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OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.
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Humans , Orthopedics , Retrospective Studies , Fractures, Bone , Treatment Outcome , Lower Extremity , Embolism, Fat/therapyABSTRACT
SUMMARY: Sex estimation from human skeletal remains is of vital importance in the buildup of a biological profile of an individual in medico-legal and bioarchaeological studies. The present study is focused on the estimation of sex from osteometric measurements of the complete femur and its fragmentary parts, and the development of a web based application related to this. Fifteen osteometric measurements were taken from 78 dry cadaveric femurs from the Faculty of Medicine, University of Kelaniya. Using R software, linear discriminant analysis and logistic regression methods were applied to build classification models with the help of the application of a stepwise procedure, to identify the best combination of measurements to estimate the sex of the femur. A cross-validation method was applied to estimate the predictive accuracy of each model. Since the linear discriminant analysis model gave more predictive accuracy than the regression model, we suggest using linear discriminant analysis to estimate the sex using osteometric measurements of the femur. From the whole femur measurements, a formula to determine sex was developed with highest total accuracy of 83 % using four parameters; epicondylar breadth, anteroposterior mid-shaft diameter, bi-trochanter length, and maximum shaft diameter. Similarly, measurements of transverse head diameter and bi-trochanter length with a total accuracy of 76 % for the proximal part of the femur, measurements of anteroposterior mid-shaft diameter with a total accuracy of 77 % for the mid-shaft, and measurements of epicondylar breadth and maximum length of the lateral condyle with a total accuracy of 70 % for the distal part of the femur were identified as significant discriminants to determine sex, and formulae were written accordingly. Average accuracy ranged from 83 % to 70 %, with male accuracy slightly higher than that of females. A web application to estimate the sex of femur using these formulae was developed and this will be of great importance for forensic medicine and bio-archaeological research in Sri Lanka.
RESUMEN: La estimación del sexo a partir de restos óseos humanos en los estudios médico-legales y bioarqueológicos es de vital importancia en la construcción de un perfil biológico de un individuo. El objetivo de este estudio fue la estimación del sexo a partir de medidas osteométricas del fémur completo y sus partes fragmentarias, y el desarrollo de una aplicación web relacionada con esto. Se tomaron quince medidas osteométricas de 78 fémures cadavéricos secos de la Facultad de Medicina de la Universidad de Kelaniya. Utilizando el software R, se aplicaron métodos de análisis discriminante lineal y regresión logística para construir modelos de clasificación con la aplicación de un procedimiento por pasos, para identificar la mejor combinación de medidas y estimar el sexo a partir del fémur. Se aplicó un método de validación cruzada para estimar la precisión predictiva de cada modelo. Dado que el modelo de análisis discriminante lineal proporcionó una mayor precisión predictiva que el modelo de regresión, sugerimos su utilización para estimar el sexo mediante mediciones osteométricas del fémur. A partir de las mediciones del fémur completo, se desarrolló una fórmula para determinar el sexo con la mayor precisión total del 83 % utilizando cuatro parámetros; anchura del epicóndilo, diámetro anteroposterior del tercio medio de la diáfisis, longitud bitrocánter y diámetro máximo de la diáfisis. De manera similar, utilizamos las mediciones del diámetro transversal de la cabeza del fémur y la longitud del bitrocánter con una precisión del 76 % para la parte proximal del hueso, las mediciones del diámetro anteroposterior del tercio medio de la diáfisis se obtuvo con una precisión del 77 %. El ancho del epicóndilo y la longitud máxima del cóndilo lateral con una precisión del 70 % para la parte distal del fémur se identificaron como discriminantes significativos para determinar el sexo y se escribieron fórmulas. La precisión promedio osciló entre el 83 % y el 70 %, siendo la precisión en los hombres ligeramente superior al de las mujeres. Se desarrolló una aplicación web para estimar el sexo del fémur utilizando estas fórmulas y creemos será importante para la medicina forense y la investigación bioarqueológica en Sri Lanka.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Sex Determination by Skeleton , Femur/anatomy & histology , Sri Lanka , Discriminant AnalysisABSTRACT
【Objective】 To explore the clinical effects of autologous platelet-rich plasma (PRP) in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation. 【Methods】 A total of 34 patients with postoperative bone nonunion for long bone shaft fracture, who were admitted and cured in the Orthopedics Department of our hospital from January 2019 to June 2020, were selected. They were randomly divided into the experimental group(n=17) and control group(n=17). Individuals in the control were treated with autologous iliac bone alone., while the experimental group were treated with autologous iliac bone graft plus autologous PRP during and after operation. After surgery, the autogenous PRP was accurately injected with ultrasound guidance every 7 days (5 mL/person, 4 occasions in total). The clinical healing time of the fracture, the grading of callus formation and the functional rehabilitation level of limbs on the affected side at different time were observed in both groups. 【Results】 All 34 patients were followed up. In the experimental group and the control group, the clinical healing time (month) of the fracture was (5.03±1.24) vs (6.91±1.41), P<0.05. The healing rate of the fracture for 6 months and 9 months was 94%(16/17)vs 59%(10/17)and 94%(16/17)vs 82%(14/17), respectively (P<0.05). The grading of callus formation within 3, 6 and 9 months was (2.11±0.69) vs (1.53±0.80), (3.06±0.90) vs (2.59±0.87) and (3.82±0.73) vs (3.35±0.86), respectively (P<0.05). The acceptance rate of functional rehabilitation of limbs on the affected side was 82.35%(14/17)vs 76.47%(13/17), P<0.05. 【Conclusion】 The application of autologous PRP in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation can achieve good clinical treatment.
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Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes.
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Background: The knowledge of variations in the position of nutrient foramina and hence nutrient arteries isimportant for orthopedicians and radiologists for various procedures.Introduction: The major blood supply to long bones occurs through the nutrient arteries, which enter through theforamina called nutrient foramina. The blood supply from nutrient artery is essential during the growing period,also during the early phases of ossification, and in procedures such as bone grafts, transplant techniques inorthopaedics. The present study analyzed the position and number of nutrient foramina in the diaphysis of fiftyadult femora.Aim: to determine the number, direction, position of nutrient foramen and whether the nutrient foramina obeythe general rule that is, directed away from the growing end of the boneMaterials and Method: The present study has been undertaken in Fifty dry adult femora of South Indian origin inthe Department of Anatomy, M.S Ramaiah Medical College, Bangalore. The number, directions, position of nutrientforamen in femur were measured with a digital Vernier caliper. The data were tabulated as mean + SD andstatistically compared between the right and left sides.Results: A total of 75 foramina were examined in the 50 bones. 40 in Right sided femur and 35 in left sided femur.46% bones had single foramina and 52% bones had double foramina. Foramen was absent in 2% bones. Allnutrient foramina in the femur were directed proximally, away from the growing end. 16% of the foramina werelocated in the proximal third of the bone and the rest 84% were located in the middle third of the bone. There wasno significant difference in location of foramina between right and left sided bones.Conclusion: This study will provide the ethnic data for comparison among various populations. It is also helpfulin interpretation of radiological images and for orthopedic procedures. Precise knowledge of usual and anomalousposition of nutrient foramina and hence the nutrient artery may help the orthopaedician for the internal fixationat appropriate place in the long bone. The location of nutrient foramen is important for bone grafts, tumourresections, in traumas, congenital pseudoarthrosis and more recently in microsurgical vascularised bonetransplantation
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BACKGROUND: Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture, bone defect and other diseases. However, few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion, and the results of various studies remain controversial, which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear. OBJECTIVE: Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and WanFang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019. Quality evaluation and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5. 1 software provided by Cochrane system. RESULTS AND CONCLUSION: Eight articles were enrolled, including 4 randomized controlled trials and 4 non-randomized controlled trials, all of which were small sample-size studies involving 30-124 cases. A total of 613 cases of nonunion were included. In the study group, patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting. In the control group, patients received autologous bone grafting. Meta-analysis results showed that there were no significant differences in postoperative healing rate, infection rate, secondary operation rate, and postoperative improvement in limb function between study and control groups (P > 0. 05). The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1. 24, 95%C/(-1. 70,-0. 79), P 0. 05). These results suggest that bone morphogenetic protein can provide a viable alternative to autologous bone grafting, and it is also a safe adjuvant for autologous bone grafting, which has the potential advantage of accelerating fracture healing, but the current evidence does not support bone morphogenetic protein in combination with autologous bone grafting.
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BACKGROUND: CT scan and differential modeling are used to analyze the fracture end, which is an effective method to judge the degree of bone healing. To obtain the high precision of differential modeling and simulation, how to select the optimal CT scanning parameters needs further research and analysis. OBJECTIVE: To compare the effects of different CT scanning parameters on modeling accuracy in personalized differential modeling analysis, to verify the accuracy and effectiveness of personalized differential modeling in the reduction of simulated target bone segments, and to explore the research value of this method in judging the degree of bone healing of long canals of lower extremities. METHODS: The model of internal fixation was established with porcine femur. Four groups of 80 kV-300 mA (group A-low dose), 120 kV-335 mA (group B-automatic tube current control system), 140 kV-300 mA (group C-manual setting comparison) and 140 kV-80 mA (group D-high kV and low mA) were used to scan the same object with the same pitch, slice thickness and environment. The scanning data of each group were selected, the same CT value range was used, and the differential modeling analysis method was used to model the target bone segment. The average area and maximum area of metal artifacts in CT scanning images, the average CT value, volume and maximum wall thickness peak after differential modeling analysis, the radiation amount under four groups of scanning conditions were compared to determine the reduction of metal artifacts, modeling accuracy and radiation, so as to select the optimal CT scanning parameters. RESULTS AND CONCLUSION: (1) Artifact measurement method results: In group A, there were many metal artifacts, which obviously obstructed bone tissue, and had a possibility of missed diagnosis. In group D, there were minimal metal artifacts, less occlusion around bone tissue, but poor image contrast and high fog. The difference between group B and group C lay in the clarity of images, and the accuracy of diagnosis was basically the same. Therefore, the order of artifact size was as follows: group A > group B > group C > Group D. (2) Differential modeling analysis results: In group B, because of the smaller artifact and less loss of CT value, the simulated model was more close to the reality. Moreover, group B adopted the automatic tube current control system, which could obviously show that the radiation amount was smaller and more protective for patients. (3) It is confirmed that the CT scan under the condition of group B can effectively reduce the interference caused by metal artifacts, better retain the original information of CT gray value, and retain the density information of the target bone segment to the maximum extent. Therefore, when establishing differential modeling, the CT automatic tube current control system is used as the optimal CT scanning parameter, which not only improves the simulation accuracy of personalized differential modeling, but also increases the accuracy of calculation.
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BACKGROUND: Membrane induction technique for treating long bone defects has advantages of few complications, significant treatment efficacy and ease in operation. In previous studies, membrane induction technique was used to treat bone defect patients with good cartilage tissue, but there are few reports regarding bone defects with large area of cartilage tissue defect or accompanying infection. OBJECTIVE: To analyze the efficacy of flap transplantation combined with membrane induction technique for repairing long bone defects and soft tissue defects. METHODS: Fifteen patients with long bone defects and soft tissue defects who were treated in Affiliated Nanhua Hospital, University of South China from October 2016 to August 2018 were selected. They were aged (47.15±8.16) years. The soft tissue defect area was 5.1 cm x 3.4 cm-21.8 cm x 9.4 cm. The length of bone defect was 5.8-19.5 cm, with an average of (11.4±2.3) cm. The patients with mildly polluted wounds underwent debridement, external fixation of fracture, and filling bone cement in the bone defect area. Wounds were covered with local pedicle flaps or free flaps. Wound infection patients underwent vacuum sealing drainage, bone cement filling and flap surgery after infection was controlled. The second graft surgery was performed at 8 to 12 weeks after primary intention, and patients were followed up for 12 months. This study was approved by the Institutional Ethics Committee of Affiliated Nanhua Hospital, University of South China. RESULTS AND CONCLUSION: (1) Nine patients with mildly contaminated wounds were treated with external fixation after debridement, bone cement filling and flap transposition. No infection occurred. (2) Six patients with infection were treated with vacuum sealing drainage for 1 to 2 weeks. After the infection was controlled completely, bone cement filling and flap transplantation were conducted. All wounds were healed. (3) Fifteen patients achieved bone healing after second bone grafting. The healing time was between 8 and 12 months, with an average of (9.18±2.10) months. (4) These results suggest that skin flap transplantation combined with membrane induction technique can effectively treat patients with long bone defects and soft tissue defects.
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Background: Musculoskeletal trauma represents a considerable global health burden. Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. So the purpose of the study was to do assessment of pain management intervention, post-op analgesics for treatment of long bone fractures.Methods: All adult patients (more than IS years) reporting to Emergency Medicine Department of a tertiary care hospital with long hone fractures of lower limb were included in the study. Patient pain management was assessed by visual analogue score (VAS). Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. The entire data is statistically analyzed using SPSS software. p-values less than 0.05 are considered to be statistically significant.Results: 74 cases got operated, 64 cases (86.5.0%) did not have any intra-op complications and 10 cases (13.50%) had intra-op complications .Postoperative analgesia the 74 cases operated was as follows: 17 cases (23.0%) epidural anaesthesia 41 Cases (55.4%) had epidural + intravenous analgesics. Recent was managed with 1.V, analgesics alone; 12 cases (16.20%) had tramadol, 2 cases (2.7%) received paracetamol and 2 cases (2.7%) had dynaper for post-operative analgesia.Conclusion: Adequate pain management on arrival in the Emergency Department is an important aspect in patient care and is not at all difficult to achieve. Femoral nerve block in Proximal lower limb fractures is very effective and easy to perform.
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The study was conducted on 10 goats, aged between 10 months to 5 years, brought to T.V.C.C, Jabalpur for the treatment of compound fracture in metacarpal and tibia. The animals were selected irrespective of their age, sex, breed and body weight. The animals were randomly divided into two equal groups. In group I, external skeletal fixation using Acrylic as the connecting bar was applied whereas in group II, Epoxy putty was used as the connecting bar. Wound area at fracture site decreased significantly at 30th day as compared to 0 day. The mean radiographic score increased significantly at 30th day and was highest at 60th day. Weight bearing score improved on 15th day and complete weight bearing was observed on 12th to 30th days in all goats. Pin loosening, pin tract drainage and inflammation were observed post-operatively
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Purpose: To demonstrate the effectiveness of intramedullaryfixation of displaced long bones shaft fractures in skeletallyimmature children using the elastic stable intramedullary nails.Patients and Methods: The case records of 20 children whounderwent fixation with titanium intramedulary nails because oflong bones fractures were reviewed. There were 2 humeral, 3forearm, 10 femoral and 5 tibial fractures. The average age ofthe patients was 11 years, and they were followed-upto 20months. Subjective satisfaction was assessed.Results: All patients achieved complete healing at a mean of7.5 weeks. Complications observed in patients were: oneneuropraxia, six entry site skin irritations, two protrusions of thewires through the skin and two skin infections at the entry site.In a subjective measure of outcome at follow-up, 89% ofpatients were very satisfied while 11% were satisfied. Therewas no report of patient’s unsatisfaction. The implants wereremoved at a median time of six months from the indexoperation.Conclusion: Elastic Stable Intra-medullary Nailing isthe method of choice for the pediatric patients, because it isminimally invasive and shows very good functional andcosmetic results. It allows an early functional and cast-freefollow-up with a quick pain reduction.
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Objective To study the evolutionary trends in the stature of Pleistocene hominins from China. Methods We took the indirect method of stature estimation from fragments of long bones; maximum length of the long bones was directly estimated from measurements of its fragments, and thereafter the stature was reconstructed from the estimated maximum length. Results The result showed that the stature variation was 155.4-169.2 cm for H. erectus (n = 4) and 155.2-171.7 cm for early modem humans (n = 12) , and only 166. 1 cm for one female in archaic Homo sapiens. The stature of Liujiang and Lijiang hominins located in the southeast was lower than other early modern humans from North China. Conclusion The stature variation is similarly from H. erectus to early modern humans, while the average stature seems to have increased continuously. We find that the geographical variation observed in modern humans has appeared in early modern humans. In addition, there is no significant difference between early modern humans and Neolithic populations.
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Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.
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Aged , Female , Humans , Cardiopulmonary Resuscitation , Death, Sudden, Cardiac , Early Diagnosis , Embolism , Embolism, Fat , Femur , Fractures, Bone , Glass , Heart Ventricles , Hemorrhage , Mortality , Pulmonary Artery , Thorax , Ventilators, MechanicalABSTRACT
Objective@#To compare the osteogenic differentiation abilities of human bone marrow mesenchymal stem cells (hBMSCs) from different sources, and to provide basis for choosing a new source of seed cells in bone tissue engineering.@*Methods@# Jaw bone-marrow-derived mesenchymal stem cells (JMMSCs) were isolated from orthognathic surgical sites and cultured by limited dilution for single cell clone. Long bone-marrow-derived mesenchymal stem cells (BMMSCs) were obtained from bone marrow of volunteers and isolated by density gradient centrifugation method. Flow cytometry was used to detect the surface markers of both cells. Osteogenic ability was assessed by PCR and Western Blot after osteogenic differentiation for the following molecules: Runx2, COL-1 and OCN. Alizarin red staining was used for determining the ability of cell mineralization after osteogenic differentiation. @*Results @#The expressions of cell surface markers CD90 and CD105 were positive in both type of cells, while CD34, CD14 and CD45 were all negative. After 21 days of osteogenic induction, JMMSCs formed significantly more mineralized nodules than BMMSCs. After 7, 14, 21 days of osteogenic induction, JMMSCs expressed more osteogenic-related molecules than BMMSCs.@*Conclusion@#The osteogenic differentiation capacity and mineralization ability of JMMSCs are significantly higher than BMMSCs. Jaw bone might be a more suitable source of seed cells in bone tissue engineering compared with long bone.
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PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
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Child , Humans , Cohort Studies , Femur , Fibula , Fractures, Open , Leg , Lower Extremity , Orthopedics , Prognosis , Tibia , TransplantsABSTRACT
PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
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Child , Humans , Cohort Studies , Femur , Fibula , Fractures, Open , Leg , Lower Extremity , Orthopedics , Prognosis , Tibia , TransplantsABSTRACT
Objective To summarize the nursing methods of Orthofix limb reconstruction system in the treatment of limb long bone defects. Methods Thirty-two patients with long bone defects were collected between January 2012 to January 2015. The patients were all treated with the Orthofix limb reconstruction system and perioperative nursing. Results All the cases were treated by the method for 8 . 5 to 18 . 2 months , averaged 15 . 40 ± 3 . 20 months . The bones extended 4 ~ 21 cm , averaged ( 8 . 06 ± 3 . 06 ) cm . The assessments of bone transport treatment showed 31 cases were excellent and 1 good. Conclusions The limb long bone defects with or without soft tissue defects caused by various causes can be treated by the Orthofix limb reconstruction system. Patients should pay attention to psychological counseling and nutritional support preoperatively. It is important for patients to pay attention to bone transport and functional exercise guidance postoperatively.
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Background: Skeletal trauma accounts for 10-15% of all childhood injuries. The increasing incidence of fractures in children mainly attributed to increased road traffi c accidents and sports participation. Materials and Methods: The study was conducted from October 2012 to April 2015 at Terna Medical College, Navi Mumbai. A 28 pediatric patients (20 male and 8 female), who came to emergency department with long bone fractures subsequently, underwent surgical fi xation of long bones by titanium elastic nailing (TENS) were included in this prospective study. Results: Road traffi c accident was the main mode of injuries. The most common long bone fracture was femur 40% and 60% tibia fracture. Pattern of fracture 33.3% transverse, 13.3% commiunited, 20% oblique, 26.7% spira, 6.7% segmental. The level of fracture 80% middle third. The time interval between trauma and surgery was average 3.65 days. Average duration in 50.20 min. Average duration of immobilization is 7.2 weeks. Duration of stay in hospital was 10.25 days. Time of union is 10.35 weeks. Time of weight bearing in the present study is 11.8 weeks. Follow-up done for period of 24 weeks. According to Flynn’s criteria, 89% of patients were excellent and 11% satisfi ed; no patients reported their outcome as not satisfi ed. Conclusion: TENS is the method of choice for the management of long bone fractures in children, because its elastic mobility promoting rapid union at fractures site, stability ideal for early mobilization. It gives lower complication rate, good outcome. It allows an early functional and cast-free follow-up, quick pain reduction compared plating technique including a minimally invasive technique. A less time-consuming procedure and easier metal work removal, cosmetically a small scar. Our study results provide new evidence that expands the inclusion criteria for this treatment and shows that TENS can be successfully used regardless of fracture location and fracture pattern.
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Objective To investigate the imaging differentiation between high-grade and low-grade limb of long bone chon-drosarcoma.Methods The MRI imaging features in 23 cases of pathologically proven limb long bone chondrosarcomas were retro-spectively analyzed,including 13 cases of low-grade and 10 cases of high-grade.The MRI imaging features including endosteal scal-loping lesion,cortical thickening,cortical destruction,bone expansion,soft tissue mass,bone marrow edema,soft tissue edema,calci-fication,hemorrhage,tumour maximal radial line and enhancing features were performed the statistical analysis.Results 13 cases were the low-grade chondrosarcomas,including atypical cartilaginous tumour and grade 1 chondrosarcomas,10 cases were high-grade chondrosarcomas (8 cases of grade Ⅱ chondrosarcomas,1 case of gradeⅢ chondrosarcomas and 1 case of dedifferentiated chondrosarcomas).Cortical destruction,soft tissue mass and soft tissue oedema had statistical differences between the low-grade and high-grade.Bone marrow had statistically significant difference.Calcification +(SC<1/3ST)had statistical difference between the low-grade and the high-grade.Calcification ++(1/3 ST
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OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.