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Introduction: Open fractures are more commonly seen in tibia as compared to other bones because of subcutaneous location and the tenuous soft tissue cover. There has been rise in open tibia fractures with increased road traffic accidents. Management of open tibial fracture remains controversial. Ilizarov external fixator is a better option for the treatment of these fractures. This study was conducted to evaluate the clinical outcome of open tibial fractures managed with an Ilizarov external fixator. Material & Methods: Twelve patients among those who presented to the emergency department with Type II, Type IIIA and Type IIIB Gustilo-Anderson type open tibial fracture were enrolled. All these cases were treated by Ilizarov external fixator and appropriate wound management. Active movements were started at the earliest after the surgery. Partial weight bearing with support was started from the second day after the surgery. Results: Mean age of the study subjects was 37.66 ± 8.77 years. Half of the patients had Type IIIB GustiloAnderson type fractures. The mean duration of fracture union was 7.1 months. Pin tract infection of the wires was the more common among complications. Excellent to good outcome was seen in 90% of study subjects. Conclusion: Ilizarov external fixator gives stable fixation of the open tibial fractures and allows better wound care. It also helps in early ambulation and rehabilitation of these patients.
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PURPOSE@#Fractures of the humerus account for 5%-8% of all fractures. Nonunion is found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a challenging problem and has to conceive a therapy based on the underlying pathology. The aim of this study was to describe our treatment concepts for this entity and present our results of the last five years.@*METHODS@#Twenty-six patients were treated for nonunion of the humerus between January 2013 and December 2017. Their charts were reviewed retrospectively and demographic data, pathology, surgical treatment and outcome were assessed.@*RESULTS@#The most frequent location for a nonunion was the humeral shaft, with the most common trauma mechanism being multiple falls. Most often atrophic nonunion (n = 14), followed by hypertrophic and infection-caused nonunion (each n = 4), were found. Our treatment concept could be applied in 19 patients, of which in 90% of those who were available for follow-up consolidation could be achieved.@*CONCLUSION@#Humeral nonunion is a heterogeneous entity that has to be analyzed precisely and be treated correspondingly. We therefore present a treatment concept based on the underlying pathology.
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Objective To analyze the reasons of the delayed healing factors after internal fixation of limb fracture and the prevention and treatment measures.Methods 220 cases who were treated with internal fixation of fracture cases were retrospectively analyzed,compared difference with patients with postoperative (observation group of 1 10 cases)and non delay healing patients (1 10 cases in the control group)related factors.Results In the obser-vation group,age (62.6 ±10.2)years old,43.6% with diseases in department of internal medicine,the loose of internal fixation ratio was 25.5%,external fixation improper proportion was 30.9%,functional exercise did not correct rate was 56.4%,higher than those of the control group (50.5 ±9.4)years old,11.8%,1.8%,7.3%,8.2%%(t=9.149 1,χ2 =27.786,26.091,58.416,19.893,all P0.05 ). Conclusion There are many factors in delayed healing after internal fixation of limb fracture,the patients age,associ-ated with diseases in department of internal medicine,the loose of internal fixation,external fixation and functional exercise is not correct are the main factor of the limbs fracture postoperative delayed healing,and should take meas-ures timely to guide firmly fixed and regular postoperative preoperative exercise and avoid postoperative delayed union and nonunion.
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Introduction: Delayed union with its subsequent morbidity remains a major problem in fracture healing. Angiogenesis plays an important role in fracture healing. Sildenafil has been shown to be a potent stimulator of angiogenesis through upregulation of pro-angiogenic factors known as vascular endothelial growth factor (VEGF). This study evaluated the role of sildenafil in accelerating the healing process in delayed union model. Methods: This was an experimental study in delayed union femoral fracture model in male Sprague Dawley rats evaluated by histomorphometry and immunohistochemistry. Twenty four rats were randomized into four groups; control (group 1), administration of sildenafil 3.5 mg/kgbw (group 2), sildenafil 5 mg/kgbw (group 3), and sildenafil 7.5 mg/kgbw (group 4). The parameters evaluated were total area of callus, osseous, cartilage, fibrous tissue, and VEGF expression. The evaluation was carried out at week-2 and -4 after intervention. Results: On week-2 evaluation, ANOVA test showed a significant difference in the total callus area with the p-value of 0.004. ANOVA test also found significant difference among groups in the osseous, cartilage, and fibrous tissue area with p-value of 0.001, 0.015 and 0.005 respectively. On week-4, ANOVA test found no significant difference among all groups in the total callus area with p-value of 0.192. However, in ANOVA test, we found significant difference between groups in the osseous and fibrous tissue area with p-value of 0.015 and 0.001 respectively. Conclusion: Sildenafil is proven to accelerate fracture healing of delayed union and to increase VEGF expression.
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Context: Bone marrow has been shown to contain osteo-progenitor cells. Percutaneous autologous bone marrow injection (PABMI) encourages early treatment of delayed union and non-union to expedite healing and minimize complications from prolong immobilization. Aims and objectives: To assess the outcome of PABMI treatment in delayed and non-union of long bones. Study design: Prospective study Participants and procedures: 24 cases (33 bones) of Delayed and non-union of long bones were selected. Percutaneous autologous bone marrow injection treatment was adopted for fracture healing. Change in pattern of union was followed after 12 weeks by clinical and radiological study. Results: 90% of tibial fractures, 66.66% of radial fractures and 50% of ulna fractures show clinical and radiological union. 100% of the fractures with no gap at the fracture site united, where the gap was less than 1 cm, 85% of bone united, in only 1 case the gap was more than 1 cm and it failed to unite. 7 out of 9 bones in hypertrophic non-union united, whereas 4 out of 6 bones in atrophic non-union united. Conclusion: Percutaneous autologous bone marrow grafting is an effective and safe method for the treatment of diaphyseal non union. We strongly believe that an injectable preparation that combines marrow with osteoinductive and osteoconductive agents should virtually eliminate the need for open harvesting and operative grafting of the problems associated with fracture healing.
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Objective To study the impact of TCM staging treatment on serum alkaline phosphatase of Rabbit radius fractures delayed union. Metheods Left radial bone defect 1 cm were created in 75 New Zealand rabbits and they were divided into 5 group: The first, the second and the third therapeutic group, model group, and delayed union group. The second therapeutic group received herb medicine two days after the operation, the first and the third therapy group received herb medicine four weeks after the operation, the model group and delayed union group received saline solution two days after the operation, and the delayed union group received local bone marrow transplantation(2ml)four weeks after the operation. Results were observed by ALP and X-ray at 4 weeks and 8 weeks after the operation. Results ALP in the second therapy group was increased significantly[(155.54±23.33)U/L]than other groups at 4 weeks after the operation(P＜0.01). ALP in the second therapy group was increased significantly than the delayed union group(P＜0.01)and the model group(P＜0.05) at 8weeks after the operation[(62.44±27.67)U/L]; ALP in the first and the third therapy group[(74.79±2.068)U/L] were significantly lower than the model group(P＜0.05), and lower than the second therapy group(P＞0.05)at 8 weeks after the operation. X-ray endoscopic scoring in the model group increased significantly than other groups(P＜0.01)4 weeks after the operation, X-ray endoscopic scoring in the second therapy group increased significantly than the first therapy group, the third therapy group and the delayed union group(P＜0.01), but no significant difference than the model group(P＞0.05)at 8 weeks after the operation. Conclusion The treatment of traditional Chinese medicine by stages can promote fracture healing.
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Objective To study the influence of the distance of displaced fragment on the union of diaphysis fracture. Methods A wedge-shaped bone fragment was taken from central radial of the right forelimb of 120 New Zealand white rabbits for estabhshment of experimental animal model. The bone fragment was fixed to the main bone with two Kirschner wires, with certain space between bone fragment and the main bone. Then, the rabbits were divided into five groups, ie, Group A (in situ fixation),Group B (the space was 1/5 diameter of the radial shaft), Group C (the space was 2/5 diameter of the radial shaft), Group D (the space was 3/5 diameter of the radial shaft), Group E (the space was 4/5 diameter of the radial shaft). The animals were killed at 2, 4, 6, 8 weeks after operation. X-ray photos were taken to observe the fracture healing and the improved Gary X-ray used for scoring. HE staining after tissue section was employed to observe the histomorphological changes of fracture healing. Immunohistochemical method was used to determine expression of BMP-2. Results X-ray findings showed insignificant statistical difference between Group A and Group B, delayed union in Groups C and D and nonunion of bone absorption in Group E. Morphological observation showed same change in fracture site in Groups A and B lout significant late in emergence, formation and remodeling of the callus in the other groups compared with Group A, mainly with delayed fracture union or nonunion. There was no statistical difference in expression of BMP-2 between Group B and Group A (P ＞ 0. 05), but there was statistical significance in Groups C, D and E compared with Group A at 2 weeks (P ＜0.01). There was statistical difference between Group E and Group A at 4 weeks (P ＜0. 01) but no statistical difference at 6 and 8 weeks between either two groups (P ＞ 0. 05). Conclusions The distance of displaced fragment will influence fracture healing. The larger distance of the displaced fragment will beget more obvious influence on fracture healing. When the distance is more than 2/5 diameter of the bone shaft, the fracture will present union disorder.
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PURPOSE: To evaluate the efficacy of the in situ late osteosynthesis for slightly displaced fractures of the lateral humeral condyle. MATERIALS AND METHODS: From 2000 to 2004, 12 patients (8 boys and 4 girls) were managed with in situ late osteosynthesis for fractures of the lateral humeral condyle. The average age at the time of operation was 6 years 1 month (1 year 7 months~9 years 1 month), and the mean amount of fragment displacement was 3.3 mm (2.0~4.5 mm). The operative procedure included curettage and in situ fixation of the fragment RESULTS: Bony union was achieved in all cases after avg. 48 months (33~73 months) follow-up assessment. According to the score system of Dhillon et al, 7 patients had excellent, 3 had good, 2 had fair results. None of the patients developed avascular necrosis or premature closure of the epiphysis. CONCLUSION: We suggest that in situ fixation is an effective method for the late treatment of slightly displaced fracture of the lateral humeral condyle.
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Child , Humans , Curettage , Displacement, Psychological , Follow-Up Studies , Necrosis , Surgical Procedures, OperativeABSTRACT
PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.
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Arthritis , Classification , External Fixators , Prognosis , Tibial FracturesABSTRACT
PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.
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Arthritis , Classification , External Fixators , Prognosis , Tibial FracturesABSTRACT
[Objective]To study the effect of Chinese traditional medicine and bone marrow transplantation on treating delayed union.[Method]The model of delayed union in 75 rabbits was made and divided into 4 groups.Group A,20 rabbits treated with Chinese traditional medicine and red marrow 2 ml;Group B, 20 rabbits treated with Chinese traditional medicine;Group C,20 rabbits treated with red marrow;Group D,15 rabbits treated with nothing.X-ray in the 4th, 8th and 12th weeks were observed after treating.And bone mineral density and biomechanics were observed in 12~(th) week after trenting.[Result]X-ray revealed that group A heal earlier than group B,C and D.At the same time,bone mineral density and biomechanics in group A was better than others.[Conclusion]The treatment of delayed union by Chinese traditional medicine and bone marrow transplantation is one of effective means.
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[Objective]To explore the effects of Chinese traditional medicine and bone marrow transplantation(BMT) on delayed union.[Method] The model of delayed union in rabbit's radius was made and divided into 4 gronps.Group A,20 rabbits treated with Chinese traditional medicine and red marrow 2 ml;Group B,20 rabbits treated with Chinese traditional medicine;Group C,20 rabbits treated with red marrow;Group D,15 rabbits treated with nothing.Histology,alkaline phosphates and xray were observed in the 4th,8th and 12th weeks after treating.[Result] Histology,alkaline phosphates and x-ray reveals that group A healed earlier than group B,C and D.At the same time,the rate of healing of group A was higher than others.[Conclusion] The treatment of delayed union by Chinese traditional medicine and bone marrow transplantation is an effective mean.
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Objective To investigate the causes of non-union and delayed union of fractures and to report the surgical techniques and outcomes of the treatments. Methods 107 cases of non-union, 54 cases of delayed union and 2 cases of congenital non-union of tibia were treated between July 1990 and December 2004 in our hospital. The treatments were evaluated retrospectively to analyze the causes of the disorder and the treatment outcomes at the follow-up. 18 cases of delayed union were treated conservatively while the other 145 cases in this series underwent surgery. Results Except in the 2 cases of congenital non-union of tibia, iatrogenic factors were found to be responsible for nonunion or delayed union in all the other 161 cases. 153 cases were followed up for an average of 17 (6 to 28) months only to reveal bone union in all the cases with a mean healing time of 10 (6 to 14) months. All the limbs regained good function. Conclusion Since development of non-union and delayed union of fractures chiefly result from iatrogenic technical defects, satisfactory results can be achieved as long as appropriate treatments are performed according to different etiological factors.
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Fracture healing consists of four stages: hematoma and inflammation, granulation tissue formation, membranous and endochondral ossification, and remodeling. During these stages, the pathological changes are continuous and overlapping and numerous inflammatory factors and growth factors play a central role in the tissue regeneration and ossification. The fracture will eventually reach primary bone healing or callus healing depending on the stability of fracture site after treatment. The delayed union and nonunion can be assessed according to the treatment time, clinical examination, radiology and biomechanical testing. It is important to understand the differences between hypertropic and atrophic nonunions and the reasons that lead to nonunion. At last, methods to promote fracture healing are summarized and classified into four groups: biological, systemic, mechanical and biophysical ones.
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Objective To observe the effects of the Ossatron high-energy shock waves on bone nonunion and delayed union.Methods Between October 2004 and October 2005,18 patients with nonunion and four patients with delayed union were treated with high-energy extracorporeal shock wave therapy(Ossatron,HMT Co., Swiss).Facture lines were located with C-arm X-ray before treatment.Parameters of shock waves were decided according to fracture sites.Patients with unstable fixation received plaster or bracing for 6 to 8 weeks after treatment. After therapy,follow-up radiography was performed at 6 and 12 weeks and monthly afterwards until the fracture united. Results The mean follow-up was 6.7 months(range,3 to 12 months).There were no complications except local petechial hemorrhage and local swelling in 10 patients.Thirteen patients(59.1%)got bony union,including 12 patients(66.7% )with stable internal fixation,and the average healing time was 4.3 months(range,6 weeks to 6 months).Nine fractures(40.9%)still suffered nonunion.Conclusion High-energy shock waves are a good alternative therapy for nonunion and delayed union,with obvious advantages of being non-invasive and safe.
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Nonunion or delayed union remains one of the major complicatio ns of fractures. Repair of fractures involves a sequence of dynamic events which ultimately restore the integrity of bone and its biomechanical properties, incl uding such methods as surgery, internal fixation, bone grafting, external fixati on, electrical stimulation, ultrasound, and high-energy extracorporeal shock wa ve. The preferred management of nonunion and delayed union is autologous bone gr afting. However, the supply of suitable bone is limited and it often results in additional morbidity to the donor site. Recently some advances have been made in the therapeutic principle for nonunion or delayed union. It is aimed at providi ng non-invasion, less complication, and safe treatment. This article introduces the development of some effective and safe therapies for nonunion or delayed un ion.
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Some of the techniques for bone grafting for delayed union or nonunion of the long bone are used currently. In 1991, at arthroscopy workshop in Phoenix, Arizona, Lanny L. Johnson, M.D. reported a case of endoscopic bone grafting for the delayed union on the humerus. He suggested the possibilities of endoscopic bone grafting such as minimal incision, magnified visualization, accurate debridement, accurate graft placement, vascular preservation, outpatient surgery and reduced cost. The author performed endoscopic bone grafting and extra-articular adhesionlysis on the delayed union of femur with extra-articular ankylosis. The patient was a 28 year old housewife with blood type Rh(-). The duration after initial operation was more than 9 months. The result of the graft was satisfactory. In the future endoscopic bone grafting could be performed for nonunion, delayed union and congenital bone defect.
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Humans , Ambulatory Surgical Procedures , Ankylosis , Arizona , Arthroscopy , Bone Transplantation , Debridement , Education , Femur , Humerus , TransplantsABSTRACT
Fractures of the metacarpal and phalanx of the hand are common occurances and bony union usually occurs without difficulties. If complication of the metacarpal and phalangeal fracture of the hand occurred, it causes significant functional deficit. The authors have reviewed 92 patients, 121 cases of metacarpal and palangeal fracture of the crushed hand which were treated with internal fixation with/without open reduction in the deparment of orthopaedic surgery in Holy Family Hospital from Jan. 1985 to Dec. 1989. The authors obtained the following results ; 1. The incidence of nonunion and delayed union was 12.4% (15/121 cases). 2. The criteriae of nonunion and delayed union are progressive angulation at fracture site after removal of implant, lack of bony union evidence in the radiography more than 12 weeks after injury, tenderness and pain on motion at fracture site and gross pseudomotion. 3. Nonunion and delayed union occurred more commonly in phalangeal fractures, shaft fractures, severely traumatized fractures (open fractures, marked displaced fractures, comminuted fractures and fractures had associated injuries in the same hand) and under-reduced fractures after internal fixation. 4. Mean TAM (total active motion) range at last follow up was 94.5°in thumb and 186.6°in finger and that of nonunion and delayed union cases was 89°in thumb and 153.5°in finger.
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Humans , Fingers , Follow-Up Studies , Fractures, Comminuted , Hand , Incidence , Radiography , ThumbABSTRACT
Nonunion is extremely rare in children, Weber et al. concluded that considerable skill is required to induce nonunion in a child and its occurrence always results from a serious error in management. Twenty-six cases of delayed union and nonunion examined and treated at department of Orthopedic Surgery, Yonsei University, Wonju College of Medicine during the period of 1970 to 1988 was observed and analysed. 1. Of the 26 cases, there was 18 male and 8 female patients. The results showed more predominence of male over female patients. 2. Delayed union and nonunions commonly occurred over 5 year of age. 3. The causes of the fractures consisted of 12 Fell from heights, 5 Traffic accidents and others. 4. Of the 26 cases, there were 21 closed fractures and 5 open fractures. 5. Prior to admission to this hospital, 15 were treated conservatively and 10 treated operatively, and one received no treatment at all. 6. The sites of delayed union and nonunion were 10 phalanges, 6 tibia, and 3 ulna in order. 7. Probably causes of the delayed union and nonunion were unsatisfactory immobilization in 13 cases, infections in 6 cases, operative complications in 6 cases, interposition of the soft tissues in 2 cases in 2 cases, persistent seperation of the fragments in 1 case. 8. We are considered that the treatment of the nonunion must be individualizd but usually requires eradication of any infection, excision of the intervening fibrous tissue, bone grafting, and internal fixation.
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Child , Female , Humans , Male , Accidents, Traffic , Bone and Bones , Fractures, Closed , Fractures, Open , Immobilization , Orthopedics , Tibia , Transplants , UlnaABSTRACT
In the treament of the non-union or delayed union of the long bone, it is very difficult to achieve union. We have experienced 15 cases of non-union or delayed union of the tibia who were treated by sliding inlay bone graft with cancellous chip bone graft from June, 1979 to April, 1984. The results were as follows: l. In all cases cancellous iliac bone graft were performed, and additionally internal fixation or simple cast immobilization were done for stabilization of the fracture site. 2. The average bone union time was 2.8 months in delayed union and 4.4 months in non-union. 3. 1n 5 failed cases there were reactivation of previous infections. 4. In 5 cases of postoperative infection, sliding grafts were sequestrated in all. 5. The advantage of this procedure in the cases without infection were: 1) In the anteromedial cortex of tibia, such a surgical intervention permits easy skin closure and prevents skin necrosis. 2) Such a procedure can recanalize the obliterated medullary cavity without disturbance of the fracture ends during operation. 6. This procedure was proved to be one of valuable adjuvant method in the treatment of uninfected non or delayed union of the tibiae.