hydroxyapatite and nanometer zoledronic acid hydroxyapatite were respectively filled in the tooth extraction pit of the two groups, and titanium screw was implanted at the same time. The isolated specimens of the upper and lower mandibles were taken at 4, 8 and 12 weeks after surgery. The data reflecting the osseointegration around the implant were obtained through gross observation, torque test, bone density test and histomorphological observation. The study was approved by the Ethical Committee of the Third Hospital of Hebei Medical University in December 2015, approval No. Z2015-021-1. RESULTS AND CONCLUSION: (1) The test results of torque mechanics showed that the average torque peak value of all titanium nails increased with the extension of time (the average value of torque peak value) and reached the maximum value at 12 weeks (the average value of torque peak value). At 4, 8 and 12 weeks after surgery, the torque peak value of titanium screw in the zoledronic acid group was higher than that in the silver nanoparticles group, and the stability of titanium screw in zoledronic acid group was better than that in silver nanoparticles group, but the difference was insignificant (P>0.05). (2) General observation and histological observation showed that at 4, 8 and 12 weeks after surgery, the hardness and structure of bone around the implants in the zoledronic acid group were significantly better than those in the silver nanoparticles group. (3) Bone mineral density analysis results showed that, at 4, 8 and 12 weeks after surgery, the gray value of bone tissue around the titanium screw in the zoledronic acid group was higher than that in the silver nanoparticles group at the same period (P>0.05). (4) These results suggest that the osseointegration of immediate implantation using nanometer zoledronic acid hydroxyapatite is better than that of the mixture of nanometer silver and nanometer hydroxyapatite.

Current status of dental implantation therapy for diabetic patients / 口腔疾病防治

@#In 2017, there were 451 million people (ages 18 to 99) with diabetes worldwide, and this number is expected to grow to 592 million by 2035. A series of complications in diabetic patients often leads to oral vascular and bone lesions. Therefore, dental implant doctors urgently need to understand the clinical characteristics of diabetes mellitus patients to provide the best treatment. For dental implant doctors, the following problems still exist in the treatment of diabetic patients with poor blood sugar control: ① alveolar fossa healing in diabetic patients is slow after extraction, and bone regeneration is often needed, which prolongs the treatment cycle and increases the pain of patients; ② the rate of new bone formation in diabetic patients after alveolar bone grafting is slow; ③ it takes a long time for the body to achieve effective bone bonding after dental implantation in diabetic patients, and the outcomes are poor; ④ the health of the tissue around dental implants is affected by blood sugar level, which is difficult to maintain in diabetic patients. Current studies suggest that the long-term success rate of implants is predictable in diabetic patients when blood sugar levels are well controlled (HbA1c < 6%). This article will review the current research status of dental implantation therapy for diabetic patients to provide a reference for clinical practice.

Using allogeneic cortical graft preserved in glycerin as spacer in the advancement of tibial tuberosity in 34 dogs / Uso de enxerto cortical alogênico preservado em glicerina como espaçador no avanço da tuberosidade tibial em 34 cães

Cranial cruciate ligament is the main responsible for knee stability by preventing cranial tibial displacement regarding the femur. Deficiency in this ligament (CCLD) may cause subluxation of the tibia and dysfunction of the pelvic member due to overloading. Tibial osteotomies are among the more current surgical techniques for treating CCLD in dogs and they proportionate the dynamic stability by means of modifying bone geometry and the distribution of forces acting on the articulation. The objective of this work is to describe the use of the allogeneic cortical bone graft conserved in glycerin as a spacer on the tibial tuberosity advancement (TTA) for treating the CCLD. In order to do that, 34 dogs submitted to TTA surgery correction were evaluated, being 23 males (67.35%) and 11 females (32.35%). Surgical procedures happened from May 2011 to October 2015. Regarding the surgical procedure after osteotomy of the tibial tuberosity, a disk of allogeneic cortical disk, sawn wedge-hapsed, conserved in glycerin, proportions of 2x1mm was applied as spacer, enabling TTA. Advancements from 3 to 12 mm were executed, depending on the need of the patient. For animals with patella dislocation, trochleoplasty and TTA were executed in order to correct the deviation. The mean ± SD age of animals was 6.67±3.58 and weight was 15.16±12.97 kg. Mongrel dogs, Poodles and Yorkshire terriers were the most affected ones. From the 36 evaluated knees, 11 (30.56%) were associated with some traumatic process and in 25 (69.44%) there was no relation with previous trauma. From those wounds, 20 (55.56%) happened in the right limb and 16 (44.44%) in the left limb and two animals had CCLD bilaterally. Animals had continuous support, discreet drawer movement and negative tibial compression 15 days after surgery. At 30 days, 26 cases (72.22%) had firm support (FS); at 45 days, 24 cases (66 test at 7 and 67%) had FS and eight cases (22.22%) without claudication (WC). During subsequent radiographic evaluations the progressive incorporation of the graft and osteotomy union were observed. In this study, most of the diagnosed CCLD occurred in males diverging from results obtained by other authors that found greater frequency in females. Support without claudication it was observed in most of the cases of implants at 60 days. We concluded that the conserved allogeneic cortical bone graft was able to promote bone union in TTA of dogs with CCLD. None of the animals had signs of contamination, infection of the surgical wound or rejection related with the presence of the graft, demonstrated by the complete graft-bone incorporation observed early at 45 days in some animals. The glycerin was a good conservation medium for those fragments intended for grafting because, besides being of low cost, it kept bone fragments free of contamination, reducing antigenicity and preserving the functions of osteoinduction and osteoconduction. The possibility of molding the graft to the animal need is a characteristic favorable to executing the modified technique that could be molded according to the size of the animal, allowing perfect adaptation to the osteotomized local in different breeds. Intercurrences commonly observed in TTA with patellar dislocation, meniscal lesions, tibial crest fracture and displacement were not found in the animals of this study, probably due to the better distribution of forces between the pass screw in TT and the TTA plate confirming that it has good adaptation to the technique conferring to the modified TTA advantages regarding the conventional TTA.(AU)

O ligamento cruzado cranial é o principal responsável pela estabilidade do joelho, impedindo o deslocamento da tíbia cranial em relação ao fêmur. A deficiência neste ligamento (CCLD) pode causar subluxação da tíbia e disfunção do membro pélvico devido à sobrecarga. As osteotomias tibiais estão entre as técnicas cirúrgicas mais atuais para o tratamento de CCLD em cães e proporcionam a estabilidade dinâmica por meio da modificação da geometria óssea da distribuição das forças que atuam sobre a articulação. O objetivo desse estudo é descrever o uso do enxerto ósseo cortical alogênico conservado em glicerina como espaçador no avanço da tuberosidade tibial (TTA) para o tratamento do CCLD. Para isso, 34 cães submetidos à cirurgia de TTA foram avaliados, sendo 23 machos (67,35%) e 11 fêmeas (32,35%). Os procedimentos curúrgicos aconteceram entre maio de 2011 e outubro de 2015. Com relação ao procedimento cirúrgico após a osteotomia da tuberosidade tibial, um disco alogênico cortical, em forma de cunha serrada, conservado em glicerina com proporções de 2 x 1mm foi aplicado como espaçador possibilitando a TTA. Avanços de 3 a 12mm foram executados, dependendo da necessidade do paciente. Para animais com luxação da patela, realizou-se a trocleoplastia e a TTA para a correção do desvio. A idade média dos animais foi de 6,67±3,58 anos e pesos médios de 15,16±12,97kg. Cães sem raça definida, Poodles e Yorkshire Terriers foram os mais afetados. Dos 36 joelhos avaliados, 11 (30,56%) foram associados a algum processo traumático e em 25 (69,44%) não havia nenhuma relação com um trauma prévio. Dos ferimentos, 20 (55,56%) aconteceram no membro direito e 16 (44,44%) no esquerdo, sendo que dois animais apresentavam CCLD bilateralmente. Os animais tiveram suporte contínuo, discreto movimento de gaveta e compressão tibial negativa 15 dias após a cirurgia. Aos 30 dias, 26 casos tinham suporte firme (FS); aos 45 dias, 24 casos tinham FS e oito casos sem claudicação (WC). Durante avaliações radiográficas subsequentes, observou-se a incorporação progressiva da união do enxerto e da osteotomia. Neste estudo, a maior parte do CCLD diagnosticado ocorreu em machos, divergindo dos resultados obtidos por outros autores que encontraram maior frequência em fêmeas. Suporte sem claudicação foi observado na maioria dos casos de implantes aos 60 dias. Foi concluído que o enxerto ósseo cortical alogênico conservado foi capaz de promover a união óssea na TTA de cães com CCLD. Nenhum dos animais apresentou sinais de contaminação, infecção da ferida cirúrgica ou rejeição relacionada à presença do enxerto, demonstrada pela incorporação completa do enxerto ósseo observada precocemente aos 45 dias em alguns animais. A glicerina foi um bom meio de conservação para os fragmentos destinados à enxertia porque, além do menor custo, manteve os fragmentos ósseos livres de contaminação, reduzindo a antigenicidade e preservando as funções de osteoindução e osteocondução. A possibilidade de moldagem do enxerto à necessidade do animal é uma característica favorável à execução da técnica modificada que pode ser moldada de acordo com o tamanho do animal, possibilitando perfeita adaptação ao local osteotomizado em diferentes raças. Intercorrências comumente observadas na TTA com luxação patelar, lesões meniscais, fratura da crista tibial e deslocamento não foram encontradas nos animais deste estudo, provavelmente devido à melhor distribuição de forças entre a passagem do parafuso no TT e a placa do TTA, confirmando que tem boa adaptação à técnica conferindo às vantagens da TTA modificada em relação à TTA convencional.(AU)

Preliminary application of pedicled vascularized fibular periosteum transplantation for union promotion of irradiated tibia sarcoma section autograft in children / 中华显微外科杂志

Objective To investigate the clinical effect of irradiated-host bone ends' union after transplantation of pedicled vascularized fibular periosteum in the treatment of Children's tibia sarcoma.Methods From June,2016 to December,2016,there were 5 children of tibia sarcoma,which were 2 boys and 3 girls,aged of 9-15 years (mean,12 years).They were treated by the re-transplantation of extracorporal irradiated segmental autograft,and used ipsilateral pedicled vascularized fibular periosteum cover the ends of irradiated-host bone to shorten the bone union time of irradiated tibia autograft and prevent nonunion.Patients were 3 cases of osteosarcoma,1 of Ewing's sarcoma,and 1 of relapse of Langerhans's cell histocytosis in tibia.The length of resect bone was 14.0-20.0 cm (mean,17.2cm),constitute of 2 osteoarticular resections and 3 intercalary resections.The method of inactivation of bone segment was intraoperative extracorporal irradiation.Regular followed-up were done postoperative.The X-ray and CT were applied to observe the function of affect limb.The bone union time and complication were record.Results All patients were followed-up of 12-18 months (mean,14.2 months).Eight ends of irradiated-host bone in 5 patients healed completely in 7.8 (6-10) months postoperative.The region of ends were covered by periosteum and showed excellent osteogenic power.There was no leg length discrepancy occurred in patients who received intercalary inactivation because of the preservation of growth plate.But the other 2 osteoarticular inactivated patients suffered leg length discrepancy of 1.0 cm and 1.5 cm respectively because of the inactivation of growth plate.At the follow-up of 12 months post-operation,the mean MTSS of affect limb was 25.8(22-28),and the mean of MTSS％ was 86％(73％-93％).Conclusion Transplantation of pedicled vascularized fibular periosteum can promote effectively healing of irradiated tibia bone after replantation in Children,with simple operation and less complications.

Applicability of polyamide 12 intramedullary locked rods in the stabilization of induced humeral fracture in cockerels (white plymouth rock) - in vivo study / Aplicabilidade da haste intramedular bloqueada de poliamida 12 na estabilização de fratura umeral induzida em galos (Plymouth Rock Branca) - estudo in vivo

The aim of this study was to evaluate the use of polyamide 12 intramedullary rods in osteotomized humerus in cockerels (White Plymouth Rock) and analyze, by radiography and histopathology, bone consolidation and the formation of bone callus. Ten cockerels were subjected to transverse osteotomy of the right humeral diaphysis followed by the insertion of polyamide 12 locked rods, with two nails in each bone fragment. Radiographies obtained at the immediate pre and post-operative period, and every 7 days for 3 months revealed no perioperatory complications. Radiography revealed a radiopaque bone callus between the 4th and 5th week post-surgery. Histopathology detected an amphophylic material (polyamide 12 rod) in the intramedullary region and the proliferation of highly vascularized connective tissue between the rod and the cortical bone. This connective tissue was highly cellular with differentiation into osteoblasts. The collagen fibers varied from loose to dense and a differentiated bone matrix, containing osteocytes in gaps and the development of bone marrow, was also observed; indicating the formation of a bone callus without signs of implant rejection. The polyamide 12 intramedullary rod was effective in the stabilization of the fractures used in this experimental model, with no rejection reaction for at least 90 days.(AU)

O presente estudo teve como objetivo avaliar a implantação de hastes intramedulares de poliamida 12, em úmeros osteotomizados de galos (Plymouth Rock Branca), bem como avaliar a consolidação óssea, por meio da verificação da formação de calo ósseo, analisando exames radiográficos e histopatológicos. Os galos foram submetidos à osteotomia transversa da diáfise do úmero direito, sendo implantadas posteriormente as hastes de poliamida 12 bloqueada com dois parafusos em cada fragmento ósseo. Após o procedimento cirúrgico, foram realizadas radiografias nos momentos pré e pós-operatório imediato e, posteriormente, a cada sete dias, durante três meses, até a realização da eutanásia. Não houve complicações perioperatórias. Ao exame radiográfico, os animais apresentaram formação de calo ósseo radiopaco entre a quarta e quinta semanas de pós-operatório. Ao exame histopatológico, foi possível notar, em todos os animais, presença de material anfofílico (haste de poliamida 12) ocupando a região intramedular óssea, e entre a haste e as corticais ósseas, proliferação de tecido conjuntivo altamente vascularizado. Tal tecido apresentou-se altamente celular com diferenciação em osteoblastos. Notaram-se também fibras colágenas, variando de aspecto frouxo a denso, e observou-se formação de matriz óssea diferenciada com osteócitos em lacunas e formações de medula óssea, denotando formação de calo ósseo sem sinais de rejeição do implante. A haste intramedular de poliamida 12 foi eficaz para estabilização das fraturas utilizando-se esse modelo experimental, sem reação de rejeição pelo período de 90 dias.(AU)

Application of pressure-protective brace in the rehabilitation training for the elder patients after surgical operation of femoral intertrochanteric fracture / 中国综合临床

Objective To observe the effect of pressure-protective brace with pressure-sensitive device in the early stage rehabilitation training enhance bone healing, shorten the treatment course and reduce complications,a kind of independently developed pressure-protective brace with pressure-sensitive device was utilized with quantified discontinuous longitudinal stress stimulation under doctors' regulation according to procedure. Methods The pressure-protective brace with pressure sensitive device for rehabilitation training was developed in May 2008 ,and was applied in clinics during January 2009 to June 2010. Forty elder patients,with complete clinical data, underwent Dynamic Hip Screw (DHS) internal fixation of femoral intertrochanteric fracture were were enrolled into this study. These cases were assigned into experimental group and control group with 20 patients respectively. The patients of experimental group performed lower extremity rehabilitation training wearing the pressure-protective brace. The load training of lower extremities with double crutches was modulated by doctors through regulating the threshold value of pressure in different time and different condition after operation according to the prearranged rehabilitative plan of individuation. The controls were instructed to performed lower extremity rehabilitation training in traditional way. Both the clinical healing and bone union time in all cases were evaluated according to the uniform standard. Results Total 40 patients were followed up for 13.0 - 24. 0 weeks ( average, 17.6 weeks ). Clinical healing time was 7.0 - 12. 0 weeks ( average,9. 1 weeks ) and bone healing time was 12. 0 - 16.0 weeks(average,13. 7 weeks)in experimental group. While in control group,the clinic healing time and bone union time was 9. 0 - 13.0 weeks( average, 11.3 weeks) and 14. 0 -20. 0 weeks (average, 16. 6 weeks)respectively. The Independent T-test results showed that whether clinic healing time or bone healing time presented significant differences between experimental group and the controls( P＜0. 01 ). All of the fractures in these two groups were healed at the end time of follow up without adverse complications,including fracture displacement, implant break, implant loose and failure. Conclusion The pressure-protective brace with pressure sensitive device used for quantifying rehabilitation training can enhance bone union, shorten the treatment course and reduce complications. This method further proves that discontinuous compressive stress in a certain range can stimulate fracture healing.

Effect of Hydroxyapatite on Bone Integration in a Rabbit Tibial Defect Model

BACKGROUND: The aim of the present study was to prepare hydroxyapatite (HA) and then characterize its effect on bone integration in a rabbit tibial defect model. The bone formation with different designs of HA was compared and the bony integration of several graft materials was investigated qualitatively by radiologic and histologic study. METHODS: Ten rabbits were included in this study; two holes were drilled bilaterally across the near cortex and the four holes in each rabbit were divided into four treatment groups (HAP, hydroxyapatite powder; HAC, hydroxyapatite cylinder; HA/TCP, hydroxyapatite/tri-calcium phosphate cylinder, and titanium cylinder). The volume of bone ingrowth and the change of bone mineral density were statistically calculated by computed tomography five times for each treatment group at 0, 2, 4, 6, and 8 weeks after grafting. Histologic analysis was performed at 8 weeks after grafting. RESULTS: The HAP group showed the most pronounced effect on the bone ingrowth surface area, which seen at 4, 6, and 8 weeks after graft (p 0.05). On histological examination, the HAP group revealed well-recovered cortical bone, but the bone was irregularly thickened and haphazardly admixed with powder. The HAC group showed similar histological features to those of the HA/TCP group; the cortical surface of the newly developed bone was smooth and the bone matrix on the surface of the cylinder was regularly arranged. CONCLUSIONS: We concluded that both the hydroxyapatite powder and cylinder models investigated in our study may be suitable as a bone substitute in the rabbit tibial defect model, but their characteristic properties are quite different. In contrast to hydroxyapatite powder, which showed better results for the bone ingrowth surface, the hydroxyapatite cylinder showed better results for the sustained morphology.

The Analysis of Conservative Treatment in Midshaft Fractures of Clavicle

PURPOSE: Most clavicular fractures can be healed by conservative treatment, although there are many factors that influence healing. The aim of the present study was to analyze factors that influence (i) bone union of midshaft fractures of the clavicle treated conservatively and (ii) bone functioning, after union. The long-term goal was to determine which treatments are adequate. MATERIALS AND METHODS: We evaluated factors that have an effect on bone union and bone function after union. We evaluated age, fracture site, comminution, displacement, shortening and other factors. Among 523 clavicular midshaft fractures that presented between January 2004 and Jun 2009 at our Department of Orthopaedic Surgery, we identified 270 who had conservative treatment and 173 patients who had surgical treatment. RESULTS: The period required for bone union increased with the degree of displacement. For the group below 12 years of age, and the group without comminution, it took half the time to achieve bone union compared with the other groups. Displacement mostly occurred within 2 weeks after conservative treatment. CONCLUSION: In patients with a comminuted clavicular midshaft fracture, we might, because of expected delays in bone union, delay the start of rehabilitation until patients are more than 13 years old. Because the degree of displacement may be increased within 2 weeks during conservative treatment, we can think about surgical treatments.

Effectiveness of the New Modified Smith-Robinson Bone Graft for Cervical Anterior Interbody Fusion / 대한정형외과학회잡지

PURPOSE: We attempted to evaluate the effectiveness of the new modified Smith-Robinson bone graft method for performing cervical anterior interbody fusion. MATERIALS AND METHODS: Forty-two patients had anterior interbody fusion on the cervical spine, using an anterior approach and the new modified Smith-Robinson's method (NMSR), between September 2001 and June 2006. There were 30 males and 12 females, with an average age of 51.2 years and the mean follow up period was 39.5 months. We measured the area from C4 to C6 in 32 cases. This was compared with the contact area of the bone graft of the NMSR method and the Original Smith-Robinson method (OSR). We also checked the time to bone union and changes of Cobb's angle at the final follow-up to evaluate the effectiveness of the NMSR. RESULTS: Bony fusion was obtained in all cases. The average size of the OSR were 169 and 152 mm2, in the males and females respectively, whereas those of the NMSR were 263, and 228 mm2. Therefore, the average size of the NMSR increased to 94 mm2 and 76 mm2 than those of the OSR method in the males and females. The average time to radiological bone union was 9.6 weeks and the changes of Cobb's angle at final follow-up were 2.5+/-2.6degrees. CONCLUSION: The NMSR technique was a very effective method for cervical anterior interbody fusion. It could enlarge the bone graft size about 50-56% compared with the OSR technique. It also shortened the period of bone union and also increased the bone union rate.

Comparative Research of Interfixation and Non-interfixation Applied to Treate the Thoracolumbar Spinal Tuberculosis / 中国医师杂志

Objective Compare the curative effect of simply bone grafting with bone grafting, sequentially or simultaneously instrumentation planting in surgical treatment of thoracolumbar spinal tuberculosis,to verify the possibility and curative effect of radical debridement,bone grafting, sequentially or simultaneously instrumentation planting.Methods Twenty-five cases were treated with radical debridement,bone grafting,21 patients with sequentially or simultaneously instrumentation planting.Evaluating the bony fusion rate,correction of deformity and the status of lesion contrastively.Results Forty-three patients were followed-up for an average of 21 monthes,all of them were cured and shown bony union. With instrumentation we got shorter bony union,better correction and no obviously correction lost.Conclusion Radical debridement,bone grafting, sequentially or simultaneously instrumentation planting can offer a complete removal of lesion as well as restruction of spinal stability which make the local immobilization possible.Through this procedure ,early rehabilitation will be possible and the cure rate fo spinal tuberculosis increased.

Quantitative Analysis for Healing of Fracture of Lower End of Radius by Dual-Energy X-ray Absorptionmetry: A Report of 126 Cases / 广州中医药大学学报

ive] To explore a new method of evaluating the healing of fractures. [Methods] Self-con trolled trial was applied. Bone mineral density ( BMD) of fracture end (region 3, R 3 ) and its neighboring proximal and distal regions ( R 2 and R 1 respectively) in 126 cases of fracture of lower end of radius was deter mined by dual-energy X-ray absorptionmetry. [Results] BMD of R3 elevated as compared with that of R 2 and R1 (P

A Clinical Study of Open Fractures of Tibia / 대한정형외과학회잡지

Open fracture characteristically has higher chances of infection and sof tissue damage in comparison with closed fracture. In spite of the development of operation methods and antibiotics, complications such as infection, nonunion, delayed union, and joint stiffness are continuously confronted as problems in the field of orthopedics. Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. Therefore a comparative analysis of the type of open fracture and the bone union time according to the initial treatment methods was made from 47 cases over the age of 20, who were followed up until bone union developed among the inpatients who were treated for open fracture of tibia in the period of 7 years from January, 1982 to December, 1988, and the results are as follows: 1. The highest incidence of fractures was encountered in 3rd decade(34%) and male to female ratio was 6:l. 2. The most common cause of fractures was traffic accident(76.6%). 3. The most common level of fracture was in mid one-third and the bone union time was longest in mid one-third. 4. The bone union time was longer, and the rate of complication was greater in order of type 1, 2 & 3 according to Gustilo's classification. 5. The good result was obtained in type 1 fractures, by using the closed reduction & cast immobilization and pin & plaster method; in type 2, the bone union time was shortest in the cases of pin & plater method; in type 3, the bone union time was shortest in the cases of closed reduction or open, reduction & external fixation. 6. Bone union was obtained in all cases of delayed union and nonunion and the bone union time was shortest in cases treated with plate & bone graft.

The Rate of Bone Union in Replanted Limbs / 대한정형외과학회잡지

In view of the problems with infection, traditional orthopedic teaching has held that the use of metalic fixation in open fractures is contraindicated. But the bone shortening and internal fixation of amputated limb is a principle for replantation. The authors experienced 23 patients of replanted limbs including femur, tibia, humerus, radius and ulnar among total 142 replantations and also analysed them in the respect of the relationship among soft tissue injury, fixatives, bone union and infection rate from February, 1975 to July, 1981 in this department. The rate of delayed union, nonunion and infection were 22.6%, 6.5% and 25.8% respectively. It seems that the union process of bone in replanted limbs is similar to that of the open fracture and also rigid internal fixation is the most useful for bony union.