ABSTRACT
We report the treatment of two patient with humeral fractures with one or more risk factors for nonunion. The first patient was elderly with a previously diagnosed central nervous sys-tem injury. The second elderly patient previously sustained a cerebral vascular accident affecting the fractured arm. The fracture was oblique in the proximal third of the humerus. We achieved bone healing non-operatively utilizing a spe-cialized plastic orthosis that included a deforming element made of dense foam. This device asymmetrically increases the soft tissue pressure around the fracture.
Subject(s)
Fracture Healing , Fractures, Ununited , Humeral Fractures , Orthotic Devices , Humans , Humeral Fractures/surgery , Humeral Fractures/physiopathology , Humeral Fractures/diagnostic imaging , Fractures, Ununited/surgery , Fractures, Ununited/physiopathology , Fractures, Ununited/etiology , Risk Factors , Male , Treatment Outcome , Aged , Female , Equipment Design , Aged, 80 and over , RadiographyABSTRACT
Appendicular metastasis from multiple myeloma (MM) frequently presents with a pathologic fracture. In this case report, a patient with a long history of MM and an associated pathologic fracture was treated using a specialized brace. This orthosis uses a deforming element to asymmetrically increase the soft tissue pressure around the pathologic fracture. The patient experienced rapid pain relief and bony healing without surgical intervention.
Subject(s)
Bone Neoplasms/therapy , Fracture Fixation/instrumentation , Fractures, Spontaneous/therapy , Multiple Myeloma/therapy , Orthotic Devices , Radius Fractures/therapy , Aged , Bone Neoplasms/complications , Bone Neoplasms/secondary , Equipment Design , Fracture Healing , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/etiology , Fractures, Spontaneous/physiopathology , Humans , Male , Multiple Myeloma/complications , Multiple Myeloma/secondary , Radius Fractures/diagnostic imaging , Radius Fractures/etiology , Radius Fractures/physiopathology , Treatment OutcomeABSTRACT
Local soft tissue compression of fractures enhances fracture healing. The mechanism remains uncertain. Past studies have focused on intermittent soft tissue compression. We report a preliminary study assessing the relationship between constant soft tissue compression and enhanced fracture healing in an osteotomy model designed to minimize confounding variables. Fibulae of nine New Zealand white rabbits were bilaterally osteotomized, openly stabilized, and fitted with spandex stockinets. Soft tissue at the osteotomy site was unilaterally compressed using a deforming element (load = 26 mmHg). The contralateral side was saved as the control and was not compressed. Osteotomies were monitored with weekly radiographs. All fibulae in both groups were healed 6 weeks postoperatively. Micro-CT analysis of bone mineral density (BMD) and bone volume (BV) was then performed on both the experimental and control sides. Radiographic measurement of transverse callus-to-shaft ratios (TCSR) was compared. BMD of the experimental callus was greater than the noncompressed controls. BV and TCSR were not different between controls and experimental osteotomies. Constant local soft tissue compression produced significant increases in BMD, but not in BV or transverse callus size, indicating significant measurable increases in callus composition without significant change in gross dimensions. Our experimental design minimizes confounding factors, such as micromotion, immobilization, and altered venous flow, suggesting that these are not the primary mechanisms for fracture healing enhancement. Further studies with more animals and study groups are necessary to confirm efficacy and identify optimal compression pressures and schedules.
