Fracture repair: modulation of fracture-callus and mechanical properties by sequential application of IL-6 following PTH 1-34 or PTH 28-48.

Fracture healing presents a sequence of three major stages: inflammation and granulation tissue formation, callus formation and remodeling. Our working hypothesis was that fracture-repair might be enhanced by stimulating proliferation of chondrocytes and osteoblasts in the early stages of fracture healing followed by sequential acceleration of the remodeling process. In the present study we employed a novel device developed by us implementing a standardized fracture in rat tibiae. We investigated the effect of PTH 28-48 or PTH 1-34 alone or in sequence combination with IL-6 together with its soluble receptor (IL-6sR) on fracture repair. PTH 28-48 or PTH 1-34 was applied locally into the hematoma of fractures on days 4, 5 and 6 and IL-6+ its soluble receptor on days 7, 9, and 11. Post-fracture callus volume as measured 14 days post-fracture was increased significantly only by PTH 1-34 (20%; P<0.01). When one of the PTH fragments and IL-6+IL-6sR were applied sequentially callus volume was increased significantly (33%; P<0.01). X-rays radiography at 5 weeks post-fracture showed enlarged callus volume following treatment by either PTH fragments alone, and complete union following the sequential injection of both PTH fragments and IL-6+IL-6sR, only. Only the combination of one of the PTH fragments with IL-6+IL-6sR, as measured 6 weeks post-fracture by three point bending, changed dramatically the quality of the regenerating bone as presented by a 300% increase in mechanical resistance when PTH 1-34 was combined and 200% when PTH 28-48 was combined relative to vehicle-treated fractured bones. We conclude that the sequential application of IL-6+IL-6sR with both PTH fragments has the potential of enhancing fracture healing in long bones and should be further explored in preclinical and in clinical studies.

Enzymatic activities in limb muscles subjected to external fixation with ring-hybrid frames.

Enzymatic activities, which originate in the muscle envelope of tibiae with an experimental segmental bone loss, provide additional evidence for the intimate bone-muscle interrelationships in new bone formation.

Adult (somatic) stem cells and the musculoskeletal system.

Stem cells offer a glimpse into a future that might unravel the promising ability of wide-ranging biological reconstructions.

Low back pain.

This study attempts to define the validity of radiographic imaging for the diagnosis of low back pain.

How does pulsed low-intensity ultrasound enhance fracture healing?

Pulsed low-energy ultrasound, a non-invasive therapeutic treatment modality, may improve callus formation and enhance fracture healing by initiating enhanced angioneogenesis.

Extreme bone lengthening using distraction osteogenesis after trauma: a case report.

We are reporting herein the result of a 22 cm tibial lengthening after using an acute shortening technique with acute temporary angulation for salvage of a posttraumatic lower limb injury. The patient was referred to our center 2 weeks after a Gustilo IIIB open complex injury to the lower limb that included bone and soft-tissue loss. After surgical debridement, the tibial gap was 22 cm and the soft-tissue defect on the anterior aspect of the calf measured 12 x 20 cm. An acute shortening using a 50 degrees angulation (apex posteriorly) of the tibia in an Ilizarov frame was done after a full assessment of all reconstructive surgical options. After complete wound healing, a progressive correction of the angulation was done. Bilevel tibial distraction at a rate of 1.75 mm/day restored the original lower limb length. The 22 cm tibial elongation included 17 cm proximal lengthening and 5 cm distal lengthening. The fractures consolidated after 371 days, all wounds had closed, and no signs of osteomyelitis were present. Good aesthetic and functional results were obtained. The patient had no leg discrepancy compared to his normal limb and he returned to his previous occupation as a garage mechanic and to his favorite sport, boxing. To our knowledge, this is the first report in the English literature of tibial lengthening of this magnitude following acute trauma.

Unilateral hinged external fixation frame for elbow compression arthrodesis: the stepwise attainment of a stable 90-degree flexion position: a case report.

We report a case of an elbow arthrodesis using a modular hinged external fixation device in a patient who sustained a complex high-energy injury. The extensive bone and soft-tissue loss and local infection precluded restoration of the articular anatomy. Other reconstructive options, including total elbow arthroplasty and allograft reconstruction, were not appropriate in this clinical situation. A transelbow hinged external fixator was applied with the elbow in extension. Subsequently, the hinge was brought gradually into 90 degrees of flexion as the elbow fused. Fixation and arthrodesis were successfully achieved by using this modular device, despite severe tissue loss and local septic complications. Furthermore, by gradually flexing the frame from full extension to 90 degrees , the need for flap coverage of the open wound was avoided.

The Ilizarov external fixation frame in compression arthrodesis of large, weight bearing joints.

Solid bony fusion of large joints affected with active chronic infections, is still the most effective surgical solution to establish a useful function of the affected limb. Even with extensive peri-articular bone loss and severe deformities, arthrodesis in a functional position can provide effective stability. The reported fusion rates in such patients are not encouraging however, and secondary amputations have been reported. Compression arthrodesis using an Ilizarov external fixation frame was performed for 17 destroyed feet (14 tibiotalar and 3 subtalar joints) and 6 badly disrupted knees in a series of 20 patients. Evaluation of the results was based on the clinical and radiological joint alignment, achievement of fusion, presence or absence of infection, and functional outcome. One patient after knee joint arthrodesis was lost to follow-up, and two knees had developed a clinically stable fibrous union. Solid fusion was obtained in all other joints. All joints were in anatomical alignment and the patients were fully functional at the time of review. Our experience of using the Ilizarov fixation frame for achieving joint fusion is very rewarding. The results reported hereby justify the further use of this hybrid frame as an effective mechanical method to achieve bony joint fusion without bone grafts, and to ensure a low failure rate.

Compound high-energy limb fractures with delayed union: our experience with adjuvant ultrasound stimulation (exogen).

The use of low intensity pulsed ultrasound accelerates cortical and cancellous bone fracture healing. Seventeen patients with eighteen high-energy fractures of the long bones were treated with low intensity pulsed ultrasound supplementation to surgical skeletal stabilization and tissue flaps. Sixteen fractures were healed within 13-52 weeks after starting ultrasound supplementation despite severe soft-tissue injuries and varying degrees of tissue loss. This method may be useful in the combined treatment of high-energy limb injuries.

Treatment of nonunions with irretrievable broken nail pieces in the distal fragment.

INTRODUCTION: We present our experience in the treatment of nonunited fractures of long bones in the presence of a retained fragment of the broken intramedullary nail. MATERIALS AND METHOD: Of 287 long bone fractures treated by intramedullary fixation, we recalled 5 patients with broken intramedullary nails. In two patients the distal fragments of broken nails were not extracted and refixation was performed by an Ilizarov ring fixation with the broken piece left in situ. RESULTS: The patients ambulated with full weight bearing immediately following surgery. We achieved good results in both patients with fracture union times between 16 and 22 weeks. No complication was observed. CONCLUSIONS: Ring fixation using thin wires or half pins inserted beside fragments of the broken nail provides a simple and minimally traumatic method of treatment in patients when encountering difficulties extracting a retained fragment of broken intramedullary nails.

Hybrid thin wire external fixation: an effective, minimally invasive, modular surgical tool for the stabilization of periarticular fractures.

Hybrid thin wire external fixation is an effective, minimally invasive treatment for the stabilization of periarticular, supracondylar, and pilon fractures. The extent of bone and soft-tissue loss, high risk of infection, and further damage to the soft tissues precludes open reduction and internal fixation as a safe treatment method. External fixation preserves the soft-tissue envelope with minimal damage and allows fracture stabilization, early loading, and mobilization, which promote bone healing.

The diabetic foot: update on a common clinical syndrome.

A cross-sectional study was conducted in 3995 non-hospitalized diabetic patients to evaluate symptoms commonly associated with "diabetic foot" syndrome. Each patient was examined twice over 2 years during routine follow-up. The male/female ratio differed significantly between the study group and general population. Men were more prevalent in the diabetic group up to age 49 years. Thereafter, the proportion of females increased. The clinical signs present in various combinations in those with diabetic feet were dermatological findings, foot and toe deformities, open wounds and ulcerations, pulselessness, and neurological deficiencies. The female/male ratio for each symptom was significantly higher for women except for ulcerations, which were more common in men.

Minimally invasive surgical techniques for the reconstruction of calcaneal fractures.

The soft tissues play a crucial part in both the stabilization of the multiple joint surfaces of the calcaneus and in allowing propulsion as needed. Therefore, minimally invasive functional stabilization of heel bone fracture is a promising technique, which may bypass all published controversies. Experience has shown that ligamentotaxis, which means the use of mechanical forces applied to the soft-tissue envelope of fractures without the surgical disruption of the latter, contributes to fracture healing and reconstruction. Therefore, based on our results, minimally invasive techniques are useful and promising in calcaneal fracture treatment.