Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing.

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis.

Operative management of unstable ankle fractures in the elderly: our institutional experience.

Ankle fractures represent an exceptionally common injury within the elderly population. The total incidence of ankle fractures has been reported to be up to 184 fractures per 100,000 persons per year, of which 20 to 30 percent occur in the elderly. This study reports the results of operative management of ankle fractures in the elderly, with regard to functional outcome and complication rates. This was a retrospective, non-randomized observational study. Subjects were identified from a trauma registry kept in our Department and were tested for eligibility. Patients were then categorized into two groups according to their age: Group A included all patients less than 65 years of age and Group B included all patients over the age of 65. The outcome was measured using the AOFAS Ankle-Hindfoot score and a Linear analog scale. A total of 120 consecutive patients fulfilled the eligibility criteria and were included in our study (60 patients in each group). We detected statistically significant difference between the LAS score of the two groups (p=0.02), the alignment between the two groups (p=0.04) and the AOFAS score versus LAS score in Group B (p=0.03). Two patients from Group B had wound dehiscence, but finally their wounds healed uneventfully. We didn't observe any serious complications such as skin necrosis, deep infection, osteomyelitis and failure of metalwork. Our study suggests that the operative management of Weber B2 and B3 injuries can result in a favorable outcome. It is however of great importance that there are no delays in treatment, that the reduction is anatomical, that the fracture fixation is satisfactory and that the rehabilitation is commenced early.

A plea for Croatian trauma system.

This paper provides an insight into Croatian health system with special focus on trauma care. The current situation is explained from a domestic point of view, but an independent review by foreign observers is also included. Fragmented approach to the treatment of injured patients in Croatia should be replaced by networking of health care componenets into a unique chain of help. The concept and five methodological steps in the development of a succesfull trauma system are presented. A good start is definitely a reorganization of existing knowledge on the basis of internationally licesed courses and the adoption of trauma registry as a standard for future discussion. Individual components of the trauma system can not be separately "optimized" so clinical and financial decisions should be planned exclusively on the integral level.

Transfixed condylar plate (TCP) provides better biomechanical and weight bearing possibilities for the fixation of trochanteric fracture.

The goal of this research was to find the implant which would provide a better possibility of the fractured osteoporotic bone weight bearing after trochanteric fracture fixation. The authors constructed a new implant based on the conventional condylar plate, as part of a stabile triangular system. Because of the special oblique form of the screw which absolutely stabilizes vertical and horizontal arm of the plate, this plate was named the transfixed condylar plate (TCP). Analysis showed 6 kN of tolerant loading elastic in TCP with a longer horizontal arm, while this value in the conventional condylar plate was 2.5 kN. Also, dynamic resistance was 2.4 times higher in TCP then in the control model. These improved biomechanical results of this plating fixation system are expected to be found in the clinical use of this plate. This would enhance an early rehabilitation and a better functional outcome.