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Sample records for fracture healing nonunion

  1. Teriparatide treatment of femoral fracture nonunion that autogenous bone grafting failed to heal: a case report.

    Science.gov (United States)

    Yu, Wei; Guo, Xiaodong

    2017-12-01

    Management of fracture nonunion is challenging as another surgical intervention for the patient is often a necessity, which has a huge impact on both quality of life and economic burden of the patient. Thus, a less aggressive and better accepted treatment for nonunion is required. We gave teriparatide to a 45-year-old man with femoral fracture nonunion 1 year after he underwent surgery with autogenous bone grafting that failed to heal his initial nonunion. Successful union was obtained after once-daily administration of teriparatide for 9 months. Our case showed teriparatide could successfully treat a femoral fracture nonunion that autogenous bone grafting failed to heal. Teriparatide may provide an alternative treatment for fracture nonunion.

  2. Extracorporeal shock wave therapy for non-unions and delayed fracture healing

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    Schaden, Wolfgang; Fischer, Andreas; Sailler, Andreas; Karadas, Ender

    2005-04-01

    Although the primary management of fractures is highly developed in Central Europe 1% of fractures develop a non-union. After successful pilot studies the Traumacenter Meidling started in December 1998 to treat non-unions regularly with shock wave therapy. From December 1998 to August 2004, 1153 patients with non-union and delayed healing fractures were treated. The results of 755 patients are available up to September 2004. The patients consisted of 250 (33%) female and 505 (67%) male. The mean age was 44.1 years (10; 90). The mean age of the non-union was 15.5 months. In 74 (10%) osteomyelitis was present before shockwave therapy. Out of 755 non-unions 593 (79%) achieved bony healing. As expected, the subgroup of 284 delayed unions (shockwave therapy 3-6 months after the trauma or the last surgery concerning the bone) showed the best results. 245 (86%) healed. Out of 471 non-unions being older than 6 months 348 (72%) achieved bony healing. Because of the efficacy and the lack of complications as well as the economic advantage in comparison to surgery, shockwave therapy is considered as therapy of first choice in the treatment of non-union and delayed healing fractures.

  3. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  4. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  5. Time-dependent changes in bone healing capacity of scaphoid fractures and non-unions.

    Science.gov (United States)

    Schmidle, Gernot; Ebner, Hannes Leonhard; Klima, Günter; Pfaller, Kristian; Fritz, Josef; Hoermann, Romed; Gabl, Markus

    2018-02-27

    The scaphoid is the most frequently fractured carpal bone and prone to non-union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non-union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate-resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = -0.427, P = 0.026) and decreasing healing activity for the gap region (r = -0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non-unions

  6. [Non-unions. From diagnosis to healing].

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    Steinhausen, E; Glombitza, M; Böhm, H-J; Hax, P-M; Rixen, D

    2013-07-01

    Non-unions are a relevant medical and socio-economic problem. Hyper-, oligo- and atrophic non-unions as well as septic and aseptic non-unions are differentiated. Correct classification is essential for the selected therapy. The "diamond concept" describes five pillars, on which bone healing is based and that have to be considered in the treatment of non-unions: osteogenic cells (mesenchymal stem cells), osteoinduction (growth factors), osteoconduction (scaffolds), mechanical stability, and vascularization. Factors that predispose to non-union also influence fracture healing. The gold standard of therapy are still resection of the non-union, decortication and autologous bone grafting. No advantage could be proven for any of the numerous procedures in monotherapy. But the combination of various procedures - polytherapy - seems to be promising. The aim is to optimize these concepts.

  7. Teriparatide as a nonoperative treatment for tibial and femoral fracture nonunion: A case report.

    Science.gov (United States)

    Xiaofeng, Li; Daxia, Xu; Yunzhen, Chen

    2017-04-01

    Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. Fracture nonunion of the right tibia and left femur. The patient received systemic treatment with teriparatide (recombinant human Parathyroid Hormone 1-34) 20 μg/d for 8 months, with further observation at 4 months after discontinuation. During treatment, bone metabolic markers were measured to evaluate metabolic activity of osteoblasts and osteoclasts. The Ethics Committee of Qilu Hospital of Shandong University approved this study. Satisfactory healing of fracture nonunion was obtained without further intervention. Anabolic treatment with teriparatide showed a positive effect on healing of fracture nonunion. Evaluation of bone metabolic markers during treatment is necessary to observe the curative effect. In view of the positive effect of teriparatide on healing of fracture nonunion in numerous animal models and clinical studies, it may be a promising alternative treatment for fracture nonunion in patients who are not suitable for surgical intervention.

  8. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

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    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  9. Non-Union in Upper Limb Fractures - Clinical Evaluation and Treatment Options.

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    Neumann, M V; Zwingmann, J; Jaeger, M; Hammer, T O; Südkamp, N P

    2016-01-01

    Although non-unions in the upper limb are rare different treatment options of this challenging situation are still affected with up to 20% of failure rate due to current literature. Risk factors for delayed and non-union of fractures are mainly the size of the fracture gap and bone loss of open fractures or in primary surgery followed by other relevant internal and external factors. In the upper limb non-unions of long bones are described with up to 30% after operative intervention. Especially in the upper limb range of motion is limited in non-union cases and disables adjacent joints like the shoulder, elbow and wrist hence reducing the total activity level of affected patients. Beside careful investigation of the causes leading to the non-union a comprehensive treatment plan should be defined to achieve successful results. Treatment can be non-operative in several, selected cases, but in the majority of cases revision surgery is necessary to achieve osseous healing. Our own experience showed that non-union in the upper limb are rare and account for only 1.7% of all surgical managed upper limb fractures. Non-union of upper limb fractures occur most frequently in clavicle fractures followed by humeral fractures. Atrophic non-union is the most frequent reason for osseous non-union (57%) and osseous healing after revision surgery in non-unions is completed after a mean of 6.45 months. This article will give a brief overview of the genesis, clinical evaluation, treatment options and recommendations in upper limb non-unions according to the current literature. Key words: fracture, upper-limb, non-union, osteosynthesis, cancellous bone-graft.

  10. Co-expression of BMPs and BMP-inhibitors in human fractures and non-unions.

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    Kloen, Peter; Lauzier, Dominique; Hamdy, Reggie C

    2012-07-01

    Bone morphogenetic proteins (BMPs) are increasingly being used clinically to enhance fracture repair and healing of non-unions. However, the potential efficacy of supraphysiological dosing for clinical results warrants further clarification of the BMP signaling pathway in human fracture healing. As BMP signaling can be fine-tuned at numerous levels, the role of BMP-inhibitors has become a major focus. The aim of the present study was to document co-expression of BMPs, pSmad 1/5/8, and BMP-inhibitors in human fracture callus and human non-unions. Using human tissue of fracture callus (n=14) and non-unions (n=4) we documented expression of BMPs (BMP2, BMP3 and BMP7), pSmad 1/5/8 and the BMP-inhibitors noggin, gremlin, chordin, Smad-6, Smad-7 and BAMBI. Co-expression of pSmad 1/5/8, BMPs and BMP-inhibitors was noted in the osteoblasts of fracture callus as well as of non-unions. Expression of BMP-inhibitors was generally stronger in non-unions than in fracture callus. The most pertinent differences were noted in the cartilaginous tissue components. Expression of BMP2 in chondrocytes was markedly decreased in non-unions compared to fracture callus and that of BMP7 was almost completely absent. Expression of BMP-inhibitors was almost the same in osteoblasts, chondrocytes and fibroblasts of fracture callus and well as in non-unions. Interestingly, although BMP ligands were present in the chondrocytes and fibroblasts of non-unions, they did not co-express pSmad 1/5/8 suggesting that BMP signaling may have been inhibited at some point before Smad 1/5/8 phosphorylation. These results suggest co-expression of BMP, pSmad 1/5/8 and BMP-inhibitors occurs in human fracture callus as well as non-unions but the relative expression of BMPs vs. BMP-inhibitors was different between these two tissue types. In contrast to our expectations, the expression of BMP inhibitors was comparable between fracture callus and non-unions, whereas the expression of BMPs was notably lower in the

  11. Are polymorphisms of molecules involved in bone healing correlated to aseptic femoral and tibial shaft non-unions?

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    Zeckey, Christian; Hildebrand, Frank; Glaubitz, Lena-Marie; Jürgens, Simon; Ludwig, Theresa; Andruszkow, Hagen; Hüfner, Tobias; Krettek, Christian; Stuhrmann, Manfred

    2011-11-01

    Fracture healing is a well-organized process between several molecules and mediators. As known from other diseases, genetic polymorphisms may exhibit different expression patterns in these mediators. Concerning fracture healing, this may lead to an extended healing process or non-union. We investigated the incidence of polymorphisms in patients with aseptic non-unions after femoral and tibial shaft fractures as compared to patients with uneventful healing. Exclusion criteria were smoking, diabetes, bilateral fractures, systemic corticoid therapy, and septic non-unions. Analysis of allele frequencies and genotype distribution of various mediators were carried out following PCR. Clinical parameters such as injury severity and in-hospital were analyzed. Fifty patients following non-union (group NU) were enrolled, the control group consisted of 44 patients (group H). A significant association of a PDGF haplotype and non-unions following fracture could be observed. There was a significantly increased in-hospital time and amount of surgical procedures in group NU. Polymorphisms within the PDGF gene seem to be a genetic risk factor for the development of non-unions of the lower extremity following fracture. The early identification of high risk patients could result in an adapted therapeutical strategy and might contribute to a significant decrease of posttraumatic non-unions. Copyright © 2011 Orthopaedic Research Society.

  12. The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures.

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    Frank, Tym; Osterhoff, Georg; Sprague, Sheila; Garibaldi, Alisha; Bhandari, Mohit; Slobogean, Gerard P

    2016-06-01

    The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra- and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion. (1) What RUSH score threshold yields at least 98% specificity to diagnose nonunion at 6 months postinjury? (2) Using the threshold identified, are patients below this threshold at greater risk of reoperation for nonunion and for other indications? A representative sample of 250 out of a cohort of 725 patients with adequate 6-month hip radiographs was analyzed from a multinational elderly hip fracture trial (FAITH). All patients had a femoral neck fracture and were treated with either multiple cancellous screws or a sliding hip screw. Two reviewers independently determined the RUSH score based on the 6-month postinjury radiographs and interrater reliability was assessed with the interclass correlation coefficient (ICC). There was substantial reliability between the reviewers assigning the RUSH scores (ICC, 0.81; 95% confidence interval [CI], 0.76-0.85). The RUSH score is a checklist-based system that quantifies four measures of healing: cortical bridging, cortical fracture disappearance, trabecular consolidation, and trabecular fracture disappearance.. Fracture healing was determined by two independent methods: (1) concurrently by the treating surgeon using both clinical and radiographic assessments as per routine clinical care; and (2) retrospectively by a Central Adjudication Committee using complete obliteration of the fracture line on radiographs alone. Receiver operating characteristic tables were used to define a RUSH threshold score that was > 98

  13. A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol

    Directory of Open Access Journals (Sweden)

    Enrique Gómez-Barrena

    2018-01-01

    Full Text Available ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32 to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC treatments versus iliac crest autograft (ICA to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments. The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n=108 will be randomly assigned to either the experimental low dose (n=36, the experimental high dose (n=36, or the comparator arm (n=36 using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

  14. A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol.

    Science.gov (United States)

    Gómez-Barrena, Enrique; Padilla-Eguiluz, Norma G; Avendaño-Solá, Cristina; Payares-Herrera, Concepción; Velasco-Iglesias, Ana; Torres, Ferran; Rosset, Philippe; Gebhard, Florian; Baldini, Nicola; Rubio-Suarez, Juan C; García-Rey, Eduardo; Cordero-Ampuero, José; Vaquero-Martin, Javier; Chana, Francisco; Marco, Fernando; García-Coiradas, Javier; Caba-Dessoux, Pedro; de la Cuadra, Pablo; Hernigou, Philippe; Flouzat-Lachaniette, Charles-Henri; Gouin, François; Mainard, Didier; Laffosse, Jean Michel; Kalbitz, Miriam; Marzi, Ingo; Südkamp, Norbert; Stöckle, Ulrich; Ciapetti, Gabriela; Donati, Davide Maria; Zagra, Luigi; Pazzaglia, Ugo; Zarattini, Guido; Capanna, Rodolfo; Catani, Fabio

    2018-01-01

    ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 10 6 hBM-MSCs is noninferior to that of 200 × 10 6 hBM-MSCs. The participants ( n = 108) will be randomly assigned to either the experimental low dose ( n = 36), the experimental high dose ( n = 36), or the comparator arm ( n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

  15. Physiology of fracture healing: New aspects

    OpenAIRE

    Gajdobranski Đorđe R.; Živković Dragana 1

    2003-01-01

    Introduction Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding p...

  16. Nonunion of forearm fracture: a rare instance in a toddler

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    Saini Pramod

    2012-12-01

    Full Text Available 【Abstract】 When compared to adults, pediatric frac-tures unite readily and nonunion is quite rare. Nonunion is often associated with open fractures, operative interventions, infection, pediatric osteogenesis imperfecta and neurofibromatosis. There are only a few studies and reports mentioning nonunion following conservative ma-nagement of closed pediatric fractures. We report here a case of an eighteen-month-old child who developed non-union following treatment of fracture of both forearm bones with cast and was successfully treated with plating. To the best of our knowledge, this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture. Key words: Forearm; Fractures, bone; Child

  17. Extracorporeal shockwave therapy (ESWT)--First choice treatment of fracture non-unions?

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    Schaden, Wolfgang; Mittermayr, Rainer; Haffner, Nicolas; Smolen, Daniel; Gerdesmeyer, Ludger; Wang, Ching-Jen

    2015-12-01

    Fracture non-unions are still a challenging problem in orthopedics. The treatment of non-unions remains highly individualized, complex, and demanding. In most countries the surgical approach with debridement of the non-union gap, anatomical reduction and appropriate osteosynthesis along with autologous bone grafting is considered as the standard of care. One of the very first non-urologic applications of extracorporeal shockwave treatment (ESWT) concerned non-healing fractures. Since the early 1990ties the knowledge of the working mechanism has increased enormously. The purpose of this review article is to demonstrate by peer-reviewed literature in conjunction with our own experiences that ESWT can be an efficient, non-invasive, almost complication-free and cost effective alternative to surgical treatment of non-healing fractures. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Muscle-bone Interactions During Fracture Healing

    Science.gov (United States)

    2015-03-01

    fracture heal - ing. The rate of delayed union or non-union in tibial fractures with associated compartment syndrome was 55...complications of open tibial shaft fractures stratified as per the Gustilo–Ander- son classification. Injury 2011;42:1408-15. 121. Giannoudis PV, Harwood PJ...Kontakis G, et al. Long- term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture , grade

  19. Successful Bone Healing of Nonunion After Ulnar Shortening Osteotomy for Smokers Treated With Teriparatide.

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    Uemura, Takuya; Okada, Mitsuhiro; Yokoi, Takuya; Shintani, Kosuke; Nakamura, Hiroaki

    2015-08-01

    Ulnar shortening osteotomy is widely performed as the standard surgical treatment for ulnar impaction syndrome and has a high percentage of success for pain relief. However, delayed union and nonunion of the osteotomy site remain the most concerning complications. In particular, smokers have a higher incidence of nonunion, which amounts to 30% of cases. For the treatment of nonunion, secondary surgical interventions such as bone grafting will be necessary but are extremely challenging. Recently, teriparatide (recombinant human parathyroid hormone [PTH 1-34]) administration has been reported in several clinical studies as a noninvasive pharmacological systemic treatment for fracture healing or nonunion. The authors present 2 cases of smokers, a 62-year-old man and a 42-year-old woman, with nonunion after ulnar shortening osteotomy and fixation with 6-hole non-locking plate for ulnar impaction syndrome. For treatment of nonunion, noninvasive therapy with teriparatide (20-µg, subcutaneous injection) in addition to low-intensity pulsed ultrasound was underwent. In both cases, partial bone union began to be observed on radiographs after the first 4 weeks of teriparatide administration and successful bone healing without additional surgical interventions was achieved after 10 and 6 months of treatment with teriparatide, respectively. The current case reports showed that non-invasive combination therapy of teriparatide and low-intensity pulsed ultrasound were a possible alternative to surgical intervention. In the future, teriparatide therapy might be applied actively to patients who have risk factors for delayed union, such a heavy smoking habit, and are expected to experience nonunion after ulnar shortening osteotomy. Copyright 2015, SLACK Incorporated.

  20. Anteroinferior plating of midshaft clavicle nonunions and fractures

    NARCIS (Netherlands)

    Kloen, Peter; Werner, Clément M. L.; Stufkens, Sjoerd A. S.; Helfet, David L.

    2009-01-01

    OBJECTIVE: Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal. INDICATIONS: Midshaft clavicle nonunions. Midshaft clavicle fractures. Clavicle malunions

  1. Ilizarov′s method for treatment of nonunion of diaphyseal fractures of the humerus

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    Kiran Manish

    2010-01-01

    Full Text Available Background: Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov′s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov′s method was analyzed. Materials and Methods: Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov′s external fixator. These included nonunion after plating (n=11, intramedullary nailing (n=1 or conservative methods (n=7. In post-surgical infected nonunion (n=6, the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13, distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status. Results: Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%. The bone healing results were excellent in eighteen cases (94.73% and good in one case (5.26%.The functional results were found to be excellent in fourteen cases (73.68%, good in four (21.05% and fair in one case (5.26%. Conclusion: Ilizarov′s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.

  2. [Tibia nonunion after intramedullar nailing for fracture: decortication and osteosynthesis by medial plating].

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    Piriou, P; Martin, J-N; Garreau de Loubresse, C; Judet, T

    2005-05-01

    Intramedullar nailing is now widely used for fractures of the tibia. Extension of nailing indications to proximal, distal, and comminuted fractures has led to a significant rate of complications. The purpose of this study was to analyze decortication and medial plating for the treatment of tibial nonunion after intramedullary nailing. Eighteen cases of aseptic tibial nonunion after nailing for fracture were treated in three women and fifteen men, mean age 39 years (19-57). The initial classification was open (n = 8), segmental (n = 3), single-focus (n = 15). The fracture site was inferior (n = 6), middle (n = 7), and superior (n = 2). Primary nailing used reaming in 15 cases (83%), unreamed in 3 (17%) static in 13 and dynamic in 5. Four plaster cabts were also applied. Complications were: infection (n = 1), compartmental syndrome (n = 2), tibial nerve palsy (n = 1), dysesthesia (n = 2), and protrusion of the nail into the knee (n = 1). Dynamization was performed in 11 patients, one with additional bone graft and fibulectomy. Repeated reamed nailing was performed in one patient. Seven nonunions were atrophic and 11 were hypertrophic. There were 13 malpositionings associated with the nonunion. Treatment of the nonunion was performed 300 days on average (90-900) after nailing: cancellous bone graft was associated with decortication in four cases because of bone loss (n = 3) or atrophic nonunion (n = 1). Union rate was 94%. Mean time for union was 108 days (80-180) with no significant difference (Student t-test) between atrophic (119 days) and hypertrophic (103 days) nonunion. Correction of the malposition was incomplete in seven patients, with angular malunion of less than 6 degrees in five patients and greater than 10 degrees in two. One late infection occurred and finally healed after external fixation and antibiotic therapy. No skin necrosis occurred. Five patients had pain on the hardware. Removal was performed in one time and pain resolved. Improvement of knee

  3. Stress Fracture and Nonunion of Coronoid Process in a Gymnast

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    T. Hetling

    2016-01-01

    Full Text Available Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

  4. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

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    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  5. Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures.

    Science.gov (United States)

    Tay, Wei-Han; de Steiger, Richard; Richardson, Martin; Gruen, Russell; Balogh, Zsolt J

    2014-10-01

    Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union. An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury. 285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant. Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion. Despite modern

  6. Use of stem-cell sheets expressing bone morphogenetic protein-7 in the management of a nonunion radial fracture in a Toy Poodle.

    Science.gov (United States)

    Song, Jaeyong; Kim, Yongsun; Kweon, Oh-Kyeong; Kang, Byung-Jae

    2017-12-31

    A 12-year-old castrated Toy Poodle was referred to the Kangwon National University Animal Hospital with an oligotrophic nonunion fracture in the distal 1/3 of the left radius and an intact ulna. After fixation by a locking plate and screws, adipose-derived mesenchymal stem-cell sheets expressing bone morphogenetic protein 7 (BMP-7) were transplanted to the fracture site to enhance the healing activity. The fracture was healed at 9 weeks after surgery. In the present case, the mesenchymal stem-cell sheets expressing BMP-7 promoted bone regeneration and healing in a nonunion fracture.

  7. Genetic polymorphisms of NOS2 and predisposition to fracture non-union: A case control study based on Han Chinese population.

    Science.gov (United States)

    Huang, Wei; Zhang, Kun; Zhu, Yangjun; Wang, Zhan; Li, Zijun; Zhang, Jun

    2018-01-01

    A non-union, especially atrophic non-unions, is a permanent failure of healing following a fracture and can be difficult to treat. Approximately 5-10% of fractures will result in a non-union during the healing process. non-unions can be classified into two types: atrophic non-union which is often due to impaired bone healing with a potential biological mechanism, and hypertrophic non-union which is due to inadequate fixation after fracture. Genetic variations also play an important role in the fracture healing response. Previous studies based on animal models have indicated that NOS2 might be greatly involved in the bone fracture healing process. In this case-control study, 346 nonunion patients were compared to 883 patients with normal fracture healing to investigate the potential genetic association between NOS2 and the fracture healing process using study subjects of Chinese Han ancestry. Twenty-seven single nucleotide polymorphisms (SNPs) covering NOS2 were genotyped in our study subjects and analyzed. In addition to the single marker-based analysis, we performed a gene-by-environment analysis to examine the potential interactions between genetic polymorphisms and some environmental factors. SNP rs2297514 showed significant association with the fracture healing process after adjusting for age and gender (OR = 1.38, P = 0.0005). Our results indicated that the T allele of rs2297514 significantly increased the risk of a non-union during the fracture healing process by 38% compared to the C allele. Further stratification analyses conducted for this SNP using data from subgroups classified by different sites of fracture indicated that significance could only be observed in the tibial diaphysis subgroup (N = 428, OR = 1.77, P = 0.0007) but not other groups including femur diaphysis, humeral shaft, ulnar shaft, and femur neck. Gene-by-environment interaction analyses of the three environmental factors showed no significant results. In this study, rs2297514 was

  8. Augmentation of bone healing in delayed and atrophic nonunion of fractures of long bones by partially decalcified bone allograft (decal bone

    Directory of Open Access Journals (Sweden)

    Anuj Jain

    2015-01-01

    Conclusion: The partially decalcified bone allograft is an effective modality for augmentation of bone healing without complication associated with autograft like donor site morbidity, increased blood loss and increase in the surgical time.

  9. Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2.

    Science.gov (United States)

    Massie, Anna M; Kapatkin, Amy S; Fuller, Mark C; Verstraete, Frank J M; Arzi, Boaz

    2017-03-20

    To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of nonunion long-bone fractures in dogs. A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases. Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7-20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up. Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

  10. Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius.

    Science.gov (United States)

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients' data, healing rates, and factors influencing scaphoid healing were analyzed. The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation. In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole.

  11. Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome.

    Science.gov (United States)

    Schoierer, Oliver; Bloess, Konstantin; Bender, Daniel; Burkholder, Iris; Kauczor, Hans-Ulrich; Schmidmaier, Gerhard; Weber, Marc-André

    2014-02-01

    To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS). Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans, K ep, iAUC and V e were correlated with union at CT 1 year later (n = 49). Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9%/50.0 % compared to 96.8%/33.3% using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans, K ep and Ve within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19). DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome. • Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within bony non-unions. • Vascularised ununited fractures appear better at 1-year CT than poorly vascularised fractures. • Non-union healing after osteosynthesis or osteoinductive drugs fundamentally requires vascularity. • DCE MRI predicts treatment outcome better than the clinical Non-Union Scoring System. • DCE MRI is clinically feasible to predict treatment outcome in bony non-unions.

  12. Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

    Science.gov (United States)

    Chalidis, Byron E; Petsatodis, George E; Sachinis, Nick C; Dimitriou, Christos G; Christodoulou, Anastasios G

    2009-10-01

    The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions.

  13. Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures.

    Science.gov (United States)

    Kuo, Shu-Jui; Su, I-Chang; Wang, Ching-Jen; Ko, Jih-Yang

    2015-12-01

    As of now, the role of extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions is inconclusive. The purpose of the study was to investigate the effectiveness of ESWT and the role of this technology in the treatment of atrophic non-union of femurs. We retrospectively analyzed 22 patients treated between July 1999 and September 2007 in our hospital with ESWT for atrophic non-unions of isthmic femoral shaft fractures that were initially treated surgically using closed reamed nailing procedure. Patients with open fractures, skeletal immaturity, on anti-osteoporotic medications, with infections, pathological fractures, smokers, with systemic disease compromising bone healing, and excessive deformity were excluded from this study. Due to incomplete follow-up one (1) patient who moved abroad after ESTW treatment was not included in this study and as part of the 22-patients cohort. Radiographs were obtained before treatment and once a month after treatment for 12 months. Using ESWT we showed that 14 fractures out of 22 (63.6%) achieved bony union with an average union time of 9.2 months (range 6-13 months). The union rate was 100% (8 of 8 cases) when ESWT was performed within 12 months from closed reamed nailing surgery versus 42.9% (6 of 14 cases) when ESWT was performed after 12 months from initial surgery. The eight (8) patients out of the total 22 patients cohort, who did not achieve bony union after ESWT, received subsequent treatment with bone grafting with augmentative plating surgery and all achieved bony union within 5 months after intervention. For patients with atrophic non-unions of femoral shaft fractures, ESWT can be used as an alternative and effective non-invasive method of treatment. ESWT treatment does not negatively influence/compromise previous surgeries and if needed it can be followed by additional surgeries without any complications. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  14. Lower extremity fractures in patients with spinal cord injury Characteristics, outcome and risk factors for non-unions.

    Science.gov (United States)

    Grassner, Lukas; Klein, Barbara; Maier, Doris; Bühren, Volker; Vogel, Matthias

    2017-05-25

    Sublesional osteoporosis is an important sequel after spinal cord injury (SCI) resulting in a high incidence of fractures and impaired osseous healing due to altered bone metabolism. The following study aims to identify demographic characteristics and outcome of patients with SCI with lower extremity fractures. Retrospective observational study. Level-I cross-regional trauma center. All patients with SCI suffering from osteoporotic/pathologic fractures during an 11-year-period (01/2003-12/2013) at the Center for Spinal Cord Injuries (Trauma Center Murnau) were analyzed via a chart review. Demographics, surgical and radiologic outcome as well as complication rate were assessed with a special emphasis on union rates and independent risk factors for non-unions. We identified 132 patients (105 males) who fulfilled the inclusion criteria. Most of them were paraplegic (n=101) and showed motor complete syndromes (n=119). Supracondylar femur fractures were the most prevalent in this study (n=47). We observed a non-union rate of 15.9% (n=21). The development of pseudarthrosis was associated with the time interval since the initial SCI (P union, regardless of their management (conservative or surgical). The following independent predictors for non-unions were identified: fracture localization (P unions remain a common complication in patients with SCI. Risk factors for non-unions of lower extremity fractures are identified.

  15. Outcome of management of humerus diaphysis non-union | Sitati ...

    African Journals Online (AJOL)

    Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a ...

  16. Use of Porcine Cancellous Bone Graft of Radial Nonunion Fracture in a Dog

    Directory of Open Access Journals (Sweden)

    S. Y. Heo, H. B. Lee, M. S. Kim and N. S. Kim*

    2012-06-01

    Full Text Available A 6-month, 1.3 kg, Yorkshire terrier was referred for treatment of a radial nonunion fracture. The nonunion fracture site had a 40 mm-long defect between both fracture ends, where a porcine cancellous bone graft was implanted. The surgical treatment of the nonunion fracture was accomplished using an external fixator and polymethylmethacrylate (PMMA. The dog had a successful clinical outcome, and a radiographic examination conducted at post-surgery week 16 revealed the incorporation of the porcine cancellous bone graft and the nonunion fracture site by newly formed bone, resulting in a complete union. Porcine cancellous bone graft should be considered as an alternative option to autografts when treating nonunion fractures with segment bones defects.

  17. Incidence, Risk Factors, and Definition for Nonunion in Pediatric Lateral Condyle Fractures.

    Science.gov (United States)

    Pace, J Lee; Arkader, Alexandre; Sousa, Ted; Broom, Alexander M; Shabtai, Lior

    Lateral condyle fractures are a common pediatric elbow injury. Nonunion is a known complication of this injury but its incidence and causative risk factors are unknown. Further, a clear and consistent definition of nonunion for pediatric lateral condyle fractures does not exist. The purpose of this study is to determine the rate of nonunion, the risk factors associated with it and to provide a clear definition. A retrospective chart review of all pediatric lateral condyle fractures treated at an urban, tertiary pediatric care center between 2001 and 2014. Data collected included demographics, Weiss classification, type of treatment, follow-up, time from injury to surgery and complications. For patients with nonunions, additional treatments and final range of motion were also recorded. A nonunion was defined as lack of callus with fragment migration by 8 weeks after initiation of treatment. A total of 530 patients were identified of which 500 were available for review. There were 7/500 (1.4%) nonunions in the cohort. Nonunion occurred in 1.4% (2/140) of type I fractures, 0% (0 /178) of type II fractures, and 3% (5/168) of type III fractures. The only significant risk factor for nonunion was the presence of a type III fracture (P=0.05). Five patients with nonunion underwent revision surgery with a partially threaded cannulated cancellous screw. All of these patients went on to union. Four of the 5 patients had their screws removed after union. Nonunion after pediatric lateral condyle fracture is rare and is defined by lack of any callus with fragment migration at 8 weeks. The only significant risk factor for nonunion development was the presence of a type III fracture. Revision surgery with a partially threaded screw achieved union in all cases. Level IV-retrospective case review.

  18. Local drug delivery for enhancing fracture healing in osteoporotic bone.

    Science.gov (United States)

    Kyllönen, Laura; D'Este, Matteo; Alini, Mauro; Eglin, David

    2015-01-01

    Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  19. Bisphosphonates and their influence on fracture healing: a systematic review.

    Science.gov (United States)

    Molvik, H; Khan, W

    2015-04-01

    Bisphosphonates are commonly used in osteoporosis, but concerns have been raised about possible negative effects on fracture healing. We systematically reviewed the literature and found that bisphosphonates significantly prolong union times of distal radius fractures but not femoral fractures. The timing of bisphosphonate introduction does not affect fracture union time. Bisphosphonates are the most commonly prescribed drugs in patients suffering from and at higher risk of developing osteoporosis. However, concerns have been raised as to whether these drugs have a negative effect on fracture healing. The aim of this systematic review is to explore further these concerns. A literature review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All relevant articles found via MEDLINE, Cochrane, CINAHL, EMBASE and Google Scholar were screened. Studies with information on bisphosphonates' effect on fracture healing in humans were included and systematically reviewed. Patients with distal radius fractures on bisphosphonates had a significantly longer union time compared with controls, but not patients with femoral fractures. No correlation between timing of bisphosphonate introduction and union time for fractures was found. Although one study reported a higher humeral non-union associated with bisphosphonate introduction following the fracture, there was no evidence that bisphosphonate introduction, timing or dose resulted in a significant delay in union following other fractures. This systematic review has shown that bisphosphonates significantly prolong union times of distal radius fractures. Some clinical findings are in contrast with preclinical studies highlighting the need to develop better animal models to study osteoporosis, treatment and fracture healing. There is also a need for more well-constructed studies looking at the clinical effect of bisphosphonate on fracture healing in a large number

  20. Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats.

    Science.gov (United States)

    Minkwitz, Susann; Faßbender, Mirja; Kronbach, Zienab; Wildemann, Britt

    2015-01-01

    Impaired bone healing can have devastating consequences for the patient. Clinically relevant animal models are necessary to understand the pathology of impaired bone healing. In this study, two impaired healing models, a hypertrophic and an atrophic non-union, were compared to physiological bone healing in rats. The aim was to provide detailed information about differences in gene expression, vascularization and histology during the healing process. The change from a closed fracture (healing control group) to an open osteotomy (hypertrophy group) led to prolonged healing with reduced mineralized bridging after 42 days. RT-PCR data revealed higher gene expression of most tested osteogenic and angiogenic factors in the hypertrophy group at day 14. After 42 days a significant reduction of gene expression was seen for Bmp4 and Bambi in this group. The inhibition of angiogenesis by Fumagillin (atrophy group) decreased the formation of new blood vessels and led to a non-healing situation with diminished chondrogenesis. RT-PCR results showed an attempt towards overcoming the early perturbance by significant up regulation of the angiogenic regulators Vegfa, Angiopoietin 2 and Fgf1 at day 7 and a further continuous increase of Fgf1, -2 and Angiopoietin 2 over time. However µCT angiograms showed incomplete recovery after 42 days. Furthermore, lower expression values were detected for the Bmps at day 14 and 21. The Bmp antagonists Dan and Twsg1 tended to be higher expressed in the atrophy group at day 42. In conclusion, the investigated animal models are suitable models to mimic human fracture healing complications and can be used for longitudinal studies. Analyzing osteogenic and angiogenic signaling patterns, clear changes in expression were identified between these three healing models, revealing the importance of a coordinated interplay of different factors to allow successful bone healing.

  1. Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats.

    Directory of Open Access Journals (Sweden)

    Susann Minkwitz

    Full Text Available Impaired bone healing can have devastating consequences for the patient. Clinically relevant animal models are necessary to understand the pathology of impaired bone healing. In this study, two impaired healing models, a hypertrophic and an atrophic non-union, were compared to physiological bone healing in rats. The aim was to provide detailed information about differences in gene expression, vascularization and histology during the healing process. The change from a closed fracture (healing control group to an open osteotomy (hypertrophy group led to prolonged healing with reduced mineralized bridging after 42 days. RT-PCR data revealed higher gene expression of most tested osteogenic and angiogenic factors in the hypertrophy group at day 14. After 42 days a significant reduction of gene expression was seen for Bmp4 and Bambi in this group. The inhibition of angiogenesis by Fumagillin (atrophy group decreased the formation of new blood vessels and led to a non-healing situation with diminished chondrogenesis. RT-PCR results showed an attempt towards overcoming the early perturbance by significant up regulation of the angiogenic regulators Vegfa, Angiopoietin 2 and Fgf1 at day 7 and a further continuous increase of Fgf1, -2 and Angiopoietin 2 over time. However µCT angiograms showed incomplete recovery after 42 days. Furthermore, lower expression values were detected for the Bmps at day 14 and 21. The Bmp antagonists Dan and Twsg1 tended to be higher expressed in the atrophy group at day 42. In conclusion, the investigated animal models are suitable models to mimic human fracture healing complications and can be used for longitudinal studies. Analyzing osteogenic and angiogenic signaling patterns, clear changes in expression were identified between these three healing models, revealing the importance of a coordinated interplay of different factors to allow successful bone healing.

  2. Cement Calcaneoplasty: An Innovative Method for Treating Nonunion in Calcaneal Insufficiency Fracture.

    Science.gov (United States)

    Godavitarne, Charles; Fawzy, Ernest; Giancola, Giorgio; Louette, Luc

    2016-01-01

    Insufficiency type stress fractures are common in older patients with osteoporosis. Persistent pain after nonunion of these fractures can be disabling, with the management options often limited. We aimed to assess the suitability of fluoroscopic-guided injection of bone cement into a persistently symptomatic nonuniting calcaneal insufficiency fracture. To the best of our knowledge, this technique has not previously been described in the published data. After local subcutaneous anesthesia, the midpoint of the fracture site was accessed by trocar insertion under radiographic guidance, and bone cement was injected directly into the site. A preprocedure visual analog scale pain score of 90 of 100 was recorded. This had improved to 0 of 100 at the 12-month follow-up point after the procedure. The aim of the present case report was to raise awareness of percutaneous calcaneoplasty, which we believe to be a safe and well-tolerated technique for the management of osteoporotic insufficiency fracture of the calcaneus. We propose that this technique be considered when conservative methods aimed at promoting fracture healing have failed. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. [{sup 18}F]FDG PET accurately differentiates infected and non-infected non-unions after fracture fixation

    Energy Technology Data Exchange (ETDEWEB)

    Wenter, Vera; Albert, Nathalie L.; Brendel, Matthias; Fendler, Wolfgang P.; Bartenstein, Peter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Cyran, Clemens C. [University of Munich, Institute for Clinical Radiology, Munich (Germany); Friederichs, Jan; Mueller, Jan-Philipp; Militz, Matthias; Hungerer, Sven [BG Trauma Center Murnau, Department of Reconstructive Arthroplasty, Murnau (Germany); PMU Salzburg, Paracelsus Medical University, Salzburg (Austria); Hacker, Marcus [University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

    2017-03-15

    Complete fracture healing is crucial for good patient outcomes. A major complication in the treatment of fractures is non-union. The pathogenesis of non-unions is not always clear, although implant-associated infections play a significant role, especially after surgical treatment of open fractures. We aimed to evaluate the value of [{sup 18}F]FDG PET in suspected infections of non-union fractures. We retrospectively evaluated 35 consecutive patients seen between 2000 and 2015 with suspected infection of non-union fractures, treated at a level I trauma center. The patients underwent either [{sup 18}F]FDG PET/CT (N = 24), [{sup 18}F]FDG PET (N = 11) plus additional CT (N = 8), or conventional X-ray (N = 3). Imaging findings were correlated with final diagnosis based on intraoperative culture or follow-up. In 13 of 35 patients (37 %), infection was proven by either positive intraoperative tissue culture (N = 12) or positive follow-up (N = 1). [{sup 18}F]FDG PET revealed 11 true-positive, 19 true-negative, three false-positive, and two false-negative results, indicating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 85 %, 86 %, 79 %, 90 %, and 86 %, respectively. The SUV{sub max} was 6.4 ± 2.7 in the clinically infected group and 3.0 ± 1.7 in the clinically non-infected group (p <0.01). The SUV{sub ratio} was 5.3 ± 3.3 in the clinically infected group and 2.6 ± 1.5 in the clinically non-infected group (p <0.01). [{sup 18}F]FDG PET differentiates infected from non-infected non-unions with high accuracy in patients with suspected infections of non-union fractures, for whom other clinical findings were inconclusive for a local infection. [{sup 18}F]FDG PET should be considered for therapeutic management of non-unions. (orig.)

  4. Use of bone marrow derived stem cells in a fracture non-union

    Directory of Open Access Journals (Sweden)

    Binod C. Raulo

    2012-01-01

    Full Text Available This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.

  5. Complications associated with plate fixation of acute midshaft clavicle fractures versus non-unions.

    Science.gov (United States)

    Sawalha, Seif; Guisasola, Inigo

    2018-03-13

    An important consideration when counselling patients with midshaft clavicle fractures is whether operative treatment of non-union, if it develops after non-operative treatment, is associated with higher complication rate than acute fracture fixation. The aim of this study is to compare complications and re-operations after open reduction and plate fixation for acute midshaft clavicle fractures versus non-unions. The study was retrospective. There were 90 patients in the acute fixation group and 20 patients in the non-union group. The mean follow-up was 8 and 15 months, respectively, Logistic regression analysis was used to assess whether 'non-union surgery' was a predictor of complications and re-operations. Of 90 patients, 23 had complications in acute fixation group. Of 20, 7 developed 8 complications in the non-union group (p = 0.4). Of 90, 12 required re-operations in the acute fixation group compared to 5/20 requiring 7 re-operations in the non-union group (p = 0.19). When any complication or re-operation was considered, 'non-union surgery' was not significant predictor for complications (p = 0.78) or re-operations (p = 0.99). The complication and re-operation rates were not higher after non-union surgery compared to acute fracture fixation and were mostly related to persistent delayed or non-union, rather than operative complications. When counselling patients about treatment of midshaft clavicle fractures, a 'higher complication rate after surgery for non-union, should it happen' should not be an argument against non-operative treatment.

  6. Non-Anatomical Surgical Solutions for Difficult Non-Unions: Case Series

    OpenAIRE

    Zaki Said, Galal; Farouk, Osama Ahmed; Galal Said, Hatem; Mohamed El-Sharkawi, Mohamed Mostafa

    2013-01-01

    Abstract Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the stand...

  7. Biological methods to enhance bone healing and fracture repair.

    Science.gov (United States)

    Verdonk, René; Goubau, Yannick; Almqvist, Fredrik K; Verdonk, Peter

    2015-04-01

    This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Bone Scan in Detection of Biological Activity in Nonhypertrophic Fracture Nonunion

    OpenAIRE

    Gandhi, Sunny J.; Rabadiya, Bhavdeep

    2017-01-01

    Biological activity of the fracture site is very important factor in treatment planning of fracture nonunion. If no biological activity is detected, then an autologous bone graft can be supplemented or osteogenic supplementations, such as bone morphogenetic protein is given. If biological activity is present, then secure fixation is sufficient to achieve bony union. Biological activity of nonunions is usually assessed by conventional radiographs. The presence of callus formation is usually as...

  9. Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

    Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.

  10. RhBMP-7 for the treatment of nonunion of fractures of long bones.

    Science.gov (United States)

    Papanagiotou, M; Dailiana, Z H; Karachalios, T; Varitimidis, S; Vlychou, M; Hantes, M; Malizos, K N

    2015-07-01

    We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union. ©2015 The British Editorial Society of Bone & Joint Surgery.

  11. Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report.

    Science.gov (United States)

    Wong, Daniel J; Holm, Tammy M; Dyer, George S M; Gates, Jonathan D

    2015-04-01

    A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. A follow-up study of the in-practice results of pulsed electromagnetic field therapy in the management of nonunion fractures

    Directory of Open Access Journals (Sweden)

    Murray HB

    2016-12-01

    Full Text Available Hallie B Murray,1 Brian A Pethica1,2 1EBI, LLC (a Zimmer Biomet company, Parsippany, NJ, USA; 2Department of Chemical and Biological Engineering, Princeton University, Princeton, NJ, USA Abstract: During normal fracture repair, healing occurs within a few months. However, for a minority of patients, the processes of bone repair are compromised or interrupted leading to the development of delayed union and nonunion fractures. Noninvasive bone growth stimulators using pulsed electromagnetic field (PEMF technology are currently in widespread use by patients with impaired fracture healing. This article reports the results of a follow-up study of 1,382 patients treated with PEMF stimulation to evaluate success rates and the relationship between average daily use and the clinical outcomes of therapy as reported by their prescribing physicians. The reported overall success rate for the 1,382 patients was 89.6%. The results were analyzed in audited subsets comparing days of treatment time and average daily use of the electrical bone growth stimulator, using several statistical methods. Linear regression analysis indicated a 6-day reduction in time to heal with each additional hour of average daily use. Survival analysis concluded that the median heal time was reduced by 35%–60%, depending on the different fracture characteristics of patients who complied with the recommended daily use of 10 hours per day. A third statistical analysis indicated that patients treated with the PEMF device for 9 hours or more per day had a significant reduction in time to heal, achieving successful fracture repair an average of 76 days earlier than patients treated with the PEMF device for an average of 3 hours or less per day. Overall, these different methods of statistical analysis indicate that PEMF therapy correlates with an acceleration in the healing of nonunion fractures. Keywords: PEMF, pulsed electromagnetic field, dose–response, nonunion, time to heal

  13. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations.

    Science.gov (United States)

    Rupp, Markus; Biehl, Christoph; Budak, Matthäus; Thormann, Ulrich; Heiss, Christian; Alt, Volker

    2018-02-01

    The intention of the current article is to review the epidemiology with related socioeconomic costs, pathophysiology, and treatment options for diaphyseal long bone delayed unions and nonunions. Diaphyseal nonunions in the tibia and in the femur are estimated to occur 4.6-8% after modern intramedullary nailing of closed fractures with an even much higher risk in open fractures. There is a high socioeconomic burden for long bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration. The classic classification of Weber and Cech of the 1970s is based on the underlying biological aspect of the nonunion differentiating between "vital" (hypertrophic) and "avital" (hypo-/atrophic) nonunions, and can still be considered to represent the basis for basic evaluation of nonunions. The "diamond concept" units biomechanical and biological aspects and provides the pre-requisites for successful bone healing in nonunions. For humeral diaphyseal shaft nonunions, excellent results for augmentation plating were reported. In atrophic humeral shaft nonunions, compression plating with stimulation of bone healing by bone grafting or BMPs seem to be the best option. For femoral and tibial diaphyseal shaft fractures, dynamization of the nail is an atraumatic, effective, and cheap surgical possibility to achieve bony consolidation, particularly in delayed nonunions before 24 weeks after initial surgery. In established hypertrophic nonunions in the tibia and femur, biomechanical stability should be addressed by augmentation plating or exchange nailing. Hypotrophic or atrophic nonunions require additional biological stimulation of bone healing for augmentation plating.

  14. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2011-01-01

    evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n = 1...... = 0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p 

  15. Association between timing of zoledronic acid infusion and hip fracture healing

    DEFF Research Database (Denmark)

    Colón-Emeric, C; Nordsletten, L; Olson, S

    2010-01-01

    evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. INTRODUCTION: Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given...... soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing. METHODS: In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n¿=¿1......¿=¿0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p¿

  16. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, M.; Leenhouts, P. A.; ten Duis, H. J.; Wendt, K. W.

    Introduction: Stabilisation. of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this Study was to determine the incidence of non-union following unreamed

  17. Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

    Directory of Open Access Journals (Sweden)

    McAlinden A

    2009-10-01

    Full Text Available Abstract A three-year-old male working border collie with an infected femoral nonunion fracture was managed in a two-stage procedure involving debridement and omentalisation, followed by stabilisation with a bone plate and an autogenous cancellous bone graft. Osseous union was documented radiographically 16 weeks after surgery. Telephone follow-up one year later revealed the dog had returned to full working function without evidence of lameness. To the authors' knowledge, this is the first clinical case described in the veterinary literature using omentalisation as an adjunct to the management of an infected, biologically inactive nonunion fracture.

  18. Reconstruction of Scaphoid Nonunion Fractures of the Proximal One Third With a Vascularized Bone Graft From the Distal Radius

    OpenAIRE

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    Objective: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. Methods: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients’ data, healing rates, and factors influencing scaphoid healing were analyzed. Results: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these...

  19. Fracture healing in osteoporotic bone.

    Science.gov (United States)

    Cheung, Wing Hoi; Miclau, Theodore; Chow, Simon Kwoon-Ho; Yang, Frank F; Alt, Volker

    2016-06-01

    As the world population rises, osteoporotic fracture is an emerging global threat to the well-being of elderly patients. The process of fracture healing by intramembranous ossification or/and endochondral ossification involve many well-orchestrated events including the signaling, recruitment and differentiation of mesenchymal stem cells (MSCs) during the early phase; formation of a hard callus and extracellular matrix, angiogenesis and revascularization during the mid-phase; and finally callus remodeling at the late phase of fracture healing. Through clinical and animal research, many of these factors are shown to be impaired in osteoporotic bone. Animal studies related to post-menopausal estrogen deficient osteoporosis (type I) have shown healing to be prolonged with decreased levels of MSCs and decreased levels of angiogenesis. Moreover, the expression of estrogen receptor (ER) was shown to be delayed in ovariectomy-induced osteoporotic fracture. This might be related to the observed difference in mechanical sensitivity between normal and osteoporotic bones, which requires further experiments to elucidate. In mice fracture models related to senile osteoporosis (type II), it was observed that chondrocyte and osteoblast differentiation were impaired; and that transplantation of juvenile bone marrow would result in enhanced callus formation. Other factors related to angiogenesis and vasculogenesis have also been noted to be impaired in aged models, affecting the degradation of cartilaginous matrixes and vascular invasion; the result is changes in matrix composition and growth factors concentrations that ultimately impairs healing during age-related osteoporosis. Most osteoporotic related fractures occur at metaphyseal sites clinically, and reports have indicated that differences exist between diaphyseal and metaphyseal fractures. An animal model that satisfies three main criteria (metaphyseal region, plate fixation, osteoporosis) is suggested for future research for

  20. Nonunion of Fractures of the Ulna and Radius Diaphyses: Clinical and Radiological Results of Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Boussakri H

    2016-07-01

    Full Text Available Aseptic nonunion of the radius and ulna is a major complication of forearm fractures, accounting for 2% to 10% of all forearm fractures. The aim of our study is to evaluate the functional and radiological results of surgical treatment of diaphyseal aseptic nonunion of the radius and ulna, with autologous bone grafting, decortication and internal plate fixation. A series of 21 patients (26 nonunions was retrospectively reviewed, the average age was 35 years with a mean of 31,58 years (range 12-44 years . The fractures included isolated radius (n=6 and ulna (n=10, and both radius and ulna (n=5. The Grace and Eversmann score was used to evaluate our results. Fifteen had very good results, five good and one average. Consolidation of the two bones was attained in 6.2 months. Therefore, the functional prognosis of the upper limb imposes the need for an adequate treatment. This management strategy has enabled us to have satisfactory results. However, the best treatment of nonunion remains the preventive treatment with an optimal management and care of the forearm fractures.

  1. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions.

    Science.gov (United States)

    Molloy, Andy P; Lipscombe, Stephen J

    2011-03-01

    Massive bone loss following calcaneal fractures is a challenging condition to treat, especially if nonunion is present. Meticulous preoperative examination and imaging are crucial for accurate preoperative planning. If performed, successful outcomes can be achieved with the strategies outlined in this article. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Surgical Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fracture Nonunion in Elite Sport Climbers.

    Science.gov (United States)

    El-Sheikh, Yasser; Lutter, Chris; Schoeffl, Isabelle; Schoeffl, Volker; Flohe, Sascha

    2017-11-14

    Repetitive stress fracture of the middle phalanx epiphysis is an injury specific to elite adolescent sport climbers. As sport climbing becomes increasingly popular in younger age groups, an increased number of these injuries have been reported in recent years. To date, treatment of these fractures has been nonsurgical, with strict rest and physiotherapy prescribed until fracture union. However, when these patients present in a delayed fashion with an established nonunion, nonsurgical treatment may fail, leading to disabling chronic pain and/or digital deformity in some cases. In this article, we present 2 cases of surgical treatment for finger middle phalanx repetitive stress epiphyseal fracture nonunion, using a percutaneous spot drilling epiphysiodesis technique. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Sport related stress fracture of the clavicle with non-union: Case report and review

    Science.gov (United States)

    Constantinou, Demitri; Kastanos, Konstantinos

    2008-01-01

    Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery. PMID:21264151

  4. Effect of Diabetes Mellitus Type II on Long Bones Fractures Healing

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2015-07-01

    Full Text Available Introduction: Fracture healing is a complex process where synthesis and activation of a cascade of cells and molecules collaborate and participate in regeneration of the fractured bones. There are several factors involved in nonunion of fractured bones. Endocrine and metabolic diseases are regarded as factors causing nonunion of fractured bones. The present study aims at evaluating effect of diabetes type II, as an important and prevalent metabolic disease, on results of surgical treatment of long bones fractures. Method: This case-control study was conducted on 74 patients with isolated fracture of tibia and femur shafts resulting from low-energy trauma. In this study, 50 patients with definite diagnosis of diabetes were compared with 24 metabolically health persons considering age, gender, type of fracture, and treatment method. The diabetic patients were classified in two groups considering their insulin or oral agent. Level of hs-CRP inflammatory marker was also determined in these patients. Union rate and duration as well as relation between inflammatory marker and union rate were studied. Results: Prevalence of nonunion and delayed union were seen in 8 (32% and 2 (8% patients with orally-treated diabetes, respectively. It was 3 (12% in diabetes patients treated with insulin. However, there was not any case of nonunion in the health group. There was a statistically significant difference between these groups. According to the regression model, hs-CRP level played a significant role considering nonunion prediction (P=0.001, Odd’s Ratio=3.4, CI95%:1.4-4.8. Also, type of diabetes treatment had a significant role in predicting nonunion (P=0.04, Odd’s Ratio=0.6, CI95%:0.3-1.4. Duration of being affected by diabetes did not play any important role in nonunion prediction. Conclusion: Prevalence of nonunion in patients with diabetes suffering from fracture and undergoing orthopedic surgery is higher than healthy people. It seems that increase

  5. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization

    NARCIS (Netherlands)

    Davids, P. H.; Luitse, J. S.; Strating, R. P.; van der Hart, C. P.

    1996-01-01

    Fourteen patients were treated operatively for delayed union and nonunion of midshaft clavicular fractures from 1986 to 1994. Radiographically, nine nonunions were atrophic and five hypertrophic, The operative technique included opening the medullary canal, bone grafting, and fixation with an AO

  6. Current concepts of fracture healing.

    Science.gov (United States)

    Hulth, A

    1989-12-01

    The current concepts of fracture healing are mainly based on two variables: blood supply and stability. The effect of electricity on delayed union has not been explained. Possible individual differences in the primary osteogenetic activity and the effect of soft-tissue injuries are seldom considered. In recent years, interesting data have revealed how biomechanical forces and electric currents can be translated to biochemical mediators such as prostaglandins (PGE2), morphogens, and growth factors. It is likely that the fracture ends emit osteogenic signal substances (such as bone morphogenetic protein) to the exudate in addition to those mediators (interleukin-1, growth factors) which are released from the blood clot as in wound healing. Movement of the fragments increases the fracture exudate with its migrating cells and sprouting vessels, resulting in exuberant callus. Cartilage is formed in the well-vascularized granulation tissue due to its ability to repel vessels. Rigid fixation minimizes granulation tissue and external callus. Rigid plates may also retard effusion of morphogens and growth factors from bone ends. Reaming of the intramedullary canal and nailing may cause additional bone damage, which may increase the osteogenetic activity. Weight bearing stimulates growth factors and PGE2. The molecular activity of the fracture exudate is the most decisive factor for bone healing. This activity can be impeded by diastasis, infections, and soft-tissue crushing injuries that cause extensive activation of macrophages and activate mediators, disturbing the osteogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle.

    Science.gov (United States)

    Lenza, Mário; Faloppa, Flávio

    2015-05-07

    This review covers two conditions: acute clavicle fractures and non-union resulting from failed fracture healing. Clavicle (collarbone) fractures account for around 4% of all fractures. While treatment for these fractures is usually non-surgical, some types of clavicular fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. This is an update of a Cochrane review first published in 2009. To evaluate the effects (benefits and harms) of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (27 June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 5), MEDLINE (1966 to June week 3 2014), EMBASE (1988 to 2014 week 25), LILACS (1982 to 27 June 2014), trial registries and reference lists of articles. We applied no language or publication restrictions. We considered randomised and quasi-randomised controlled trials evaluating any surgical intervention for treating people with fractures or non-union of the middle third of the clavicle. The primary outcomes were shoulder function or disability, pain and treatment failure (measured by the number of participants who had undergone or were being considered for a non-routine secondary surgical intervention for symptomatic non-union, malunion or other complications). Two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, we pooled results of comparable trials. We included seven trials in this review with 398 participants. Four trials were new in this update.The four new trials (160 participants) compared intramedullary fixation with open reduction and internal fixation with plate for treating acute middle third clavicle fractures in adults. Low quality evidence from the four trials indicated that intramedullary fixation did not

  8. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut.

    Science.gov (United States)

    Rollo, G; Tartaglia, N; Falzarano, G; Pichierri, P; Stasi, A; Medici, A; Meccariello, L

    2017-12-01

    Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

  9. The healing of fractured bones

    Energy Technology Data Exchange (ETDEWEB)

    Bacon, G.E. [Central Electricity Generating Board, Cheltenham (United Kingdom)

    1997-04-01

    A method utilising neutron beams of width 1 mm, used on D1B (2.4 A) and D20 (1.3 A) to study the healing of fractured bones is presented. It is found that the callus bone uniting the fractured tibia of a sheep, whose healing had been encouraged by daily mechanical vibration over a period of three months, showed no trace of the large preferential vertical orientation of the apatite crystals which is characteristic of the normal bone. Nevertheless the bone had regained about 60% of its mechanical strength and the callus bone, although not oriented, was well crystallized. It is considered that the new monochromator for D20, expected to give increased intensity at 2.5 A, will be of considerable advantage. (author). 2 refs.

  10. Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients.

    Science.gov (United States)

    Metsemakers, W-J; Handojo, K; Reynders, P; Sermon, A; Vanderschot, P; Nijs, S

    2015-04-01

    Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures. Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study. Statistical analysis was performed to determine predictors of deep infection and compromised fracture healing. Compromised fracture healing was subdivided in delayed union and nonunion. The following independent variables were selected for analysis: age, sex, smoking, obesity, diabetes, American Society of Anaesthesiologists (ASA) classification, polytrauma, fracture type, open fractures, Gustilo type, primary external fixation (EF), time to nailing (TTN) and reaming. As primary statistical evaluation we performed a univariate analysis, followed by a multiple logistic regression model. Univariate regression analysis revealed similar risk factors for delayed union and nonunion, including fracture type, open fractures and Gustilo type. Factors affecting the occurrence of deep infection in this model were primary EF, a prolonged TTN, open fractures and Gustilo type. Multiple logistic regression analysis revealed polytrauma as the single risk factor for nonunion. With respect to delayed union, no risk factors could be identified. In the same statistical model, deep infection was correlated with primary EF. The purpose of this study was to evaluate risk factors of poor outcome after IMN of tibial shaft fractures. The univariate regression analysis showed that the nature of complications after tibial shaft nailing could be multifactorial. This was not confirmed in a multiple logistic regression model, which

  11. Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Jairamchander Pingle

    2014-01-01

    femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO. Materials and Methods: Over a period of 35 years (1974-2008, 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008, All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years. Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. Results: Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°. Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore′s pins. These were reopened and cancellous screws were inserted in the same tracks. Conclusions: Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

  12. Thoracic Outlet Syndrome in a Volleyball Player Due to Nonunion of the First Rib Fracture.

    Science.gov (United States)

    Puttmann, Kathleen T; Satiani, Bhagwan; Vaccaro, Patrick

    2016-11-01

    Fracture of the first rib with ensuing callus formation is a rare cause of thoracic outlet syndrome. We report a case of a 17-year-old female volleyball player who presented with months of chronic arm pain. Radiographic imaging demonstrated nonunion fracture of the first rib. Physical therapy had been unsuccessful in relieving the pain, and surgical management was performed with resection of the first rib through a transaxillary approach with complete resolution of symptoms. Inflammation surrounding such fractures may destroy tissue planes, making dissection more technically difficult.

  13. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures.

    Science.gov (United States)

    el Moumni, M; Leenhouts, P A; ten Duis, H J; Wendt, K W

    2009-02-01

    Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure. Between March 1995 and June 2005, 125 patients with 129 traumatic femoral shaft fractures were treated with as unreamed femoral nail. From this retrospective single centre study, 18 patients were excluded due to insufficient follow up data, including 1 patient who died within 2 days after severe head injury. Sixty-six patients had suffered multiple injuries. 21 fractures were open. According to the AO classification, there were 54 type A, 42 type B, and 14 type C fractures. Dynamic proximal locking was performed in 44 cases (36 type A and 8 type B fractures). Non-union occurred in two patients (1.9%; one type B and one type C fractures). Intra-operative complications were seen in three patients (2.8%). Postoperative in-hospital complications occurred in 29 patients (27%). Local superficial infection occurred in two patients (1.9%), there were no cases of deep infection. Implant failure occurred in three patients (2.8%): nail breakage was seen in two patients. In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.

  14. Intertrochanteric fracture non-unions with implant failure of the ...

    African Journals Online (AJOL)

    Failure of internal fixation of intertrochanteric fracture is associated with delayed union or malunion resulting in persistent pain and diminished function. We report a rare case of implant failure of the gamma nail with intertrochanteric fracture non union treated by DCS plate screw and bone graft. Pan African Medical Journal ...

  15. Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures.

    Science.gov (United States)

    Lam, S W; Teraa, M; Leenen, L P H; van der Heijden, G J M G

    2010-07-01

    Nonunion after intramedullary nailing (IMN) in patients with tibial shaft fractures occurs up to 16%. There is no agreement whether reaming prior to IMN insertion would reduce the nonunion rate. We aimed to compare the nonunion rate between reamed and unreamed IMN in patients with tibial shaft fractures. A systematic search was conducted in Pubmed, Embase, and the Cochrane Library. The selected publications were: (1) randomised controlled trials; (2) comparing the nonunion rate; (3) in patients with tibial shaft fractures; (4) treated with either reamed or unreamed IMN. Seven studies that satisfied the criteria were identified. They showed that reamed IMN led to reduction of nonunion rate compared to unreamed IMN in closed tibial shaft fractures (risk difference ranging 7.0-20%, number needed to treat ranging 5-14), while the difference between compared treatments for open tibial shaft fractures was not clinically relevant. The evidence showed a consistent trend of reduced nonunion rate in closed tibial shaft fracture treated with reamed compared to unreamed IMN. 2010 Elsevier Ltd. All rights reserved.

  16. Contemporary Management of Mandibular Fracture Nonunion-A Retrospective Review and Treatment Algorithm.

    Science.gov (United States)

    Ostrander, Benjamin T; Wang, Howard D; Cusano, Alessandro; Manson, Paul N; Nam, Arthur J; Dorafshar, Amir H

    2018-02-06

    Nonunion is an uncommon complication after mandibular fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a 1- versus 2-stage approach and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics. The authors conducted a retrospective study consisting of patients who presented to 2 level 1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was 1- versus 2-stage treatment. Outcomes were examined to propose a treatment algorithm. Eighteen patients were included in the study. The sample's mean age was 44.0 ± 19.3 years and most were men (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required 2-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3 ± 20.4 months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). The authors' 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management. Nonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining the approach and timing of reconstruction. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    Directory of Open Access Journals (Sweden)

    Sujit Kumar Tripathy

    2016-01-01

    Full Text Available Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%. Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

  18. Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study.

    Science.gov (United States)

    Schnetzke, Marc; Morbitzer, Christian; Aytac, Sara; Erhardt, Matthias; Frank, Christian; Muenzberg, Matthias; Studier-Fischer, Stefan; Helbig, Lars; Suda, Arnold J; Gruetzner, Paul-Alfred; Guehring, Thorsten

    2015-01-09

    Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = -0.31) was found. This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could

  19. Evaluation of nonunion fractures in dogs by use of B-mode ultrasonography, power Doppler ultrasonography, radiography, and histologic examination.

    Science.gov (United States)

    Risselada, Marije; van Bree, Henri; Kramer, Martin; Chiers, Koen; Duchateau, Luc; Verleyen, Piet; Saunders, Jimmy H

    2006-08-01

    To investigate the use of ultrasonography to assess nonunion of fractures in dogs and to compare results of ultrasonography, radiography, and histologic examination. 8 nonunion fractures in 6 dogs (1 each in 5 dogs and 3 in 1 dog); dogs ranged from 7 to 94 months of age and weighed 6 to 30 kg. Diagnostic assessment consisted of complete clinical and orthopedic examinations, radiography, B-mode (brightness mode) ultrasonography, and power Doppler ultrasonography. Biopsy samples were obtained during surgery for histologic examination. They were stained with H&E and immunolabeled by use of anti-CD31 antibodies. Correlations of power Doppler score, power Doppler count, vessel area, and radiographic prediction with the mean number of vessels counted per hpf were derived. Radiographically, 7 of 8 nonunion fractures were diagnosed as atrophic and were therefore estimated to be nonviable. Vascularity of nonunion fractures during power Doppler ultrasonography ranged from nonvascularized to highly vascularized. Absolute vessel count during histologic examination ranged from 0 to 63 vessels/hpf; 5 nonunion sites had a mean count of > 10 vessels/hpf. Vascularity during power Doppler ultrasonography was highly correlated with the number of vessels per hpf, whereas the correlation between the radiographic assessment and histologic evaluation was low. Radiographic prediction of the viability of nonunion fractures underestimated the histologically assessed vascularity of the tissue. Power Doppler ultrasonography provided a more accurate estimation of the viability of the tissue and therefore the necessity for debridement and autografts during revision surgery.

  20. Supracondylar Femoral Nail in the management of non-union of humeral shaft fractures.

    Science.gov (United States)

    Bajaj, S K; Mohan, N Rama; Kumar, C Senthil

    2004-05-01

    We reviewed seven patients with established non-union of a shaft of humerus fracture, treated by locked intramedullary nailing using the Intramedullary Supracondylar Nail (IMSC Nail; Smith & Nephew Richards, Memphis TN). The mean age of the patients was 65 years (range 48-78 years). Three of the fractures involved the proximal third of the diaphysis while the remaining four involved the middle third. Six of the original fractures were closed and one was an open fracture. The time interval between the original injury and final surgery averaged 9.3 months. All the nailings were done by the ante-grade approach with static locking. Six of the patients had closed nailing and one had open nailing with bone grafting. The mean follow-up was 8 months and osseous union was achieved in all seven cases at a mean of 5.6 months. We conclude that the Supracondylar Femoral Nail is a useful alternative implant in the management of non-union of fractures of the humeral shaft with wide medullary canals.

  1. Successful treatment of recalcitrant nonunions with combined magnetic field stimulation.

    Science.gov (United States)

    Longo, J A

    1997-01-01

    Nonunions and delayed unions have been classically defined by Bassett as an arrest of the fracture healing process at an intermediary stage of repair, at which time the fracture gap is bridged by fibrocartilage. It is estimated that approximately 10-20 % of long bone fractures in the United States will result in delayed unions when compared to the average rate of healing for the location and type of fracture. Many of these will go on to a nonunion if biological or biomechanical factors are not optimized to enhance healing. Additional commorbities such as smoking, ethanol abuse, malnutrition, malabsorption and altered neurologic conditions can contribute to delayed unions or nonunions. Even despite appropriate and aggressive early management of long bone fractures, a certain percentage still lack progression of healing and go on to nonunion. Classical surgical management of nonunions includes obtaininjg fracture stabilization with ORIF techniques and bone grafting, with reported clinical successes ranging from 50-80%. Those that fail to achieve union despite classical management are indeed recalcitrant nonunions.

  2. How do bisphosphonates affect fracture healing?

    Science.gov (United States)

    Kates, Stephen L; Ackert-Bicknell, Cheryl L

    2016-01-01

    Bisphosphonates (BPs) have been in use for many years for the treatment of osteoporosis, multiple myeloma, Paget's disease, as well as a variety of other diseases in which there is reduced bone mineral density. Given that bisphosphonates inhibit bone resorption, an important stage of fracture healing; this class of compounds has been widely studied in preclinical models regarding their influence on fracture healing. In animal models, bisphosphonate treatment is associated with a larger fracture callus, coincident with a delay in remodeling from primary woven bone to lamellar bone, but there is no delay in formation of the fracture callus. In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing. Rarely, patients with long term use of Bisphosphonates may develop an atypical fracture and delay in fracture healing has been observed. In summary, bisphosphonates appear safe for use in the setting of acute fracture management in the upper and lower extremity in humans. While much remains unknown about the effects on healing of long-term bisphosphonates, use prior to "typical" fracture, in the special case of atypical fracture, evidence suggests that bisphosphonates negatively influence healing. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept.

    Science.gov (United States)

    Miska, M; Findeisen, S; Tanner, M; Biglari, B; Studier-Fischer, S; Grützner, P A; Schmidmaier, G; Moghaddam, A

    2016-01-01

    Between 2005 and 2012, 50 patients (23 female, 27 male) with nonunion of the humeral shaft were included in this retrospective study. The mean age was 51.3 years (14 to 88). The patients had a mean of 1.5 prior operations (sd 1.2;1 to 8). All patients were assessed according to a specific risk score in order to devise an optimal and individual therapy plan consistent with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis to an angular stable locking compression plate was performed. According to the individual risk an additional bone graft and/or bone morphogenetic protein-7 (BMP-7) were applied. A successful consolidation of the nonunion was observed in 37 cases (80.4%) with a median healing time of six months (IQR 6). Younger patients showed significantly better consolidation. Four patients were lost to follow-up. Revision was necessary in a total of eight (16%) cases. In the initial treatment, intramedullary nailing was most common. The use of locking compression plates in combination with autologous cancellous bone graft has been shown to be a safe and effective treatment. In more complex cases, the use of the Masquelet technique and BMP-7 may be indicated at the first revision operation. Our results suggest the Diamond Concept is a successful treatment strategy for nonunions of the humeral shaft. ©2016 The British Editorial Society of Bone & Joint Surgery.

  4. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN or surface implants like Dynamic Condylar Screw (DCS are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years and mean followup period was 52.1 months (range 27-72 months. Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  5. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

    Science.gov (United States)

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years) and mean followup period was 52.1 months (range 27-72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  6. A protocol for staged arthroplasty to salvage infected nonunion of hip fractures.

    Science.gov (United States)

    Ebied, Ayman M; Elseedy, Adel I; Gamal, Osama

    2017-03-01

    Nonunion of hip fractures is not uncommon. Total hip arthroplasty is used to salvage cases of non union or secondary arthritis in these fractures. However, this option may not be available or may be difficult to achieve when infection has superseded the site of nonunion. The objective of this prospective study was to assess if a staged protocol of treatment yields good results in these difficult cases. Twenty-seven consecutive patients who had deep hip infection with failed treatment of hip fractures (intracapsular in 16 cases and extracapsular in 11) were treated between June 2007 and September 2011. Twenty-six completed the planned two-stage hip arthroplasty and one case was lost after the first stage. The average age of the patients was 48.9 years (range 26-74 years) with an average follow up period of 44 months (30-72 months). Analysis was done using the paired t test where P < 0.05 was considered significant. Infection was controlled in all cases that completed the treatment protocol with no recurrence in all cases at the latest follow up. The Harris hip score of the patients improved significantly from 29 preoperatively to 85 at the latest follow up (P < 0.0001). Two patients had hip dislocation with displacement of the trochanteric fragment while three other patients had fibrous union of the trochanter. Staged Arthroplasty procedure to salvage infected non-union of hip fractures is successful in eradicating infection and regaining hip function. Level of evidence IV.

  7. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults.

    Science.gov (United States)

    Mills, Leanora A; Aitken, Stuart A; Simpson, A Hamish R W

    2017-08-01

    Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.

  8. Subtrochanteric fracture non-unions with implant failure managed with the "Diamond" concept.

    Science.gov (United States)

    Giannoudis, Peter V; Ahmad, Mudussar A; Mineo, Giuseppe V; Tosounidis, Theodoros I; Calori, Giorgio M; Kanakaris, Nikolaos K

    2013-01-01

    Subtrochanteric femoral non-unions in the setting of failed metalwork pose a challenging clinical problem. This study assessed the clinical outcome of patients treated according to the principles of the "Diamond" concept. Between 2007 and 2011 all patients presented with a subtrochanteric atrophic aseptic non-union in the setting of metalwork failure (broken cephalomedullary reconstruction nail), and treated in a single tertiary referral unit were included to this study. The hypertrophic and the non-unions of pathologic fractures were excluded. The revision strategy was based on the "Diamond concept"; optimisation of the mechanical and the biological environment (implantation of growth factor (rhBMP-7), scaffold (RIA bone graft from contralateral femur) and concentrated mesenchymal stem cells (MSCs) harvested from the iliac crest). The minimum follow up was 26 months (16-48). Fourteen patients met the inclusion criteria. A specific sequence of metalwork failure was noted with initial breakage of the distal locking screws followed by nail breakage at the lag screw level. The intraoperative examination of the removed nails revealed no gross structural damage indicative of inappropriate drilling at the time of the initial intramedullary nailing. Varus mal-alignment was present in the majority of the cases, with an average of 5.2 degrees (0-11). The average time to distal locking screw failure was 4.4 months (2-8.5) and nail failure was 6.5 months (4-10). The time to union after the revision surgery was 6.8 months (5-12). Complications included two deaths in elderly patients (due to unrelated causes), one pulmonary embolism, one myocardial infarction, one below the knee deep vein thrombosis and one blade plate failure that required further revision with double plating and grafting. Varus mal-alignment must be avoided in the initial stabilisation of subtrochanteric fractures. Distal locking screw failure is predictive of future fracture non-union and nail breakage. In

  9. Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

    OpenAIRE

    Chalidis, Byron E.; Petsatodis, George E.; Sachinis, Nick C.; Dimitriou, Christos G.; Christodoulou, Anastasios G.

    2009-01-01

    The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9?years. No correlation was found between union and nail diameter ...

  10. Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome

    International Nuclear Information System (INIS)

    Schoierer, Oliver; Bender, Daniel; Schmidmaier, Gerhard; Bloess, Konstantin; Kauczor, Hans-Ulrich; Weber, Marc-Andre; Burkholder, Iris

    2014-01-01

    To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS). Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans , K ep , iAUC and V e were correlated with union at CT 1 year later (n = 49). Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9 %/50.0 % compared to 96.8 %/33.3 % using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans , K ep and V e within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19). DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome. (orig.)

  11. Delayed Fracture Healing in Diabetics with Distal Radius Fractures.

    Science.gov (United States)

    Pscherer, S; Sandmann, G H; Ehnert, S; Nussler, A K; Stöckle, U; Freude, T

    2017-01-01

    PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.

  12. Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure.

    Science.gov (United States)

    Tsang, S T J; Mills, L A; Baren, J; Frantzias, J; Keating, J F; Simpson, A H R W

    2015-12-01

    The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (punion. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Effect of tenoxicam on fracture healing in rat tibiae.

    Science.gov (United States)

    Giordano, Vincenzo; Giordano, Marcos; Knackfuss, Irocy G; Apfel, Mara Ibis R; Gomes, Renato Das C

    2003-02-01

    Nonsteroidal anti-inflammatory drugs have been implicated in the development of delayed unions and nonunion after fractures in animal models. Previous investigations have identified two important factors as determinants of delayed fracture healing: early drug administration and a dose-dependent effect. The purpose of this investigation was to study the effect of tenoxicam, a nonsteroidal anti-inflammatory drug, on the fracture healing process in rat tibiae. Fifty-eight Wistar rats were randomly divided in four groups (I, II, III, and IV). Group I (control group, n=12) was given 0.1ml saline solution per day intramuscularly. Groups II (n=12), III (n=12), and IV (n=12) were administered 10mg per kg per day of tenoxicam intramuscularly. Administration of substances was begun on a week before to 48h after the fracturing procedure and continued during the entire experiment. Callus formation was studied histologically and histomorphologically, using light microscopy. In addition, a histologic grading based on the morphologic stage of fracture healing was carried out at 4 weeks, according to the criteria proposed by Allen et al. There was a significant difference in treatment effect between Group I (saline solution) and Groups II, III, and IV (tenoxicam) (P=0.07). Histologically and histomorphologically, there were qualitative and quantitative delay in callus formation at all tenoxicam groups. This was more pronounced the earlier the nonsteroidal anti-inflammatory drug was started, although no significant difference could be detected between Groups II, III, and IV (P>(alpha=10%)). Four weeks after fracture, Group I (n=3) showed complete osseous union, Groups II (n=3) and III (n=3), complete cartilaginous union, and Group IV (n=3), incomplete osseous union, according to Allen et al. By using this rating scale, the difference between control and drug-treated groups was statistically significant (P<0.1). Under studied conditions, this investigation shows that administration

  14. Impaired Fracture Healing after Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Philipp Lichte

    2015-01-01

    Full Text Available Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP of 35 mmHg for 90 minutes. Serum cytokines (IL-6, KC, MCP-1, and TNF-α were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  15. Symptomatic medial humeral epicondylar fracture non-union- rare presentation of a relatively common injury.

    Science.gov (United States)

    Kulkarni, Vidisha S; Arora, Nitish; Gehlot, Harshit; Saxena, Sagar; Kulkarni, Sunil G; Bajwa, Supreet

    2017-08-01

    Symptomatic non-union of medial humeral epicondylar fractures is a limited entity. Some studies recommend surgical excision of the fragment, but the results are controversial. The purpose of this study is to evaluate the outcome of open reduction and internal fixation of a medial epicondyle non-union fragment. A retrospective study was conducted in all the patients, who were operated in our hospital between the year 2010 and 2015 for symptomatic medial humeral epicondyle non-union. Inclusion criteria were open reduction and internal fixation of symptomatic medial epicondyle non-union and minimum one year of follow-up from time of surgery. Exclusion criteria included other associated musculoskeletal disorders of the affected limb. Open reduction and internal fixation of the fragment was done in all patients and the ulnar nerve was decompressed and anteriorly transposed in cases where symptomatology was present. Outcome was assessed with radiograph, range/arc of motion, Visual analogue pain scoring and two functional outcome tools. Study sample consisted of 14 patients, with mean age at presentation of 14.9 years (range 6 to 50 years) with mean time since injury of 7.7 months (range 3 to 24 months). Patients presented with medial elbow pain and prominence, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, at a mean of three years after surgery (range 1.5 to 5 years), patients reported an improvement in visual analogue pain score from a mean of 7.29±1.3 to 0.21±0.4, and the difference was statistically significant (p=0.001). Mean postoperative Quick DASH (Disability of Arm, Shoulder, and Hand) score was 5.21±7.2. Mean Mayo Elbow Performance Score was 96.7±6.1. Improvement in arc of motion was statistically significant (p=0.001). Radiographic union was achieved in all patients except one who had fibrous union. Functional elbow range of motion was achieved in 13 out of 14 cases (92.8%) and ulnar

  16. Chance Fracture Secondary to a Healed Kyphotic Compression Osteoporotic Fracture

    Directory of Open Access Journals (Sweden)

    Teh KK

    2009-11-01

    Full Text Available Chance fracture is an unstable vertebral fracture, which usually results from a high velocity injury. An elderly lady with a previously healed osteoporotic fracture of the T12 and L1 vertebra which resulted in a severe kyphotic deformity subsequently sustained a Chance fracture of the adjacent L2 vertebrae after a minor fall. The previously fracture left her with a deformity which resulted in significant sagittal imbalance therefore predisposing her to this fracture. This case highlights the importance of aggressive treatment of osteoporotic fractures in order to prevent significant sagittal imbalance from resultant (i.e. kyphotic deformity.

  17. Biological Perspectives of Delayed Fracture Healing

    OpenAIRE

    Hankenson, KD; Zmmerman, G; Marcucio, R

    2014-01-01

    Fracture healing is a complex biological process that requires interaction among a series of different cell types. Maintaining the appropriate temporal progression and spatial pattern is essential to achieve robust healing. We can temporally assess the biological phases via gene expression, protein analysis, histologically, or non-invasively using biomarkers as well as imaging techniques. However, determining what leads to normal verses abnormal healing is more challenging. Since the ultimate...

  18. Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture.

    Science.gov (United States)

    Androjna, Caroline; Fort, Brian; Zborowski, Maciej; Midura, Ronald J

    2014-09-01

    Delayed bone healing has been noted in osteoporosis patients and in the ovariectomized (OVX) rat model of estrogen-depletion osteopenia. Pulsed electromagnetic field (PEMF) devices are clinically approved as an adjunct to cervical fusion surgery in patients at high risk for non-fusion and for the treatment of fracture non-unions. These bone growth stimulating devices also accelerate the healing of fresh fracture repair in skeletally mature normal rats but have not been tested for efficacy to accelerate and/or enhance the delayed bone repair process in OVX rats. The current study tested the hypothesis that daily PEMF treatments would improve the fracture healing response in skeletally mature OVX rats. By 6 weeks of healing, PEMF treatments resulted in improved hard callus elastic modulus across fibula fractures normalizing the healing process in OVX rats with respect to this mechanical property. Radiographic evidence showed an improved hard callus bridging across fibula fractures in OVX rats treated with PEMF as compared to sham treatments. These findings provide a scientific rationale for investigating whether PEMF might improve bone-healing responses in at-risk osteoporotic patients. © 2014 Wiley Periodicals, Inc.

  19. 17β-estradiol improves the efficacy of exploited autologous bone marrow-derived mesenchymal stem cells in non-union radial defect healing: A rabbit model.

    Science.gov (United States)

    Zamani Mazdeh, Delaram; Mirshokraei, Pezhman; Emami, Mohammadreza; Mirshahi, Ali; Karimi, Iraj

    2017-12-28

    Exploiting mesenchymal stem cells (MSCs) appears to be an appealing alternative to the traditional clinical approach in the treatment of non-union bone defects. It has been shown that 17β-estradiol improves the osteogenesis and proliferation potential of the MSCs via estrogen receptors. We investigated the effect of 17β-estradiol on exploiting autologous BMSCs (bone marrow-derived MSCs) for the purpose of healing of radial non-union segmental defect in rabbit. Twenty rabbits were divided into 4 experimental groups: 1. Control group; 2. MSC treatment group; 3. 17β-estradiol (E2) treatment group; and 4. E2+MSC treatment group. Isolated BMSCs were seeded in a critical-sized defect on radial mid-diaphysis that was filled with autologous fibrin clot differently in 4 groups: 1. intact fibrin clot (control); 2. Fibrin clot containing MSCs; 3. Estradiol; and 4. E 2 and MSCs. Defect healing was assessed by radiological (week 0, 2, 4, 6, 8 and 10) and histopathological evaluation (week 10). Radiological evaluation data demonstrated that quantities for the E2+MSC group were significantly the greatest in comparison with the other groups at week 4 to 10 inclusive. Moreover, Histopathological evaluation indicated that the E2+MSC group had the highest score which was significantly greater than the E2 group and the control group (Punion bone fractures. Exploiting mesenchymal stem cells (MSCs) appears to be an appealing alternative to the traditional clinical approach in the treatment of non-union bone defects. It has been shown that 17β-estradiol improves the osteogenesis and proliferation potential of the MSCs via estrogen receptors. We investigated the effect of 17β-estradiol on exploiting autologous BMSCs (bone marrow-derived MSCs) for the purpose of healing of radial non-union segmental defect in rabbit. Twenty rabbits were divided into 4 experimental groups: 1. Control group; 2. MSC treatment group; 3. 17β-estradiol (E2) treatment group; and 4. E2+MSC treatment group

  20. An interface finite element model can be used to predict healing outcome of bone fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; García-Aznar, J M

    2014-01-01

    After fractures, bone can experience different potential outcomes: successful bone consolidation, non-union and bone failure. Although, there are a lot of factors that influence fracture healing, experimental studies have shown that the interfragmentary movement (IFM) is one of the main regulators for the course of bone healing. In this sense, computational models may help to improve the development of mechanical-based treatments for bone fracture healing. Hence, based on this fact, we propose a combined repair-failure mechanistic computational model to describe bone fracture healing. Despite being a simple model, it is able to correctly estimate the time course evolution of the IFM compared to in vivo measurements under different mechanical conditions. Therefore, this mathematical approach is especially suitable for modeling the healing response of bone to fractures treated with different mechanical fixators, simulating realistic clinical conditions. This model will be a useful tool to identify factors and define targets for patient specific therapeutics interventions. © 2013 Published by Elsevier Ltd.

  1. Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results.

    Science.gov (United States)

    Moed, B R; Subramanian, S; van Holsbeeck, M; Watson, J T; Cramer, K E; Karges, D E; Craig, J G; Bouffard, J A

    1998-01-01

    Based on the results of a pilot study indicating the potential value of ultrasound (US) as a diagnostic tool for the early assessment of fracture healing and the related need for secondary operative procedures in patients treated by statically locked intramedullary (IM) nailing without reaming, a protocol was established for a larger scale prospective trial. The purpose of this study was to evaluate the outcome of this follow-up trial. All skeletally mature patients admitted to the Henry Ford Hospital (Detroit, Michigan) from January 1993 to August 1994 who had sustained an acute fracture of the tibial shaft and who were treated by statically locked IM nailing, without reaming, were candidates for study. Forty-seven patients with fifty fractures that could be evaluated by US were included. The adopted determinants for fracture healing were complete disappearance of the IM nail on US examination performed at six weeks postoperatively, or progressive disappearance of the nail noted between the initial six-week study and a second nine-week US examination, both in conjunction with periosteal callus formation. Radiographs were obtained to monitor maintenance of reduction and to further evaluate fracture healing. Of thirty-eight fractures with a positive US (thirty-two at six weeks, six at nine weeks), thirty-seven healed uneventfully, a positive predictive value of 97 percent. Radiographic fracture healing was not evident until, on average, nineteen weeks after injury. The single false-positive fracture progressed to nonunion. Of the twelve fractures with negative US studies, ten underwent secondary procedures (nine dynamization, one bone graft), with four progressing to nonunion. Two patients refused secondary surgery; screw failure occurred in both. Otherwise, there were no hardware failures in this series. The results of this study indicate that US may provide important prognostic information concerning fracture healing after unreamed tibial nailing, upon which

  2. Fracture healing with osteopathy in traditional Mongolian medicine.

    Science.gov (United States)

    Zhao, Namula; Wang, Mei; Li, Xueen

    2013-02-01

    To explore the concept and norm of fracture healing with osteopathy in traditional Mongolian medicine (TMM). Based on the correspondence between man and the universe (including psychosomatic integration) in fracture healing with osteopathy in TMM, we used modern physio-psychological and biomechanical principles and methods to probe the integrated, dynamic and functional characteristics of fracture healing. Based on the integration of limbs and the body, unification of the body and function and harmony of man and nature (including psychosomatic integration), fracture healing with osteopathy in TMM comprises the concept of natural functional healing of fractures, and follows the norm of considering physiological healing and psychological function as well as limb healing and motor function. Fracture healing with osteopathy in TMM is characterized by a lack of trauma without future complications. This therapy makes the concept of fracture healing develop in the direction of humanity, behaviorism and integration.

  3. Negligence claims following non-union and malunion of long bone fractures: An analysis of 15 years of data.

    Science.gov (United States)

    Metcalfe, C W; Harrison, W D; Nayagam, S; Narayan, B

    2016-10-01

    Non-unions and malunions are recognised to be complications of the treatment of long bone fractures. No previous work has looked at the implications of these complications from a medicolegal perspective. A complete database of litigation claims in Trauma and Orthopaedic Surgery was obtained from the NHS Litigation Authority. Two separate modalities of the treatment of long bone fractures were examined i) non-union and ii) acquired deformity. The type of complaint, whether defended or not, and costs were analysed. There were claims of which 97 related to non-union and 32 related to postoperative limb deformity. The total cost was £8.2 million over a 15-year period in England and Wales. Femoral and tibial non-unions were more expensive particularly if they resulted in amputation. Rotational deformity cost nearly twice as much as angulation deformities. The cosmetic appearances of rotational malalignment and amputation results in higher compensation; this reinforces an outward perception of outcome as being more important than harmful effects. Notwithstanding the limitations of this database, there are clinical lessons to be gained from these litigation claims. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  4. Early prediction of tibial and femoral fracture healing: Are we reliable?

    Science.gov (United States)

    Squyer, Emily R; Dikos, Gregory D; Kaehr, David M; Maar, Dean C; Crichlow, Renn J

    2016-12-01

    To evaluate the ability of orthopaedic trauma subspecialists to predict early bony union in femoral and tibia shaft fractures. Eight orthopaedic trauma subspecialists prospectively predicted the probability of bony union at 6 and 12 weeks post-operatively for an aggregate of 48 femoral and tibial shaft fractures treated at a Level 1 trauma centre. An additional orthopaedic trauma subspecialist was blinded to treating surgeon and adjudicated healing at 18 weeks. The Squared-Error Skill Score (SESS) determined the likelihood of accurate forecasting for bony union. Nine patients were lost follow-up, resulting in 39 fractures (81.25% retention) including 20 femoral and 19 tibial fractures. Fourteen fractures were open, 15 were not-yet united at final follow-up. SESS values were 0.25-0.77. The ability to predict union (sensitivity) was 1.000. The ability to predict nonunions (specificity) was 0.330-0.500. The probability of a correct predicted union was 0.727 and correct predicted nonunion at final follow-up was 1.000. AO/OTA type A fractures pattern predictions were highly accurate. As body mass index increased, predictions trended toward decreased accuracy (p=0.06). Tobacco use, age, gender, associated injuries, open fractures, and surgeons' years in clinical practice were not associated with accuracy of predictions. At 12-weeks post-operatively orthopaedic trauma subspecialists can confidently predict the union state in this patient population. This data is most useful in the nonunion patient, directing early intervention, thereby decreasing patient disability and discomfort. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Non-anatomical surgical solutions for difficult non-unions: case series.

    Science.gov (United States)

    Zaki Said, Galal; Farouk, Osama Ahmed; Galal Said, Hatem; Mohamed El-Sharkawi, Mohamed Mostafa

    2013-01-01

    Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the standard techniques or a limited surgical interference, that might not be anatomical, may succeed in improving function. We present four cases of non-anatomical salvage solutions for difficult long bone non-unions with satisfactory functional outcome.

  6. Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

    Science.gov (United States)

    El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

    Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    External and internal fixators use bone screws that are locked to a plate or bar to prevent periosteal compression and associated impairment of blood supply. Both osteosynthesis techniques rely on secondary bone healing with callus formation with the exception of compression plating of simple...

  8. Inhibition of Midkine Augments Osteoporotic Fracture Healing.

    Directory of Open Access Journals (Sweden)

    Melanie Haffner-Luntzer

    Full Text Available The heparin-binding growth and differentiation factor midkine (Mdk is proposed to negatively regulate osteoblast activity and bone formation in the adult skeleton. As Mdk-deficient mice were protected from ovariectomy (OVX-induced bone loss, this factor may also play a role in the pathogenesis of postmenopausal osteoporosis. We have previously demonstrated that Mdk negatively influences bone regeneration during fracture healing. Here, we investigated whether the inhibition of Mdk using an Mdk-antibody (Mdk-Ab improves compromised bone healing in osteoporotic OVX-mice. Using a standardized femur osteotomy model, we demonstrated that Mdk serum levels were significantly enhanced after fracture in both non-OVX and OVX-mice, however, the increase was considerably greater in osteoporotic mice. Systemic treatment with the Mdk-Ab significantly improved bone healing in osteoporotic mice by increasing bone formation in the fracture callus. On the molecular level, we demonstrated that the OVX-induced reduction of the osteoanabolic beta-catenin signaling in the bony callus was abolished by Mdk-Ab treatment. Furthermore, the injection of the Mdk-Ab increased trabecular bone mass in the skeleton of the osteoporotic mice. These results implicate that antagonizing Mdk may be useful for the therapy of osteoporosis and osteoporotic fracture-healing complications.

  9. Non-union of osteoporotic vertebral fractures - identification and treatment of an underestimated pathology in elderly patients with persistent back pain.

    Science.gov (United States)

    Adler, Daniel; Tschoeke, Sven K; von der Hoeh, Nicolas; Gulow, Jens; von Salis-Soglio, Georg; Heyde, Christoph-E

    2014-12-01

    Non-union of osteoporotic vertebra fractures are a seldom entity. However, when back pain persists in the course of conservatively treated osteoporotic vertebra fractures, a non-union should be considered. We thus sought to validate our diagnostic algorithm in patients with known osteoporotic vertebra fractures presenting persistent back pain and advert to the diagnosis and treatment of vertebral non-unions. Patients admitted with preexisting osteoporotic vertebra fractures and therapy-resistant back pain were retrospectively analysed. All admitted patients were subject to standard plain radiographs in erect position and conventional CT or MR imaging of the spine, respectively. In addition, patients with suspected non-union were subject to lateral fulcrum radiographs in supine position. From a total of 172 admitted patients, four patients presented with non-union of a fractured osteoporotic vertebra (2%). The subsequent surgical therapy included cement-augmented rod-and-screw stabilization, with or without additional correction of deformity, and kyphoplasty (N = 3) or kyphoplasty alone (N = 1). All surgical interventions were successful in pain reduction and allowed immediate and improved postoperative mobilisation. Non-union of osteoporotic vertebra fractures must be considered when symptoms outlast conservative treatment. In these cases, plain lateral fulcrum radiographs are a simple and effective adjunct to the conventional diagnostic methods. Surgical stabilization then proves to be the effective treatment of choice.

  10. Deferoxamine restores callus size, mineralization, and mechanical strength in fracture healing after radiotherapy.

    Science.gov (United States)

    Donneys, Alexis; Ahsan, Salman; Perosky, Joseph E; Deshpande, Sagar S; Tchanque-Fossuo, Catherine N; Levi, Benjamin; Kozloff, Ken M; Buchman, Steven R

    2013-05-01

    Therapeutic augmentation of fracture-site angiogenesis with deferoxamine has proven to increase vascularity, callus size, and mineralization in long-bone fracture models. The authors posit that the addition of deferoxamine would enhance pathologic fracture healing in the setting of radiotherapy in a model where nonunions are the most common outcome. Thirty-five Sprague-Dawley rats were divided into three groups. Fracture, irradiated fracture, and irradiated fracture plus deferoxamine. The irradiated fracture and irradiated fracture plus deferoxamine groups received a human equivalent dose of radiotherapy [7 Gy/day for 5 days, (35 Gy)] 2 weeks before mandibular osteotomy and external fixation. The irradiated fracture plus deferoxamine group received injections of deferoxamine into the fracture callus after surgery. After a 40-day healing period, mandibles were dissected, clinically assessed for bony union, imaged with micro-computed tomography, and tension tested to failure. Compared with irradiated fractures, metrics of callus size, mineralization, and strength in deferoxamine-treated mandibles were significantly increased. These metrics were restored to a level demonstrating no statistical difference from control fractures. In addition, the authors observed an increased rate of achieving bony unions in the irradiated fracture plus deferoxamine-treated group when compared with irradiated fracture (67 percent and 20 percent, respectively). The authors' data demonstrate nearly total restoration of callus size, mineralization, and biomechanical strength, and a threefold increase in the rate of union with the use of deferoxamine. The authors' results suggest that the administration of deferoxamine may have the potential for clinical translation as a new treatment paradigm for radiation-induced pathologic fractures.

  11. Temporal and spatial vascularization patterns of unions and nonunions: role of vascular endothelial growth factor and bone morphogenetic proteins.

    Science.gov (United States)

    Garcia, P; Pieruschka, A; Klein, M; Tami, A; Histing, T; Holstein, J H; Scheuer, C; Pohlemann, T; Menger, M D

    2012-01-04

    Failure of fracture-healing with nonunion is a major clinical problem. Angiogenesis is closely linked to bone regeneration, but the role of angiogenesis in nonunion formation remains unclear. Because established nonunions are well vascularized, we hypothesized that lack of vascular endothelial growth factor (VEGF) expression and vascularization during the early time course of fracture-healing determine nonunion formation. In seventy-two CD-1 mice, a femoral osteotomy with a gap size of 1.80 mm (nonunion group) or a gap size of 0.25 mm (union group) was created and stabilized by a pin-clip technique. Healing was analyzed after three, seven, fourteen, twenty-one, twenty-eight, and seventy days by micro-computed tomography and histomorphometry. Vascularization was determined in different healing zones by immunohistochemical staining of PECAM-1 (platelet-endothelial cell adhesion molecule). Additional animals were analyzed after seven, fourteen, and twenty-one days with Western blot analysis of VEGF, bone morphogenetic protein (BMP)-2, and BMP-4 expression. Micro-computed tomography and histomorphometry showed complete bone-bridging in the union group, whereas animals in the nonunion group showed atrophic nonunion formation. Vascularization increased from day 3 to day 7 in both groups, with a subsequent decrease after fourteen days. However, overall vascularization did not differ between unions and nonunions over time. It is of interest that vascularization within the endosteal healing zone was even higher in nonunions than in unions after fourteen days. Expression of VEGF was significantly higher in nonunions, while expression of BMP-2 and 4 and proliferating cell nuclear antigen were found significantly reduced compared with unions. Because vascularization during the early time course of fracture-healing was not impaired despite the failure of bone-healing in nonunions, we rejected our hypothesis and accepted the null hypothesis that nonunion formation is not due to

  12. Bone morphogenetic protein-7: Review of signalling and efficacy in fracture healing

    Directory of Open Access Journals (Sweden)

    Steven Cecchi

    2016-01-01

    Full Text Available Bone morphogenetic proteins (BMPs are a group of signalling molecules that belong to the transforming growth factor-β superfamily of proteins. Initially identified for their ability to induce bone formation, recent advances in the understanding of cellular and molecular mechanisms regarding BMPs have led to the use of the growth factor to accelerate bone healing. Recent clinical trials have demonstrated that BMPs, BMP-7 in particular, may present an alternative line of treatment other than the gold standard, autogenous bone grafting, in the treatment of fracture nonunion. We performed a literature search in September 2014 of PubMed and Embase using search terms, including “bone morphogenetic proteins”, “BMP-7”, “non-union”, “fracture healing” and “cost-effectiveness”, reviewing the efficacy, safety, and cost of treatment of nonunions with BMP-7. The authors further canvassed the reference lists of selected articles and used online search tools, such as Google Scholar. BMP-7 uses both the canonical and noncanonical signalling pathways. The treatment of fracture nonunion with recombinant human BMP-7 (rhBMP-7 has a comparable efficacy with that of autogenous bone grafting with an average union rate of 87% compared with 93% for bone grafting. Furthermore, fewer complications have been described with the use of rhBMP-7 compared with traditional bone grafting. We describe the signalling pathways that BMP-7 uses to exert its effect on bone. In nonunions, rhBMP-7 has been shown to have a similar efficacy to bone grafting with fewer complications.

  13. Stimulation of bone healing in new fractures of the tibial shaft using interferential currents.

    Science.gov (United States)

    Fourie, J A; Bowerbank, P

    1997-01-01

    The aim of this research was to establish whether interferential currents (IFC) could significantly reduce the healing time for fractures of the tibia and thereby prevent nonunion. Males between the ages of 12 and 86, who had sustained fractures of the tibiae, were entered into this double blind clinical trial. According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomization into two groups; an experimental group (n = 41) and placebo group (n = 35). A further group was entered retrospectively--control group (n = 151). IFCs were applied to the experimental group via suction electrodes for 30 minutes per day for 10 days, using a beat frequency of 10-25 Hz and a swing mode of 6 integral of 6. The placebo group had only suction electrodes applied, the intermittent mode produced a rhythmical massage effect; subjects in this group commented on pain relief which resulted in the addition of the control group as a check on the possible effect of intermittent suction. The control group received no intervention. The data were analysed using analysis of covariance which resulted in a finding of no significant difference in the time taken to union for the three groups. This means that to date there is no reason to believe that IFCs (using the parameters of this trial) can reduce the healing time for new fractures of the tibia or prevent nonunion. However, further investigation is recommended.

  14. Recurrent hydatosis at the site of non-union humerus fracture

    Directory of Open Access Journals (Sweden)

    Mohsen Nourbakhsh

    2012-01-01

    Full Text Available Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2-4%, where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection.

  15. Operative Fixation of an Anterior Inferior Iliac Spine Apophyseal Avulsion Fracture Nonunion in an Adolescent Soccer Player: A Case Report.

    Science.gov (United States)

    Carr, James B; Conte, Evan; Rajadhyaksha, Evan A; Laroche, Kevin A; Gwathmey, F Winston; Carson, Eric W

    2017-01-01

    A 14-year-old male competitive soccer player presented with a history of recurrent right hip pain for 18 months. He was diagnosed with an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture nonunion with subspinal impingement, which was confirmed by radiographs, computed tomography, and magnetic resonance imaging. The patient underwent surgical fixation and subspinal decompression. He returned to competitive soccer 5 months postoperatively. AIIS apophyseal avulsion fractures occur in adolescent athletes and generally respond to nonoperative treatment. When such management is unsuccessful, surgical fixation can lead to resolution of pain with return of full function.

  16. DESCRIPTION OF HISTOPATOLOGICAL FEMORAL FRACTURES HEALING WITH EXCESSIVE OF CALCIUM-CARBONATE TREATMENT IN MALE RAT

    Directory of Open Access Journals (Sweden)

    Ira Sari Yudaniayanti

    2008-12-01

    Full Text Available Fracture healing is a complex process that requires the ordered synthesis of matrix proteins and deposition of mineral. Complications such as delayed union or non-union may arise from excessive flexibility bone because low mineral content of bone or apposition of both fracture fragments is not complete yet. The aim of this study is to determine the effect of excessive calcium carbonate (CaCO3 on the healing femoral fracture in rat by examining histopathological change of femoral fracture. Twelve male Sprague Dawley rats, 12 weeks old were subjected to this investigation. The entire rats model at 13 weeks old were treated reposition of femoral dexter fractures with intramedullary pin fixation. The rats model were evenly randomly divided into three groups of four at 15 weeks old ; group I treated with normal diet, group II with normal diet + CaCO3 supplement 75 mg/day, group III with normal diet + CaCO3 supplement 225 mg/day per oral. At the end of the experiment (19 weeks old, the rats were killed, subsequently dexter femur were taken out for determining the histopathological examination. The results showed that excessive suplementation CaCO3 to description of histopathological fracture healing on group III had even better, callus was able to bridge the fracture fragment with completely. The proportion woven bone and trabeculae were higher, while group II were cartilage dominate in callus, and group I were higher fibrous tissue. From the results can be concluded that given CaCO3 225 mg/ day accelerate the healing process of femoral fractures.

  17. The science of ultrasound therapy for fracture healing

    Directory of Open Access Journals (Sweden)

    Della Rocca Gregory

    2009-01-01

    Full Text Available Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  18. The science of ultrasound therapy for fracture healing.

    Science.gov (United States)

    Della Rocca, Gregory J

    2009-01-01

    Fracture healing involves a complex interplay of cellular processes, culminating in bridging of a fracture gap with bone. Fracture healing can be compromised by numerous exogenous and endogenous patient factors, and intense research is currently going on to identify modalities that can increase the likelihood of successful healing. Low-intensity pulsed ultrasound (LIPUS) has been proposed as a modality that may have a benefit for increasing reliable fracture healing as well as perhaps increasing the rate of fracture healing. We conducted a review to establish basic scince evidence of therapeutic role of lipus in fracture healing. An electronic search without language restrictions was accomplished of three databases (PubMed, Embase, Cinahl) for ultrasound-related research in osteocyte and chondrocyte cell culture and in animal fracture models, published from inception of the databases through December, 2008. Studies deemed to be most relevant were included in this review. Multiple in vitro and animal in vivo studies were identified. An extensive body of literature exists which delineates the mechanism of action for ultrasound on cellular and tissue signaling systems that may be related to fracture healing. Research on LIPUS in animal fracture models has demonstrated promising results for acceleration of fracture healing and for promotion of fracture healing in compromised tissue beds. A large body of cellular and animal research exists which reveals that LIPUS may be beneficial for accelerating normal fracture healing or for promoting fracture healing in compromised tissue beds. Further investigation of the effects of LIPUS in human fracture healing is warranted for this promising new therapy.

  19. Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report

    OpenAIRE

    Ciurlia Emanuele; Puddu Leonardo; Caggiari Gianfilippo; Andreozzi Matteo; Carlo Doria

    2017-01-01

    Introduction: The worldwide incidence of traumatic fractures has been growing over the last years due to the progressive aging of the population. Today, the increase of arthroplasty procedures in orthopaedic surgery is related to a high rate of peri-prosthetic fractures. Healing of the fracture is a multifactorial metabolic process; if these factors are impaired, healing process could be interrupted resulting in non-union. Presentation of case: We report our experience about a case of a hu...

  20. Computational evaluation of the compositional factors in fracture healing affecting ultrasound axial transmission measurements.

    Science.gov (United States)

    Machado, Christiano Bittencourt; de Albuquerque Pereira, Wagner Coelho; Talmant, Maryline; Padilla, Frédéric; Laugier, Pascal

    2010-08-01

    This work aimed at computationally evaluating the compositional factors in fracture healing affecting ultrasound axial transmission (UAT), using four numerical daily-changing healing models, representing more realistic clinical conditions. Using two-dimensional (2-D) simulations, a 1-MHz source and a receiver were positioned parallel to the bone surface to detect the first arriving signal (FAS). The time-of-flight of the FAS (TOF(FAS)) was found to be sensitive only to superficial modifications in the propagation path. It was also shown that callus mature bone better explained alone the variation in TOF(FAS) (R(2) >or= 0.70, p consolidation delays and nonunions. Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  1. Validation of the Non-Union Scoring System in 300 long bone non-unions.

    Science.gov (United States)

    Calori, G M; Colombo, M; Mazza, E L; Mazzola, S; Malagoli, E; Marelli, N; Corradi, A

    2014-12-01

    Non-union of long bones is a significant consequence of fracture treatment. The ideal classification for non-union of long bones would give sufficient significant information to the orthopaedic surgeon to enable good management of the treatment required and to facilitate the creation of comparable study groups for research purposes. The Non-Union Scoring System (NUSS) is a new scoring system to assist surgeons in the choice of the correct treatment in non-union surgery. The aim of this study was to determine the evidence supporting the use of the NUSS classification in the treatment of non-unions of long bones and to validate the treatment algorithm suggested by this scoring system. A total of 300 patients with non-union of the long bones were included in the clinical study. A radiographic and clinical healing was reached in 60 of 69 non-unions (86%) in group 1 (0-25 points), in 102 of 117 non-unions (87%) in group 2 (26-50 points), and in 69 of 84 (82%) in group 3 (51-75 points). The mean time to clinical healing was 7.17 ± 1.85 months in group 1, 7.30 ± 1.72 months in group 2 and 7.60 ± 1.49 months in group 3. The mean time to radiographic healing was 8.78 ± 2.04 months in group 1, 9.02 ± 1.84 months in group 2 and 9.53 ± 1.40 months in group 3. There are few articles in the scientific literature that examine the classification systems for non-union. A statistical analysis of the first results we have obtained with the use of NUSS showed significant rates of union in all the evaluated groups. This indicates that NUSS could be an appropriate scoring system to classify and stratify non-unions and to enable the surgeon to choose the correct treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report.

    Science.gov (United States)

    Dilogo, Ismail Hadisoebroto; Primaputra, Muhammad Rizqi Adhi; Pawitan, Jeanne Adiwinata; Liem, Isabella Kurnia

    2017-01-01

    Non-union due to large bone loss often causes significant long-term morbidity. We incorporate the use of allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) as part of the diamond concept of regenerative medicine in a case of infected non-union fracture. We reported a 54-year-old female patient presenting with pain on the right thigh. She was previously diagnosed with a closed fracture of the right femoral shaft and underwent four surgeries before finally being referred to Dr. Cipto Mangunkusumo General Hospital with infected non-union of the right femoral shaft. The patient was treated with a combination of UC-MSCs, bone morphogenetic protein-2 (BMP-2), Hydroxyapatite (HA), and mechanical stabilization using Masquelet Technique. The combination of allogeneic MSCs, BMP2, HA, and Masquelet Technique was successful in creating new bone with no apparent side effects. Bone loss might be caused by external factors (true defects), or structural loss of the existing bone. The combination of allogeneic UC-MSCs, BMP-2, HA and an induced membrane technique pioneered by Masquelet allowed for faster regeneration process and more optimal bone healing. This paper aims to assess and compare the result of such procedures with the previous four surgeries done to the patient, which did not yield satisfactory results. The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Effects of anti-osteoporosis medications on fracture healing

    DEFF Research Database (Denmark)

    Jørgensen, Niklas R; Schwarz, Peter

    2011-01-01

    A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, postmenopausal women, and in people with malnutrition. At present, no pharmacologic treatments are available. Thus, there is an unmet need for medications that can...... stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis and, intriguingly, a number of animal studies prove the ability of PTH to induce fracture healing. PTH may therefore be a potential novel treatment option in humans with impaired...... healing. However, more randomized clinical trials documenting the clinical efficacy of PTH as a promoter of fracture healing in the clinical setting are warranted. Also, strontium ranelate seems to have beneficial effects on fracture healing under conditions with impaired healing. However, no clinical...

  4. Is non-union of tibial shaft fractures due to nonculturable bacterial pathogens? A clinical investigation using PCR and culture techniques

    Directory of Open Access Journals (Sweden)

    Gille Justus

    2012-05-01

    Full Text Available Abstract Background Non-union continues to be one of the orthopedist’s greatest challenges. Despite effective culture methods, the detection of low-grade infection in patients with non-union following tibial fracture still presents a challenge. We investigated whether “aseptic” tibial non-union can be the result of an unrecognized infection. Methods A total of 23 patients with non-union following tibial shaft fractures without clinical signs of infection were investigated. Intraoperative biopsy samples obtained from the non-union site were examined by means of routine culture methods and by polymerase chain reaction (PCR for the detection of 16 S ribosomal RNA (rRNA. Control subjects included 12 patients with tibial shaft fractures. Results 23 patients (8 women and 15 men; mean age: 47.4 years were included into this study. Preoperative C-reactive protein levels (mean: 20.8 mg/l and WBC counts (mean: 8,359/μl in the study group were not significantly higher than in the control group. None of the samples of non-union routine cultures yielded microorganism growth. Bacterial isolates were found by conventional culturing methods in only 1 case of an open fracture from the control group. In this case, PCR yielded negative results. 16 S rRNA was detected in tissue specimens from 2 patients (8.7% with non-union. The analysis of these variable species-specific sequences enabled the identification of specific microorganisms (1x Methylobacterium species, 1x Staphylococcus species. Both PCR-positive patients were culture-negative. Conclusions The combination of microbiological culture and broad-range PCR seems to substantially add to the number of microbiological diagnoses obtained and may improve the clinican’s ability to tailor therapy to the individual patient’s needs.

  5. Comparison of effects of LLLT and LIPUS on fracture healing in animal models and patients: A systematic review.

    Science.gov (United States)

    Bayat, Mohammad; Virdi, Amarjit; Jalalifirouzkouhi, Reza; Rezaei, Fatemehalsadat

    2018-01-01

    The aim of this paper is to study the in vivo potency of low-level laser therapy (LLLT) and low intensity pulsed ultrasound (LIPUS) alone, accompanied by bone grafts, or accompanied by other factors on fracture healing in animal models and patients. In this paper, we aim to systematically review the published scientific literature regarding the use of LLLT and LIPUS to accelerate fracture healing in animal models and patients. We searched the PubMed database for the terms LLLT or LIPUS and/or bone, and fracture. Our analysis also suggests that both LIPUS and LLLT may be beneficial to fracture healing in patients, and that LIPUS is more effective. These finding are of considerable importance in those treatments with a LIPUS, as a laser device may reduce healing time. The most clinically relevant impact of the LIPUS treatment could be a significant reduction in the proportion of patients who go on to develop a nonunion. If it is confirmed that the therapeutic influence is true and reliable, patients will obtain benefits from LIPUS and LLLT. Further clinical trials of high methodological quality are needed in order to determine the optimal role of LIPUS and LLLT in fracture healing in patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing.

    Science.gov (United States)

    Lee, J R; Kim, H-J; Lee, K-B

    2016-04-01

    The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). Non-union develops significantly more frequently in

  7. Ultrasound stimulation of maxillofacial bone healing

    NARCIS (Netherlands)

    Schortinghuis, J; Stegenga, B; Raghoebar, GM; de Bont, LGM

    A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%,

  8. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers

    National Research Council Canada - National Science Library

    Jones, D

    1995-01-01

    .... Pulsing electromagnetic fields (PEMFs)have been shown to speed the healing of non-union fractures and we have used them successfully to treat stress fractures in the lower limbs. All women at Ft...

  9. Fixation and Grafting After Limited Debridement of Scaphoid Nonunions.

    Science.gov (United States)

    McInnes, Colin W; Giuffre, Jennifer L

    2015-09-01

    To evaluate a surgical technique of treating nondisplaced waist and proximal pole scaphoid nonunions without avascular necrosis (AVN). We performed a retrospective review of all patients with nondisplaced, scaphoid waist or proximal pole nonunions without AVN treated with the following technique. Two K-wires are positioned along the scaphoid axis to stabilize the proximal and distal poles. Debridement with a curette or burr is performed parallel to the nonunion site until the K-wires are visualized and punctate bleeding of the proximal and distal fragments is encountered. The volar, radial fibrous union is left intact. Distal radius cancellous bone graft is packed into the nonunion site. A headless screw is placed perpendicular to the fracture and the K-wires are removed. Between 2012 and 2014, 12 patients (ages 13-29 y) with clinical and radiographic evidence (10 had computed tomography or magnetic resonance imaging; 2 had radiographs only) of scaphoid nonunion were identified (10 transverse waist and 2 proximal pole fractures). Median interval from injury to surgery was 38 weeks (range, 3 mo to 9 y). Four patients were active smokers and 2 had failed previous iliac crest bone grafting. All patients healed as confirmed by computed tomography. Average time to union was 14 weeks (range, 6-31 wk). Four patients had delayed union requiring a bone stimulator. All patients had resolution of pain and there were no complications. The technique described is an effective and efficient method of treating nondisplaced scaphoid nonunions without AVN. We suggest that complete debridement of the nonunion is not essential to achieve union. In addition, pinning the proximal and distal scaphoid poles initially and maintaining the volar fibrous union of the scaphoid nonunion stabilizes the fracture fragments, increasing the technical ease of grafting and fixation. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights

  10. Self-healing in fractured GaAs nanowires

    International Nuclear Information System (INIS)

    Wang Jun; Lu Chunsheng; Wang Qi; Xiao Pan; Ke Fujiu; Bai Yilong; Shen Yaogen; Wang Yanbo; Chen Bin; Liao Xiaozhou; Gao Huajian

    2012-01-01

    Molecular dynamics simulations are performed to investigate a spontaneous self-healing process in fractured GaAs nanowires with a zinc blende structure. The results show that such self-healing can indeed occur via rebonding of Ga and As atoms across the fracture surfaces, but it can be strongly influenced by several factors, including wire size, number of healing cycles, temperature, fracture morphology, oriented attachment and atomic diffusion. For example, it is found that the self-healing capacity is reduced by 46% as the lateral dimension of the wire increases from 2.3 to 9.2 nm, and by 64% after 24 repeated cycles of fracture and healing. Other factors influencing the self-healing behavior are also discussed.

  11. A special healing pattern in stable metaphyseal fractures.

    Science.gov (United States)

    Chen, Wen Tao; Han, Da Cheng; Zhang, Pei Xun; Han, Na; Kou, Yu Hui; Yin, Xiao Feng; Jiang, Bao Guo

    2015-04-01

    Metaphyseal fractures heal in a rapid fashion that is different from the bone shaft healing process. Animal studies have focused on diaphyseal fractures. We investigated the metaphyseal fracture-healing process in rabbits. 60 rabbits (divided into 12 groups) underwent proximal tibial osteotomy, anatomical reduction, and fixation with screws. After surgery, the proximal tibiae were harvested at different time points for histology. No obvious osteonecrosis or bone resorption were found 2 weeks after surgery. From day 5 to week 5, woven bone or new trabeculae formed. From week 2, remodeling into lamellar bone started and reached a peak at week 6. These 3 stages overlapped. Histomorphometry showed that the structure changed as a unimodal curve. The healing process of metaphyseal fractures appears to differ from the commonly studied healing process in diaphyseal fractures. It is rapid, and can be divided into 4 histological stages: cellular activation and differentiation, formation of woven bone, transformation of woven bone into lamellar bone, and further remodeling.

  12. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing

    Directory of Open Access Journals (Sweden)

    Yokoyama Kazuhiko

    2008-01-01

    Full Text Available Background: The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN by multivariate analysis. Materials and Methods: We examined 99 open tibial fractures (98 patients treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (≤6 h or> 6 h, method of soft-tissue management, skin closure time (≤1 week or> 1 week, existence of polytrauma (ISS< 18 or ISS≥18, existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Results: Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5 of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection ( P < 0.0001. In the immediate nailing group alone, the deep infection rate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA ( P = 0.016. Nonunion occurred in 17 fractures (20.3%, 17/84. Multivariate analysis revealed that Gustilo type, skin closure time, and

  13. Experimental fracture protocols in assessments of potential agents for osteoporotic fracture healing using rodent models.

    Science.gov (United States)

    Ibrahim, Nurul 'Izzah; Mohamad, Sharlina; Mohamed, Norazlina; Shuid, Ahmad Nazrun

    2013-12-01

    Osteoporosis may cause bone fracture even under slight trauma. Osteoporotic fracture has become a major public health problem but until today, the treatments available are not satisfactory. Many pre-clinical testings on animals were done to find new agents that can be sourced from natural products and synthetic drugs for osteoporotic fracture healing. Animal models are more appropriate for fracture healing study than human subject due to several reasons including the ethical issues involved. The bones of rodents are similar to human in term of their morphological change and response to therapy. Small rodents such as rats and mice are suitable animal models for fracture healing studies as they have a similar bone remodeling system to human. To date, there is no specific guideline to carry out fracture healing studies in animal models for the evaluation of new agents. This paper highlights the protocols of various fracture and fixation methods for experimental osteoporotic fracture healing using rodent models.

  14. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  15. The Ameloblastin extracellular matrix molecule enhances bone fracture resistance and promotes rapid bone fracture healing

    Science.gov (United States)

    Lu, Xuanyu; Li, Wenjin; Fukumoto, Satoshi; Yamada, Yoshihiko; Evans, Carla; Diekwisch, Thomas G.H.; Luan, Xianghong

    2016-01-01

    The extracellular matrix (ECM) provides structural support, cell migration anchorage, cell differentiation cues, and fine-tuned cell proliferation signals during all stages of bone fracture healing, including cartilaginous callus formation, callus remodeling, and bony bridging of the fracture gap. In the present study we have defined the role of the extracellular matrix protein ameloblastin (AMBN) in fracture resistance and fracture healing of mouse long bones. To this end, long bones from WT and AMBNΔ5-6 truncation model mice were subjected to biomechanical analysis, fracture healing assays, and stem cell colony formation comparisons. The effect of exogenous AMBN addition to fracture sites was also determined. Our data indicate that lack of a functional AMBN in the bone matrix resulted in 31% decreased femur bone mass and 40% reduced energy to failure. On a cellular level, AMBN function inhibition diminished the proliferative capacity of fracture repair callus cells, as evidenced by a 58% reduction in PCNA and a 40% reduction in Cyclin D1 gene expression, as well as PCNA immunohistochemistry. In terms of fracture healing, AMBN truncation was associated with an enhanced and prolonged chondrogenic phase, resulting in delayed mineralized tissue gene expression and delayed ossification of the fracture repair callus. Underscoring a role of AMBN in fracture healing, there was a 6.9-fold increase in AMBN expression at the fracture site one week after fracture, and distinct AMBN immunolabeling in the fracture gap. Finally, application of exogenous AMBN protein to bone fracture sites accelerated callus formation and bone fracture healing (33% increase in bone volume and 19% increase in bone mineral density), validating the findings of our AMBN loss of function studies. Together, these data demonstrate the functional importance of the AMBN extracellular matrix protein in bone fracture prevention and rapid fracture healing. PMID:26899203

  16. Salvage of a femoral nonunion after primary non-Hodgkin?s lymphoma of bone: A case report and literature review

    OpenAIRE

    Xie, Xue Tao; Gao, You Shui; Zhang, Chang Qing

    2011-01-01

    Summary Background With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin?s lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult. Case ...

  17. Non-unions treated with bone morphogenic protein 7: introducing the quantitative measurement of human serum cytokine levels as promising tool in evaluation of adjunct non-union therapy.

    Science.gov (United States)

    Moghaddam, Arash; Breier, Lisa; Haubruck, Patrick; Bender, Daniel; Biglari, Bahram; Wentzensen, Andreas; Zimmermann, Gerald

    2016-01-01

    In this study we sought to determine if application of bone morphogenic protein 7 (BMP-7) promotes physiological bone healing of non-unions and to investigate if serum cytokine analysis may serve as a promising tool in the analysis of adjunct non-union therapy. Therefore we analyzed the influence of BMP-7 application on the serum cytokine expression patterns on patients with impaired bone healing compared to patients that showed proper bone healing. Our study involved analyzing blood samples from 208 patients with long bone fractures together with patients that subsequently developed non-unions. From this large pool, 15 patients with atrophic non-union were matched to 15 patients with atrophic non-union treated with local application of BMP-7 as well as normal bone healing. Changes in the cytokine expression patterns were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd week. The patients were followed both clinically and radiologically for the entire duration of the study. Serum cytokine expression levels of transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) were analyzed and compared. Serum expression of TGF-β were nearly parallel in all three groups, however serum concentrations were significantly higher in patients with proper bone healing and those treated with BMP-7 than in patients with non-unions (p unions (p unions led to similar cytokine expression patterns after treatment as those found in patients with proper bone healing. Our results suggest that treatment with BMP-7 promote healing of non-unions. Furthermore, quantitative measurement of serum cytokine expression is a promising tool for evaluating the effectiveness of additional non-union therapies such as adjunct application of growth factors.

  18. Management of nonunion after an old - neglected ankle fracture in diabetic patient; case report

    Directory of Open Access Journals (Sweden)

    Tudor M. Gavrilă

    2016-11-01

    Full Text Available Ankle fractures represent 9% of fractures. Even if it is a relatively usual fracture, the presence of diabetes makes treatment more difficult and rate of complications is higher than in the rest of population. The incidence of ankle fractures increased in the last half century. Many studies from SUA, England, Sweden and Finland suggest that the epidemiology of ankle fractures continues to change as populations age, up to the age 60 of years in men and above age of 50 years in women. Two-thirds of fractures are isolated malleolar fractures, bimalleolar fractures occur in one-fourth of patients and trimaleolar fractures occur in the rest of them. We present a case of 60 years old women with non-insulin dependent diabetes for 22 years who sustained a fracture of ankle. Her first presentation at doctor was after 4 months after injury and surgical treatment occurred after 8 months after the injury. She was operated using an external fixator. Despite the fact the treatment was delayed, the evolution of lesion was good and patient could regained normal gate.

  19. The reliability of plain radiography in experimental fracture healing

    NARCIS (Netherlands)

    Blokhuis, T. J.; de Bruine, J. H.; Bramer, J. A.; den Boer, F. C.; Bakker, F. C.; Patka, P.; Haarman, H. J.; Manoliu, R. A.

    2001-01-01

    To investigate the reliability of radiographs in the evaluation of healing of closed fractures. A closed midshaft tibial fracture was created in 40 goats and stabilized with an external fixator. The animals were assigned to four groups: no injection, injection of 1 mg osteogenic protein-1 (OP-1), 1

  20. Reaming and the healing of fractures | Umebese | Nigerian Journal ...

    African Journals Online (AJOL)

    OBJECTIVE: We quantified fracture healing response in the intramedullary nailed fractures of femur. PATIENTS AND METHOD: By a simple method of measuring size and mass of callus formation radiologically in 30 patients who had undergone open retrograde intramedullary Kuntscher nailing. We then compared the ...

  1. Effects of radiation and surgery on healing of femoral fractures in a rat model.

    Science.gov (United States)

    Nicholls, Fred; Janic, Katarina; Filomeno, Paola; Willett, Thomas; Grynpas, Marc; Ferguson, Peter

    2013-08-01

    Management of soft tissue sarcoma involves multimodality treatment, including surgery and radiotherapy. Pathologic fracture of the femur after such treatment in the thigh is one serious, late complication and nonunion rates of 80-90% are reported. We hypothesize that the combination of radiotherapy and periosteal stripping (during tumor resection) leads to greater impairment of the fracture repair process than either intervention alone. Female Wistar retired breeder rats were randomized into four treatment groups (control, radiotherapy, surgery, and combination of radiotherapy and surgery) and three end-points (21, 28, and 35 days post-fracture). Designated animals first underwent radiotherapy, followed by surgical stripping of the periosteum 3 weeks later and femoral fracture with fixation after another 3 weeks. Animals were sacrificed and fractures examined using microCT and histomorphometry. Simple transverse or short oblique femoral fractures were produced. By 35 days, control animals formed unions, periosteum-stripped animals formed hypertrophic non-unions and irradiated animals formed atrophic non-unions. Histomorphometry revealed an absence of chondroid and osteoid production in animals undergoing radiotherapy. The relative contribution of periosteal stripping to occurrence of non-union was statistically insignificant. Radiation prior to fracture reliably resulted in atrophic non-union in our model. The contribution of periosteal stripping was negligible. Copyright © 2013 Orthopaedic Research Society.

  2. Radiographic features of teriparatide-induced healing of femoral fractures

    Directory of Open Access Journals (Sweden)

    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  3. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases.

    Science.gov (United States)

    Gross, Jean-Baptiste; Diligent, Jérôme; Bensoussan, Danièle; Galois, Laurent; Stoltz, Jean-François; Mainard, Didier

    2015-01-01

    Non-union of long bones is still a current problem in traumatology. Although corticocancellous bone autograft remains the usual procedure for the treatment of non-union, innovative therapies such as, percutaneous autologous concentrated bone marrow grafting (PABMG), are now appearing. Over a period of 8 years, 45 non-union of long bones were treated by PABMG in the Department of Orthopaedic and Traumatologic Surgery (University Hospital of Nancy, France): 26 tibiae, 16 femurs, 3 humeri. Efficiency was evaluated by clinical criteria: full weight-bearing without pain, absence of motion at non-union site, and radiological criteria: healing of 3 corticales out of 4. Eighteen out of 28 non-unions at the tibia were healed (69%), 10 at the femur (63%), but none was noticed at the humerus. Some pejorative prognosis factors were noted such as: tobacco, alcohol abuse, diabetes and history of infection at the fracture site. An earlier grafting improved the success rate. The number of CFU-F (Colony Forming Unit Fibroblastic) affected the healing time more than the healing rate. The procedure, even though a little invasive, enables the healing of non-union in two out of three cases with less morbidity than conventional procedures. This procedure fits perfectly into the therapeutic arsenal of non-union.

  4. Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.

    Science.gov (United States)

    Flierl, Michael A; Smith, Wade R; Mauffrey, Cyril; Irgit, Kaan; Williams, Allison E; Ross, Erin; Peacher, Gabrielle; Hak, David J; Stahel, Philip F

    2013-09-09

    Novel bone substitutes have challenged the notion of autologous bone grafting as the 'gold standard' for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. The autograft cohort had a statistically significant shorter time to union (198 ± 172-225 days) compared to allograft (416 ± 290-543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159-619 days) or rhBMP-2 (217 ± 158-277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.

  5. The use of 18F-fluoride and 18F-FDG PET scans to assess fracture healing in a rat femur model

    Science.gov (United States)

    Hsu, W. K.; Feeley, B. T.; Krenek, L.; Stout, D. B.; Chatziioannou, A. F.; Lieberman, J. R.

    2011-01-01

    Purpose Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with 18F-fluoride ion, which localizes in regions of high osteoblastic activity, and 18F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Methods Fractures were created in the femurs of immuno-competent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, 18F-fluoride, and 18F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. Results All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. 18F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using 18F-FDG PET imaging at any time point. Conclusion This study suggests that 18F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time point

  6. Exposure to Secondhand Smoke Impairs Fracture Healing in Rats.

    Science.gov (United States)

    Santiago, Hildemberg A R; Zamarioli, Ariane; Sousa Neto, Manoel D; Volpon, Jose B

    2017-03-01

    Nonsmokers may be affected by environmental tobacco smoke (secondhand smoke), but the effects of such exposure on fracture healing have not been well studied. To explore the possible effects of passive inhalation of tobacco smoke on the healing of a diaphyseal fracture in femurs of rats. We hypothesized that secondhand exposure to tobacco smoke adversely affects fracture healing. A mid-diaphyseal fracture was created in the femur of 41 female Wistar rats and fixed with an intramedullary metallic pin; 14 rats were excluded (nine for inadequate fractures and five for K wire extrusion). Tobacco exposure was provided by a smoking machine on a daily basis of four cigarettes a day. Each cigarette yielded 10 mg tar and 0.8 mg nicotine, and was puffed by alternating injections of fresh air for 30 seconds and smoke air for 15 seconds. The smoke exposure was previously adjusted to provide serum levels of cotinine similar to human secondhand tobacco exposure. Cotinine is a predominant catabolite of nicotine that is used as a biological biomarker for exposure to tobacco smoke. In one group (n = 11), the animals were intermittently exposed to tobacco smoke before sustaining the fracture but not afterward. In another group (n = 7), the exposure occurred before and after the fracture. The control group (n = 9) was sham-exposed before and after the fracture. We evaluated the specimens 28 days after bone fracture. The callus quality was measured by dual-energy x-ray absorptiometry (bone mineral density [BMD], bone mineral content [BMC], and callus area), μCT (callus volume and woven bone fraction), and mechanical bending (maximum force and stiffness). Tobacco exposure resulted in delayed bone callus formation, which is represented by decreased BMD (Control: 0.302 ± 0.008 g/cm 2 vs Preexposed: 0.199 ± 0.008 g/cm 2 and Pre- and Postexposed: 0.146 ± 0.009 g/cm 2 ; mean difference = 0.103 g/cm 2 , 95% CI, 0.094-0.112 g/cm 2 and mean difference = 0.156 g/cm 2 , 95% CI, 0.147-0.167 g

  7. Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting.

    Science.gov (United States)

    Niu, Yunfei; Bai, Yushu; Xu, Shuogui; Liu, Xinwei; Wang, Panfeng; Wu, Dajiang; Zhang, Chuncai; Li, Ming

    2011-07-01

    Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects. Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted. The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain. The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.

  8. [Non-union of the clavicle after intramedullary nailing with a steel Kirschner wire].

    Science.gov (United States)

    Faymonville, C; Jubel, A; Schiffer, G

    2010-04-01

    Elastically stable intramedullary nailing is a safe surgical procedure used to treat mid-shaft clavicular fractures of types A and B according to the Orthopaedic Trauma Association (OTA) classification. In the case reported intramedullary fixation with a Kirschner wire and an incorrectly performed surgical technique led to pseudoarthrosis (non-union). After revision surgery with an elastically stable titanium nail and a correct surgical technique, fracture healing was achieved.

  9. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    Science.gov (United States)

    2006-12-01

    USA Corresponding author Belinda R. Beck, Ph.D. Griffith University School of Physiotherapy and Exercise Science, PMB 50 Gold Coast Mail Centre Q...accelerate tibial stress fracture healing? Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2006 2. Beck B.R., Bergman G., Arendt E...Predicting Recovery from Tibial Stress Fracture Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2007 (submitted) 15 Presentations

  10. Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator

    Directory of Open Access Journals (Sweden)

    Kusnezov Nicholas

    2017-01-01

    Full Text Available Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA autogenous bone grafting (ABG of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints. Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80% went on to union within six months and 13 (86.7% within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA. Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.

  11. Endogenous PTH deficiency impairs fracture healing and impedes the fracture-healing efficacy of exogenous PTH(1-34.

    Directory of Open Access Journals (Sweden)

    Yongxin Ren

    Full Text Available Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH.Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/- mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/- mice compared to vehicle-treated wild-type and Pth(-/- mice.Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing.

  12. HEALING OF ARTICULAR AND PERIARTICULAR METACARPAL AND PHALANGEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Aleksandar Kruščić

    2003-12-01

    ligamentotaxis were without significant slides, the fragments healing in good position. End functional results were satisfactory. We had only one decubitus, which healed per primam after reshaping of the splint.Conclusions. The application of local analgesia and ligamentotaxis represents a simple and safe method of treatment. It allows individual biomechanical neutralization of the pathologic activity of kinetic energy vectors on the fracture. Repositioning and physiological positioning of the hand in Softcast plaster is simple, there is no need to hospitalize the patient for surgery. This makes the method less costly as well. There are less fracture slides, and repairs due to decubitus are simpler as there is no need for total immobilization removal. Therefore ligamentotaxis is the method of choice.

  13. Low-intensity pulsed ultrasound affects RUNX2 immunopositive osteogenic cells in delayed clinical fracture healing

    NARCIS (Netherlands)

    Rutten, S.; Nolte, P.A.; Korstjens, C.M.; Klein-Nulend, J.

    2009-01-01

    Introduction: Osteogenic cell proliferation and differentiation play an important role in adequate fracture healing, and is target for osteoinductive therapies in delayed fracture healing. The aim of this study was to investigate whether low-intensity pulsed ultrasound enhances fracture healing at

  14. Long bone nonunions treated with autologous concentrated bone marrow-derived cells combined with dried bone allograft.

    Science.gov (United States)

    Scaglione, M; Fabbri, L; Dell'Omo, D; Gambini, F; Guido, G

    2014-08-01

    Nowadays the treatment of long bone nonunion continues to be one of the most complex and debated topics due to the large number of failures. For several years, in the relevant literature three factors have been considered essential in the healing process: growth factors and hormones, osteoprogenitor cells (mesenchymal stem cells), and extracellular matrix. The mechanical stability of the fracture site is considered the fourth element of the "Diamond concept theory." The aim of our study was to evaluate the validity of biological adjuvants of mechanical synthesis allowing a faster healing process of nonunions. We dealt with 19 patients with long bone nonunion. All patients have been treated with concentrated mesenchymal stem cells without bone autologous transplant. We used the Extracell BMC-marrow aspirate protocol of Regen Lab. The radiographic parameters taken into account for the diagnosis of successful healing were the presence of a bridge callus, obliteration of the fracture line and bone cortical continuity. Clinically, the pain was investigated with VAS score (visual analogue scale), where zero means no pain and 10 the worst possible pain. Radiographic investigation shows complete healing in 78.9 % (15 cases) with an average time to healing of 6.5 months (minimum healing time 80 days) corresponding also in complete remission of clinical symptoms. The use of growth factors and autologous mesenchymal stem cells through the enforcement of system for tissue regeneration is a valid and innovative biotechnology technique for the treatment long bone nonunions.

  15. Minimally invasive plate augmentation in the treatment of long-bone non-unions.

    Science.gov (United States)

    Park, Ki-Chul; Oh, Chang-Wug; Kim, Joon-Woo; Park, Kyeong-Hyeon; Oh, Jong-Keon; Park, Il-Hyung; Kyung, Hee-Soo; Heo, Jeong

    2017-11-01

    Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants. Seventeen patients with hypertrophic non-union of the long bones between 2010 and 2014 on radiography who previously underwent intramedullary (IM) nailing or plate osteosynthesis for long-bone fractures were included. A locking compression plate was inserted with at least three mono- or bicortical screws at each proximal and distal segment. Broken or loosened interlocking screws of IM nail were simultaneously re-fixed. Fracture site exposure, pre-fixed implant removal, and bone grafting were not performed. We investigated whether union occurred and analyzed functional outcomes and complications. Eleven femoral and six tibial non-unions were prospectively included. In the pre-existing implants, 13 nails and 4 plates were found. All cases achieved union at a mean 22.7 weeks. One case of superficial infection was managed with oral antibiotics. Deep infection or implant failure did not occur. Minimally invasive plate augmentation can achieve additional stability and promote healing of hypertrophic non-union of the long bones. When indicated, this technique is the least invasive alternative to exchange nailing and reduces surgical risks in the treatment of diaphyseal non-union.

  16. Implant removal after fracture healing : facts and fiction

    NARCIS (Netherlands)

    Vos, D.I.

    2013-01-01

    A frequently asked question to trauma and orthopaedic surgeons is whether and if yes, when an implant will be removed? Although implant removal after fracture healing is daily practice, a scientific basis doesn’t exist. All studies in this thesis were performed to unravel the facts and fiction of

  17. Teriparatide and vertebral fracture healing in Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Izolda Biro

    2017-12-01

    This case is unique as complete healing was achieved without preceding surgical intervention. Further exploration of the use of Teriparatide in spinal fractures in patients with AS is recommended to support the theories generated by this and other existing cases in the literature.

  18. Evaluating fracture healing using digital x-ray image analysis

    African Journals Online (AJOL)

    2011-03-02

    Mar 2, 2011 ... of Edinburgh, developing techniques for assessing fracture healing using digital X-ray image analysis. She currently works in ... Digital X-ray combined with image analysis could provide a simple and cost-effective solution to this problem. .... output in which post-processing can be controlled. If digital X-ray ...

  19. Biomechanical Characteristics of Osteoporotic Fracture Healing in Ovariectomized Rats: A Systematic Review.

    Science.gov (United States)

    Chen, Lin; Yang, Long; Yao, Min; Cui, Xue-Jun; Xue, Chun-Chun; Wang, Yong-Jun; Shu, Bing

    2016-01-01

    Biomechanical tests are widely used in animal studies on osteoporotic fracture healing. However, the biomechanical recovery process is still unknown, leading to difficulty in choosing time points for biomechanical tests and in correctly assessing osteoporotic fracture healing. To determine the biomechanical recovery process during osteoporotic fracture healing, studies on osteoporotic femur fracture healing with biomechanical tests in ovariectomized rat (OVX) models were collected from PUBMED, EMBASE, and Chinese databases. Quadratic curves of fracture healing time and maximum load were fitted with data from the analyzed studies. In the fitted curve for normal fractures, the predicted maximum load was 145.56 N, and the fracture healing time was 88.0 d. In the fitted curve for osteoporotic fractures, the predicted maximum load was 122.30 N, and the fracture healing time was 95.2 d. The maximum load of fractured femurs in OVX rats was also lower than that in sham rats at day 84 post-fracture (D84 PF). The fracture healing time was prolonged and maximum load at D84 PF decreased in OVX rats with closed fractures. The maximum load of Wister rats was higher than that of Sprague-Dawley (SD) rats, but the fracture healing time of SD and Wister rats was similar. Osteoporotic fracture healing was delayed in rats that were 12 weeks old at ovariectomy. There was no significant difference in maximum load at D84 PF between rats with an osteoporosis modeling time = 12 weeks. In conclusion, fracture healing was delayed and biomechanical property decreased by osteoporosis. Time points around D95.2 PF should be considered for biomechanical tests of osteoporotic femur fracture healing in OVX rat models. Osteoporotic fracture healing in OVX rats was affected by the fracture type but not by the strain of the rat.

  20. The Effect of Low Molecular Weight Heparins on Fracture Healing.

    Science.gov (United States)

    Kapetanakis, Stylianos; Nastoulis, Evangelos; Demesticha, Theano; Demetriou, Thespis

    2015-01-01

    Venous Thromboembolism is a serious complication in the trauma patient. The most commonly studied and used anticoagulant treatment in prophylaxis of thrombosis is heparin. The prolonged use of unfractionated heparin has been connected with increased incidence of osteoporotic fractures. Low molecular-weight-heparins (LMWHs) have been the golden rule in antithrombotic therapy during the previous two decades as a way to overcome the major drawbacks of unfractioned heparin. However there are few studies reporting the effects of LMWHs on bone repair after fractures. This review presents the studies about the effects of LMWHs on bone biology (bone cells and bone metabolism) and underlying the mechanisms by which LMWHs may impair fracture healing process. The authors' research based on literature concluded that there are no facts and statistics for the role of LMWHs on fracture healing process in humans and the main body of evidence of their role comes from in vitro and animal studies. Further large clinical studies designed to compare different types of LMWHs, in different dosages and in different patient or animal models are needed for exploring the effects of LMWHs on fracture healing process.

  1. The effect of immunonutrition (glutamine, alanine on fracture healing

    Directory of Open Access Journals (Sweden)

    Abdullah Küçükalp

    2014-11-01

    Full Text Available Background: There have been various studies related to fracture healing. Glutamine is an amino acid with an important role in many cell and organ functions. This study aimed to make a clinical, radiological, and histopathological evaluation of the effects of glutamine on fracture healing. Methods: Twenty rabbits were randomly allocated into two groups of control and immunonutrition. A fracture of the fibula was made to the right hind leg. All rabbits received standard food and water. From post-operative first day for 30 days, the study group received an additional 2 ml/kg/day 20% L-alanine L-glutamine solution via a gastric catheter, and the control group received 2 ml/kg/day isotonic via gastric catheter. At the end of 30 days, the rabbits were sacrificed and the fractures were examined clinically, radiologically, and histopathologically in respect to the degree of union. Results: Radiological evaluation of the control group determined a mean score of 2.5 according to the orthopaedists and 2.65 according to the radiologists. In the clinical evaluation, the mean score was 1.875 for the control group and 2.0 for the study group. Histopathological evaluation determined a mean score of 8.5 for the control group and 9.0 for the study group. Conclusion: One month after orally administered glutamine–alanine, positive effects were observed on fracture healing radiologically, clinically, and histopathologically, although no statistically significant difference was determined.

  2. Multiple Rib Nonunion: Open Reduction and Internal Fixation and Iliac Crest Bone Graft Aspirate.

    Science.gov (United States)

    Kaplan, Daniel J; Begly, John; Tejwani, Nirmal

    2017-08-01

    Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management. Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing. This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.

  3. Fracture and Healing of Rock Salt Related to Salt Caverns

    International Nuclear Information System (INIS)

    Chan, K.S.; Fossum, A.F.; Munson, D.E.

    1999-01-01

    In recent years, serious investigations of potential extension of the useful life of older caverns or of the use of abandoned caverns for waste disposal have been of interest to the technical community. All of the potential applications depend upon understanding the reamer in which older caverns and sealing systems can fail. Such an understanding will require a more detailed knowledge of the fracture of salt than has been necessary to date. Fortunately, the knowledge of the fracture and healing of salt has made significant advances in the last decade, and is in a position to yield meaningful insights to older cavern behavior. In particular, micromechanical mechanisms of fracture and the concept of a fracture mechanism map have been essential guides, as has the utilization of continuum damage mechanics. The Multimechanism Deformation Coupled Fracture (MDCF) model, which is summarized extensively in this work was developed specifically to treat both the creep and fracture of salt, and was later extended to incorporate the fracture healing process known to occur in rock salt. Fracture in salt is based on the formation and evolution of microfractures, which may take the form of wing tip cracks, either in the body or the boundary of the grain. This type of crack deforms under shear to produce a strain, and furthermore, the opening of the wing cracks produce volume strain or dilatancy. In the presence of a confining pressure, microcrack formation may be suppressed, as is often the case for triaxial compression tests or natural underground stress situations. However, if the confining pressure is insufficient to suppress fracture, then the fractures will evolve with time to give the characteristic tertiary creep response. Two first order kinetics processes, closure of cracks and healing of cracks, control the healing process. Significantly, volume strain produced by microfractures may lead to changes in the permeability of the salt, which can become a major concern in

  4. Role of Teriparatide in Accelerating Metatarsal Stress Fracture Healing: A Case Series and Review of Literature

    Directory of Open Access Journals (Sweden)

    Pooja Raghavan

    2012-01-01

    Full Text Available Bone fractures are one of the leading causes of emergency room visits worldwide, with approximately 8 million bony fractures occurring annually in the US alone. Although the majority of fractures do not cause significant long-term morbidity and mortality, approximately 10% of these fractures result in impaired fracture healing, drastically affecting quality of life in affected patients. By increasing bone formation, teriparatide, an anabolic agent used in the treatment of postmenopausal osteoporosis, has shown promise in accelerating the rate of fracture healing. We present two patients with impaired healing of metatarsal fractures who were subsequently treated with teriparatide. Both patients experienced successful bony union of the fracture after the use of teriparatide. These findings suggest that teriparatide may be useful in the clinical setting for the acceleration of fracture healing, especially in patients who are at risk for impaired fracture healing.

  5. Modeling the effects of inflammation in bone fracture healing

    Science.gov (United States)

    Kojouharov, H. V.; Trejo, I.; Chen-Charpentier, B. M.

    2017-10-01

    A new mathematical model is presented to study the early inflammatory effects in bone healing. It consists of a system of nonlinear ordinary differential equations that represents the interactions among macrophages, mesenchymal stem cells, and osteoblasts. A qualitative analysis of the model is performed to determine the equilibria and their corresponding stability properties. A set of numerical simulations is performed to support the theoretical results. The model is also used to numerically monitor the evolution of a broken bone for different types of fractures and to explore possible treatments to accelerate bone healing by administrating anti-inflammatory drugs.

  6. Means of enhancing bone fracture healing : Optimal cell source, isolation methods and acoustic stimulation

    NARCIS (Netherlands)

    Ghebes, Corina Adriana; Braham, Maaike Vera Jasmijn; Zeegers, Adelgunde Veronica Clemens Maria; Renard, Auke Jan Sijbe; Fernandes, Hugo; Saris, Daniel B F

    2016-01-01

    Background: The human body has an extensive capacity to regenerate bone tissue after trauma. However large defects such as long bone fractures of the lower limbs cannot be restored without intervention and often lead to nonunion. Therefore, the aim of the present study was to assess the pool and

  7. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

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    Golubović Ivan

    2012-01-01

    Full Text Available Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  8. Endogenous PTH Deficiency Impairs Fracture Healing and Impedes the Fracture-Healing Efficacy of Exogenous PTH(1-34)

    Science.gov (United States)

    Feng, Yuxu; Shu, Lei; Cao, Xiaojian; Karaplis, Andrew; Goltzman, David; Miao, Dengshun

    2011-01-01

    Background Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s) whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH. Methodology/Principal Findings Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth −/−) mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg) for 1–4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth −/− mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth −/− mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth −/− mice compared to vehicle-treated wild-type and Pth −/− mice. Conclusions/Significance Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing. PMID:21829585

  9. The Impact of Type 2 Diabetes on Bone Fracture Healing

    Directory of Open Access Journals (Sweden)

    Carlos Marin

    2018-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.

  10. Hypertrophic Nonunion Humerus Mimicking an Enchondroma

    Directory of Open Access Journals (Sweden)

    N. K. Magu

    2014-01-01

    Full Text Available Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.

  11. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  12. HIV infection and its effects on fracture healing: a literature review

    African Journals Online (AJOL)

    transmission from mother to child during childbirth or breastfeeding. The World Health Organization (WHO) ... infection has on the healing process of open and closed fractures. It also attempts to explore the effects that HIV ... open fractures are associated with complications in both wound healing and fracture union.

  13. Treatment of diaphyseal non-unions of the ulna and radius.

    Science.gov (United States)

    Kloen, Peter; Wiggers, Jim K; Buijze, Geert A

    2010-12-01

    Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

  14. Biomechanical behavior of the tibiofibular frame in nonunion.

    Science.gov (United States)

    Gunzburg, R; Boulvin, S; Bourgeois, R; Wagner, J

    1991-01-01

    In this paper an in vitro investigation of the biomechanical behavior of the tibiofibular frame in nonunion using electrical extensometry is presented. The intact and untreated nonunited frames are studied as well as three surgical treatments classically used in nonunion: the plating technique, the onlay graft technique and the external fixation according to Ilizarov. The monopodal position with extended knee is considered, and particular attention is paid to the different muscle insertions. The results for the plating and onlay grafting techniques resemble those for the intact frame, whereas the Ilizarov external fixator increases the overall rigidity of the frame. In the untreated nonunited tibiofibular frame, an inversion of the tension and compression areas at the level of the tibia was found. We hypothesize that this phenomenon could be one of the mechanical factors leading to nonunion. Indeed, cyclic stresses in the fracture callus might prevent bony fusion, for the areas healing under compression stresses must become tension areas once the tibia is healed and vice versa.

  15. The systemic angiogenic response during bone healing.

    Science.gov (United States)

    Weiss, Stefan; Zimmermann, Gerald; Pufe, Thomas; Varoga, Deike; Henle, Philipp

    2009-07-01

    Angiogenesis is known to be a critical and closely regulated step during bone formation and fracture healing driven by a complex interaction of various cytokines. Delays in bone healing or even nonunion might therefore be associated with altered concentrations of specific angiogenic factors. These alterations might in turn be reflected by changes in serum concentrations. To determine physiological time courses of angiogenic cytokines during fracture healing as well as possible changes associated with failed consolidation, we prospectively collected serum samples from patients who had sustained surgical treatment for a long bone fracture. Fifteen patients without fracture healing 4 months after surgery (nonunion group) were matched to a collective of 15 patients with successful healing (union group). Serum concentrations of angiogenin (ANG), angiopoietin 2 (Ang-2), basic fibroblast growth factor (bFGF), platelet derived growth factor AB (PDGF-AB), pleiotrophin (PTN) and vascular endothelial growth factor (VEGF) were measured using enzyme linked immunosorbent assays over a period of 24 weeks. Compared to reference values of healthy uninjured controls serum concentrations of VEGF, bFGF and PDGF were increased in both groups. Peak concentrations of these cytokines were reached during early fracture healing. Serum concentrations of bFGF and PDGF-AB were significantly higher in the union group at 2 and 4 weeks after the injury when compared to the nonunion group. Serum concentrations of ANG and Ang-2 declined steadily from the first measurement in normal healing fractures, while no significant changes over time could be detected for serum concentrations of these factures in nonunion patients. PTN serum levels increased asymptotically over the entire investigation in timely fracture healing while no such increase could be detected during delayed healing. We conclude that fracture healing in human subjects is accompanied by distinct changes in systemic levels of specific

  16. Biomechanical assessment and clinical analysis of different intramedullary nailing systems for oblique fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; Seral, B; García-Aznar, J M

    2016-09-01

    The aim of this study is to evaluate the fracture union or non-union for a specific patient that presented oblique fractures in tibia and fibula, using a mechanistic-based bone healing model. Normally, this kind of fractures can be treated through an intramedullary nail using two possible configurations that depends on the mechanical stabilisation: static and dynamic. Both cases are simulated under different fracture geometries in order to understand the effect of the mechanical stabilisation on the fracture healing outcome. The results of both simulations are in good agreement with previous clinical experience. From the results, it is demonstrated that the dynamization of the fracture improves healing in comparison with a static or rigid fixation of the fracture. This work shows the versatility and potential of a mechanistic-based bone healing model to predict the final outcome (union, non-union, delayed union) of realistic 3D fractures where even more than one bone is involved.

  17. Laboratory investigation of crushed salt consolidation and fracture healing

    International Nuclear Information System (INIS)

    1987-01-01

    A laboratory test program was conducted to investigate the consolidation behavior of crushed salt and fracture healing in natural and artificial salt. Crushed salt is proposed for use as backfill in a nuclear waste repository in salt. Artificial block salt is proposed for use in sealing a repository. Four consolidation tests were conducted in a hydrostatic pressure vessel at a maximum pressure of 2500 psi (17.2 MPa) and at room temperature. Three 1-month tests were conducted on salt obtained from the Waste Isolation Pilot Plant and one 2-month test was conducted on salt from Avery Island. Permeability was obtained using argon and either a steady-state or transient method. Initial porosities ranged from 0.26 to 0.36 and initial permeabilities from 2000 to 50,000 md. Final porosities and permeabilities ranged from 0.05 to 0.19 and from -5 md to 110 md, respectively. The lowest final porosity (0.05) and permeability ( -5 md) were obtained in a 1-month test in which 2.3% moisture was added to the salt at the beginning of the test. The consolidation rate was much more rapid than in any of the dry salt tests. The fracture healing program included 20 permeability tests conducted on fractured and unfractured samples. The tests were conducted in a Hoek cell at hydrostatic pressures up to 3000 psi (20.6 MPa) with durations up to 8 days. For the natural rock salt tested, permeability was strongly dependent on confining pressure and time. The effect of confining pressure was much weaker in the artificial salt. In most cases the combined effects of time and pressure were to reduce the permeability of fractured samples to the same order of magnitude (or less) as the permeability measured prior to fracturing

  18. Therapeutic ultrasound in fracture healing: The mechanism of osteoinduction

    Directory of Open Access Journals (Sweden)

    John P

    2008-01-01

    Full Text Available Background: Ultrasound has been used therapeutically for accelerating fracture healing since many years. However, the controversy on the exact mechanism of osteoinduction still continues. In this study, we try to bring out the exact biomolecular mechanism by which ultrasound induces fracture healing. Materials and Methods: The study was conducted in two phases: animal experiments and clinical study. In the first phase, we induced fractures on the left tibia of Wistar strain rats under anaesthesia. They were divided into two groups. One of the groups was given low-intensity, pulsed ultrasound (30 MW/cm 2 20 min a day for 10 days. Tissue samples and radiographs were taken weekly for 3 weeks from both the groups. In the second phase of our study, ten patients with fractures of the distal end of the radius (ten fractures were included. Five of these were treated as cases, and five were treated as controls. Ultrasound was given 30 MW/cm 2 for 20 min every day for 2 weeks. The patients were assessed radiologically and sonologically before and after ultrasound therapy. Tissue samples were studied with thymidine incorporation test with and without adding various neurotransmitter combinations. Results: Radiological findings revealed that there was an increased callus formation in the ultrasound group. At the cellular level, there was an increased thymidine incorporation in the ultrasound group. When various neurotransmitters were added to the cells, there was an increased thymidine incorporation in the ultrasound group. In the second phase of the study, radiological and sonological assessments showed that there was an increased callus formation in the ultrasound group. In cytological study, thymidine incorporation was found to be increased in the ultrasound group. Conclusions: The results of animal and clinical studies demonstrated an early and increased callus formation in the ultrasound group. Cytological studies revealed increased thymidine

  19. Combined effect of teriparatide and low-intensity pulsed ultrasound for nonunion: a case report.

    Science.gov (United States)

    Nozaka, Koji; Shimada, Yoichi; Miyakoshi, Naohisa; Yamada, Shin; Hongo, Michio; Kasukawa, Yuji; Saito, Hidetomo; Kijima, Hiroaki

    2014-05-27

    Low-intensity pulsed ultrasound is a pain-free therapy performed daily at home by the patient and has been shown to promote fracture healing. Teriparatide is a parathyroid hormone preparation that activates osteoblastic bone formation and is also reported to be effective in promoting bony union. We report the case of a 56-year-old Japanese male with a femoral shaft fracture who underwent intramedullary osteosynthesis nailing initially. He had no radiologic or clinical sign of healing 3 months later and low-intensity pulsed ultrasound was initiated at that time. He was reassessed in another 3 months, with evidence of mild bone consolidation but the fracture gap persisted. Subsequent treatment with human parathyroid hormone was initiated in combination with low-intensity pulsed ultrasound. Full fracture healing was present 6 months after beginning the combination low-intensity pulsed ultrasound and teriparatide. It is hypothesized that the potential additive effects of low-intensity pulsed ultrasound and teriparatide therapy ultimately triggered sufficient bone formation to support osseous union. The case reported herein is a femoral shaft atrophic nonunion in which traditional interventions failed. Successful fracture healing was finally achieved with low-intensity pulsed ultrasound and teriparatide therapy. This is the first reported case of diaphyseal nonunion with deterioration of bone quality in long bones resolved with teriparatide and low-intensity pulsed ultrasound.

  20. Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy.

    Science.gov (United States)

    Schweizer, Andreas; Mauler, Flavien; Vlachopoulos, Lazaros; Nagy, Ladislav; Fürnstahl, Philipp

    2016-01-01

    To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides. Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared. In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant. Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the

  1. Three phase bone scintigraphy with (99m)Tc-MDP and serological indices in detecting infection after internal fixation in malunion or nonunion traumatic fractures.

    Science.gov (United States)

    Yang, Fang; Yang, Zheng; Feng, Jin; Zhang, Lianna; Ma, Daqing; Yang, Jigang

    2016-01-01

    To evaluate the diagnostic efficacy of technetium-99m-methylene diphosphonate ((99m)Tc-MDP) three phase bone scintigraphy in detecting infection in malunion or nonunion traumatic fractures after internal fixation. One hundred and eighty four patients with malunion or nonunion fractures after internal fixation (130 men and 54 women; age range, 16-79 years) underwent (99m)Tc-MDP three phase bone scintigraphy (3PBS). They were divided into the infection group (n=96) and the control group without infection (n=88) based on the final diagnosis after operation. The sensitivity, specificity, accuracy, positive prediction value (PPV) and negative prediction value (NPV) were calculated and compared. All patients carried out other laboratory tests related to infection such as complete serum blood cells count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The (99m)Tc-MDP 3PBS for the blood flow phase showed sensitivity, specificity, accuracy, positive predictive value and negative predictive value, 91.7% (88/96), 72.7% (64/88), 82.6% (152/184), 78.6% (88/112) and 88.9% (64/72), respectively and for the blood pool phase, 93.8% (90/96), 61.4% (54/88), 78.3% (144/184), 72.6% (90/124) and 90.0% (54/60) respectively. The semiquantitative indices of the ratio between the abnormal and the normal region of interest (ROI), called by us the A/N ratio, for both blood flow and blood pool phases as estimated between the infection group and the control group were statistically different. It is the opinion of the authors that (99m)Tc-MDP 3PBS provided high predictive values in diagnosing infection in patients with malunion or nonunion traumatic fractures after internal fixation. The diagnostic value of blood flow and blood pool phases estimated of the 3PBS was better than the laboratory indices: white blood cell counts, CRP, and ESR.

  2. Modeling Staphylococcus epidermidis-Induced Non-Unions: Subclinical and Clinical Evidence in Rats.

    Directory of Open Access Journals (Sweden)

    Arianna Barbara Lovati

    Full Text Available S. epidermidis is one of the leading causes of orthopaedic infections associated with biofilm formation on implant devices. Open fractures are at risk of S. epidermidis transcutaneous contamination leading to higher non-union development compared to closed fractures. Although the role of infection in delaying fracture healing is well recognized, no in vivo models investigated the impact of subclinical low-grade infections on bone repair and non-union. We hypothesized that the non-union rate is directly related to the load of this commonly retrieved pathogen and that a low-grade contamination delays the fracture healing without clinically detectable infection. Rat femurs were osteotomized and stabilized with plates. Fractures were infected with a characterized clinical-derived methicillin-resistant S. epidermidis (10(3, 10(5, 10(8 colony forming units and compared to uninfected controls. After 56 days, bone healing and osteomyelitis were clinically assessed and further evaluated by micro-CT, microbiological and histological analyses. The biofilm formation was visualized by scanning electron microscopy. The control group showed no signs of infection and a complete bone healing. The 10(3 group displayed variable response to infection with a 67% of altered bone healing and positive bacterial cultures, despite no clinical signs of infection present. The 10(5 and 10(8 groups showed severe signs of osteomyelitis and a non-union rate of 83-100%, respectively. The cortical bone reaction related to the periosteal elevation in the control group and the metal scattering detected by micro-CT represented limitations of this study. Our model showed that an intra-operative low-grade S. epidermidis contamination might prevent the bone healing, even in the absence of infectious signs. Our findings also pointed out a dose-dependent effect between the S. epidermidis inoculum and non-union rate. This pilot study identifies a relevant preclinical model to assess the

  3. Resultados de tratamento cirúrgico da pseudoartrose de fratura diafisária do úmero com placa de compressão dinâmica e enxerto de osso esponjoso Results of surgical treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone grafting

    Directory of Open Access Journals (Sweden)

    Olasinde Anthony Ayotunde

    2012-01-01

    Full Text Available OBJETIVO: Avaliamos o tratamento da pseudoartrose de fratura diafisária do úmero com placa de compressão dinâmica de janeiro de 2002 a dezembro de 2009. MÉTODOS: Vinte e dois pacientes foram tratados durante o período do estudo. O trauma foi a causa predominante de lesão em 86,4% dos pacientes. RESULTADOS: A pseudoartrose foi atrófica em 81,8% e hipertrófica em 18,2% dos indivíduos. Havia lesão primária do nervo radial nervo em 27,3% dos pacientes. Todos os participantes tinham fratura fechada à apresentação e 81,2% deles tinham recebido tratamento anterior de traditional bone setters (pessoa que faz a redução de ossos quebrados ou deslocados, geralmente sem ser médico licenciado e 18,8% tinham falha do tratamento conservador com gesso. O tempo médio até a união foi 16 semanas. O tratamento anterior com traditional bone setters afetou significantemente o tempo de consolidação da fratura (p OBJECTIVE: We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from January 2002 to December 2009. METHODS: Twenty two patients were treated over the study period. Trauma was the predominant cause of injury in 86,4% of the patients. RESULTS: Nonunion was atrophic in 81,8% and hypertrophic in 18,2% of the individuals. There was a primary injury of the radial nerve in 27,3% of the patients. All the participants had closed fracture at presentation, and 81,2% had received previous treatment from traditional bone setters and 18,8% had failure of the conservative cast management.The average time to healing was 16 weeks. Previous treatment from traditional bone setters significantly affected the time to fracture healing (p<0,05. All fractures had successful union. CONCLUSION: It was concluded that dynamic compression plating remains an effective treatment option for nonunion of humeral shaft fracture. Level of Evidence III, Retrospective study.

  4. Management of a 15-year-old scaphoid non-union.

    Science.gov (United States)

    Wong, Kai Yuen; Sharp, Olivia; Johnston, Phillip

    2018-01-04

    Scaphoid non-union affects wrist joint function and is often associated with a predictable pattern of degenerative change. A 30-year-old man presented with a symptomatic 15-year-old right scaphoid fracture with secondary scaphoid non-union advanced collapse of his right wrist. There was no evidence of avascular necrosis. The initial injury was from a fall onto his outstretched hand. We performed a right scaphoid open reduction, internal fixation and iliac crest bone graft. One year after the operation, the patient had good wrist function and grip strength. A CT scan showed union of the fracture. Studies have shown that if the time between initial fracture and treatment of non-union exceeds 5 years, the chances of healing of the non-union are markedly reduced. In our case, despite the long duration between timing of injury and surgery, there was union and good return of function. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones.

    Science.gov (United States)

    Zhai, Lei; Ma, Xin-Long; Jiang, Chuan; Zhang, Bo; Liu, Shui-Tao; Xing, Geng-Yan

    2016-09-01

    Currently, the available treatments for long bone nonunion (LBN) are removing of focus of infection, bone marrow transplantation as well as Ilizarov methods etc. Due to a high percentage of failures, the treatments are complex and debated. To develop an effective method for the treatment of LBN, we explored the use of human autologous bone mesenchymal stems cells (hBMSCs) along with extracorporeal shock wave therapy (ESWT). Sixty three patients of LBN were subjected to ESWT treatment and were divided into hBMSCs transplantation group (Group A, 32 cases) and simple ESWT treatment group (Group B, 31 cases). The patients were evaluated for 12 months after treatment. In Group A, 14 patients were healed and 13 showed an improvement, with fracture healing rate 84.4%. In Group B, eight patients were healed and 13 showed an improvement, with fracture healing rate 67.7%. The healing rates of the two groups exhibited a significant difference ( P 0.05). However, the callus formation in Group A was significantly higher than that in the Group B after treatment for 6, 9, and 12 months ( P Autologous bone mesenchymal stems cell transplantation with ESWT can effectively promote the healing of long bone nonunions.

  6. Effects of local vanadium delivery on diabetic fracture healing.

    Science.gov (United States)

    Ippolito, Joseph A; Krell, Ethan S; Cottrell, Jessica; Meyer, Ryan; Clark, Devin; Nguyen, Daniel; Sudah, Suleiman; Muñoz, Maximillian; Lim, Elisha; Lin, Anthony; Lee, Thomas Jae Hoon; O'Connor, James Patrick; Benevenia, Joseph; Lin, Sheldon S

    2017-10-01

    This study evaluated the effect of local vanadyl acetylacetonate (VAC), an insulin mimetic agent, upon the early and late parameters of fracture healing in rats using a standard femur fracture model. Mechanical testing, and radiographic scoring were performed, as well as histomorphometry, including percent bone, percent cartilage, and osteoclast numbers. Fractures treated with local 1.5 mg/kg VAC possessed significantly increased mechanical properties compared to controls at 6 weeks post-fracture, including increased torque to failure (15%; p = 0.046), shear modulus (89%; p = 0.043), and shear stress (81%; p = 0.009). The radiographic scoring analysis showed increased cortical bridging at 4 weeks and 6 weeks (119%; p = 0.036 and 209%; p = 0.002) in 1.5 mg/kg VAC treated groups. Histomorphometry of the fracture callus at days 10 and 14 showed increased percent cartilage (121%; p = 0.009 and 45%; p = 0.035) and percent mineralized tissue (66%; p = 0.035 and 58%; p = 0.006) with local VAC treated groups compared to control. Additionally, fewer osteoclasts were observed in the local VAC treated animals as compared to controls at day 14 (0.45% ± 0.29% vs. 0.83% ± 0.36% of callus area; p = 0.032). The results suggest local administration of VAC acts to modulate osteoclast activity and increase percentage of early callus cartilage, ultimately enhancing mechanical properties comparably to non-diabetic animals treated with local VAC. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2174-2180, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Role of injecting bone marrow aspiration injection in treating delayed union and non-union.

    Science.gov (United States)

    Akram, Muhammad; Irshad, Muhammad; Farooqi, Faheem Mubashir; Sah, Ranjeet Kumar; Shahzad, Muhammad Latif; Sarfraz, Ahmad Humayun; Awais, Syed Muhammad

    2014-12-01

    To access the role of bone marrow injection in the management of delayed union and non-union. The prospective study was conducted at the Department of Orthopaedic Surgery and Traumatology, Mayo Hospital, Lahore, from January 2012 to December 2013, and comprised patients who had long bone fractures that resulted in delayed or non-union and were treated with bone marrow injections. Aspiration of bone marrow was done from tibial tuberosity and was injected percutaneously at the fracture site. The whole procedure was carried out as a day case. Fracture site mobility, tenderness and radiological features were assessed using the Union Scale score. Of the 25 patients, 18(72%)were male and 7(28%) were female with an overall mean age of 38±12.96SD years (range: 17-61 years). There were 19(76%) tibial shaft fractures, 4(16%) had shaft of femur fracture, and 2(8%) had humeral shaft fracture. Mean time duration between the injury and the procedure was 34 ±3.46 SD weeks (range: 30-42 weeks). Overall, 23 (92%) patients showed union and the mean time of healing was 15 ±2.73SD weeks (range: 12-22 weeks) after the procedure. Percutaneous bone marrow injection provided an alternative to open bone grafting, having least complications, especially for early intervention in the fracture-healing process.

  8. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Zhongju Shi

    Full Text Available Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn't come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing.We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs which concerned the treatment of teriparatide for fracture healing.Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain.This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed.

  9. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Shi, Zhongju; Zhou, Hengxing; Pan, Bin; Lu, Lu; Liu, Jun; Kang, Yi; Yao, Xue; Feng, Shiqing

    2016-01-01

    Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn't come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing. We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs) which concerned the treatment of teriparatide for fracture healing. Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain. This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed.

  10. Immunohistochemical localization of key arachidonic acid metabolism enzymes during fracture healing in mice.

    Directory of Open Access Journals (Sweden)

    Hsuan-Ni Lin

    Full Text Available This study investigated the localization of critical enzymes involved in arachidonic acid metabolism during the initial and regenerative phases of mouse femur fracture healing. Previous studies found that loss of cyclooxygenase-2 activity impairs fracture healing while loss of 5-lipoxygenase activity accelerates healing. These diametric results show that arachidonic acid metabolism has an essential function during fracture healing. To better understand the function of arachidonic acid metabolism during fracture healing, expression of cyclooxygenase-1 (COX-1, cyclooxygenase -2 (COX-2, 5-lipoxygenase (5-LO, and leukotriene A4 hydrolase (LTA4H was localized by immunohistochemistry in time-staged fracture callus specimens. All four enzymes were detected in leukocytes present in the bone marrow and attending inflammatory response that accompanied the fracture. In the tissues surrounding the fracture site, the proportion of leukocytes expressing COX-1, COX-2, or LTA4H decreased while those expressing 5-LO remained high at 4 and 7 days after fracture. This may indicate an inflammation resolution function for 5-LO during fracture healing. Only COX-1 was consistently detected in fracture callus osteoblasts during the later stages of healing (day 14 after fracture. In contrast, callus chondrocytes expressed all four enzymes, though 5-LO appeared to be preferentially expressed in newly differentiated chondrocytes. Most interestingly, osteoclasts consistently and strongly expressed COX-2. In addition to bone surfaces and the growth plate, COX-2 expressing osteoclasts were localized at the chondro-osseous junction of the fracture callus. These observations suggest that arachidonic acid mediated signaling from callus chondrocytes or from callus osteoclasts at the chondro-osseous junction regulate fracture healing.

  11. High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.

    Science.gov (United States)

    Schilcher, Jörg

    2015-12-01

    Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. We searched the orthopaedic surgical registry in Östergötland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to

  12. Scintigraphic control of bone-fracture healing under ultrasonic stimulation: An animal experimental study

    International Nuclear Information System (INIS)

    Klug, W.; Franke, W.G.; Knoch, H.G.

    1986-01-01

    In a model of closed lower-leg fracture in rabbits and of secondary bone-fracture healing, scintigraphic control until biological healing was performed. Biological fracture healing was assumed for a region of interest (ROI)-activity ratio close to 1.0. After application of sup(99m)Tc-HEDP, 151 examinations were performed. ROI activity increased significantly until day 14 p.i. and reached the maximum value (Q=6.44) on day 14 postfracture. Sixty-one lower leg fractures were treated by ultrasound from days 14-28 postfractures. These stimulated fractures were biologically healed on day 168 postfracture. The fractures that were not treated by ultrasound could not be detected by scanning after day 203 postfracture. (orig.)

  13. Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study.

    Science.gov (United States)

    Vicenti, G; Pesce, V; Tartaglia, N; Abate, A; Mori, C M; Moretti, B

    2014-12-01

    The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Femoral neck fractures after removal of hardware in healed trochanteric fractures.

    Science.gov (United States)

    Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés

    2017-12-01

    Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or

  15. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion - A Rare Case Report and Review of Literature.

    Science.gov (United States)

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere. The interesting intraoperative findings, noteworthy, are about the extensive metallosis and the gross cortical defect measuring 10cm x 1cm x 1cm, corresponding to the foot print of the previous plate with exposed medullary canal. It was managed by debridement, dual plate fixation using 9 holed and 12 holed stainless steel LCPs in an orthogonal fashion and autologous bone grafting. The nonunion healed in 5 months and she regained all the movements except for terminal 10° of elbow extension and 15° of shoulder abduction at her final follow up of 30 months. According to Stewart and Hundley classification the final result was found to be good. We recommend the judicious use of long and short plates in 90-90 orientation along with autogenous bone grafting in the management of a long standing humeral shaft nonunion having extensive cortical resorption following surgical stabilization by plating.

  16. Intramedullary nailing in segmental tibial fractures.

    Science.gov (United States)

    Melis, G C; Sotgiu, F; Lepori, M; Guido, P

    1981-10-01

    Thirty-eight consecutive segmental fractures of the tibia were treated by intramedullary nailing with the Küntscher-Herzog nail. Twenty-two fractures were closed and sixteen were open. Reaming of the medullary cavity was performed and adequate fixation was ensured by use of a plaster cast. Weight-bearing was allowed after thirty-days for closed fractures and sixty days for open fractures. All of the closed fractures healed without malunion or infection. Of the patients with open fractures, one had an infection; one, non-union; and one, malunion. In all cases but one, union was slower at the distal fracture.

  17. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union.

    Science.gov (United States)

    Zhang, Qun; Zhang, Wei; Zhang, Zhuo; Tang, Peifu; Zhang, Lihai; Chen, Hua

    2017-10-01

    A variety of approaches have been used to treat oligotrophic or atrophic non-union. Conventional methods are often associated with great operative trauma, increased blood loss, a risk of re-infection, higher medical costs, and complications at the donor site. This study aimed to assess the clinical efficacy of the accordion technique combined with Minimally Invasive Percutaneous Decortication (MIPD) for these types of bone non-union. From January 2010 to December 2015, 20 patients with long bone aseptic non-unions of the lower extremities without bone defects who were treated with the accordion technique combined with MIPD. The limb-length discrepancy (LLD) was less than 2cm in all patients. None of the patients received autogenous bone grafts during follow-up. All surgeries were performed by the same surgeon, and the modified Application of methods of Ilizarov (ASAMI) criteria were used to evaluate the operative effectiveness. A total of 20 patients were included in this study, and 1 patient was lost during follow-up. Fifteen of these patients presented with oligotrophic non-unions, and 5 patients presented with atrophic non-unions. The average follow-up period in these patients was 12.1 months (range: 8-42 months). The alternative compression and distraction procedure was repeated 1-3 times. Blood loss was 30 to 250ml during surgery. Ultimately, bone union was achieved in 19 patients and failed in 1 patient. The fractures healed within 4-8 months (average time: 5.9 months), and fracture healing was considered excellent in 19 patients and poor in 1 patient. Postoperative function was evaluated as excellent in 9 patients, good in 6 patients, fair in 4 patients, and poor in 1 patient. The accordion technique combined with MIPD, which is a simple, minimally invasive procedure that does not require autologous bone grafting, resulted in a high bone union rate and good postoperative function. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate.

    Science.gov (United States)

    Kim, Dohyun; Yue, Wonyoung; Yoon, Tai-Cheol; Park, Sung-Ho; Kim, Euiseong

    2016-02-01

    The purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material. The clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen. Of the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing. Within the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Chuang, Po-Yao; Lin, Shih-Jie; Lee, Chien-Yin; Huang, Kuo-Chin; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-05-01

    Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications

  20. [The acetabulum nonunion: reconstruction and reosteosynthesis : A long-term outcome].

    Science.gov (United States)

    Pluemer, J; Kruppa, C; Yilmaz, E; Schildhauer, T A; Dudda, M

    2017-01-01

    Acetabular nonunions are rare, especially after operative treatment of an acetabular fracture. There are only single reports of the reconstruction and therapy of acetabular nonunion. Furthermore, there are fewer reports for treatment of acetabular nonunion with a long follow-up. We report a successful revision of an acetabular nonunion after transversal fracture and previous operative intervention, as well as the long-term follow-up after revision surgery.

  1. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Directory of Open Access Journals (Sweden)

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  2. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  3. Fracture behaviour of a self-healing microcapsule-loaded epoxy system

    Directory of Open Access Journals (Sweden)

    2011-03-01

    Full Text Available The effect of temperature on the fracture behaviour of a microcapsule-loaded epoxy matrix was investigated. Microencapsulated epoxy and mercaptan-derivative healing agents were incorporated into an epoxy matrix to produce a polymer composite capable of self-healing. Maximum fracture loads were measured using the double-torsion method. Thermal aging at 55 and 110°C for 17 hours [hrs] was applied to heal the pre-cracked samples. The addition of microcapsules appeared to increase significantly the load carrying capacity of the epoxy after healing. Once healed, the composites achieved as much as 93–171% of its virgin maximum fracture load at 18, 55 and 110°C. The fracture behavior of the microcapsule- loaded epoxy matrix was influenced by the healing temperature. The high self-healing efficiency may be attributed to the result of the subsurface micro-crack pinning or deviation, and to a stronger microencapsulated epoxy and mercaptanderivative binder than that of the bulk epoxy. The results show that the healing temperature has a significant effect on recovery of load transferring capability after fracture.

  4. Reaming in treatment of non-unions in long bones: cytokine expression course as a tool for evaluation of non-union therapy.

    Science.gov (United States)

    Westhauser, Fabian; Zimmermann, Gerald; Moghaddam, Sanaz; Bruckner, Tom; Schmidmaier, Gerhard; Biglari, Bahram; Moghaddam, Arash

    2015-08-01

    The analysis of peripheral serum cytokine expression patterns has been shown to be a possible method for demonstrating changes in bone metabolism. The aim of this study is to evaluate the effectiveness of this method within the treatment of long bone non-union with intramedullary reaming, a well-established non-union treatment concept. Three groups were added to this study: group one (G1) suffered from long bone non-unions, treated successfully with intramedullary reaming; group two (G2) consisted of long bone fractures with proper fracture healing; and group three (G3) included long bone fractures resulting in non-unions. We took blood samples on day 2, and after week 1, 4, 6, month 3 and 6 after initial treatment. Clinical and radiological follow-up were provided for 6 months. We measured transforming growth factor ß-1 (TGFß-1), platelet-derived growth factor (PDGF-AB), and insulin like growth factor-1 (IGF-1) at all-time points. TGF-ß1 levels in G1 and G2 increased from day 2 to 6 weeks after surgery. In general, G1 and G2 showed parallel TGF-ß1 expression patterns, and G3 had a significant peak during first week compared to G1 (p = 0.023). PDGF peaked in G3 during first week after treatment, whereas G1 had its maximum after 4 weeks and G2 after 6 weeks. We were able to detect a significantly lower PDGF concentration at 3 months in G1 compared to G3 (p = 0.029). IGF-1 showed a peak concentration in G1 during the first 4 weeks. Afterwards, concentration levels in both G1 and G2 were higher. Our study was able to show that the cytokine expression pattern in physiological bone healing is similar to that in successful non-union treatment with intramedullary reaming. Our results show that the effect of non-union therapy could be observed objectively by measuring cytokine expression patterns in peripheral blood even in a small group of patients.

  5. Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons.

    Science.gov (United States)

    Bhandari, Mohit; Fong, Katie; Sprague, Sheila; Williams, Dale; Petrisor, Bradley

    2012-08-01

    Despite the large number of fracture outcome studies, there remains variability in the definitions of fracture-healing. It is unclear how orthopaedic surgeons are diagnosing and managing delayed unions and nonunions in clinical practice. We aimed to explore the current opinions of orthopaedic surgeons with regard to defining, diagnosing, and treating delayed unions and nonunions in extremity fractures. We developed a survey using previous literature, key informants in the field of orthopaedic surgery, and a sample-to-redundancy strategy. Our final survey contained four sections and twenty-nine questions focusing on demographics and surgical experience, definitions of fracture union, prognostic factors for union, and the need for clinical trials. The Internet-based survey and follow-up e-mails were continued until our a priori sample size of a minimum of 320 completed and eligible responses were collected. Three hundred and thirty-five surgeons completed the survey. The typical respondent was a North American, male orthopaedic surgeon or consultant over the age of thirty years who had completed trauma fellowship training, worked in an academic practice, supervised residents, and had more than six years of experience in treating orthopaedic injuries. Most surgeons endorsed a lack of standardization in definitions for delayed unions (73%) and nonunions (55%); almost all agreed that defining a delayed union and nonunion should be done on the basis of both radiographic and clinical criteria (88%). Most respondents believed that the degree of soft-tissue injury (approximately 93%), smoking history (approximately 82%), and vascular disease (approximately 76%) increased the risk of healing complications. Surgeons use similar prognostic factors to define and assess delayed unions and nonunions, but there is a lack of consensus in the definitions of delayed union and nonunion. The need for standardization and future randomized trials was strongly endorsed.

  6. Treatment of Tibial Non-Unions - State of the Art and Future Implications.

    Science.gov (United States)

    Märdian, S; Giesecke, M; Haschke, F; Tsitsilonis, S; Wildemann, B; Schwabe, P

    2016-01-01

    healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

  7. The effect of PTH(1-34) on fracture healing during different loading conditions

    DEFF Research Database (Denmark)

    Ellegaard Larsen, Maria; Kringelbach, Tina; Syberg, Susanne

    2013-01-01

    Parathyroid hormone (PTH) and PTH(1-34) have been shown to promote bone healing in several animal studies. It is known that the mechanical environment is important in fracture healing. Furthermore, PTH and mechanical loading has been suggested to have synergistic effects on intact bone. The aim...... of the present study was to investigate whether the effect of PTH(1-34) on fracture healing in rats was influenced by reduced mechanical loading. For this purpose, we used female, 25-week-old ovariectomized rats. Animals were subjected to closed midshaft fracture of the right tibia 10 weeks after ovariectomy...... injections of hPTH(1-34) (20 µg/kg/day) and the other half received vehicle treatment. Fracture healing was assessed by radiology, dual-energy X-ray absorptiometry (DXA), histology, and bone strength analysis. We found that unloading reduced callus area significantly, whereas no effects of PTH(1...

  8. Infected nonunion of tibia

    Directory of Open Access Journals (Sweden)

    Milind Madhav Chaudhary

    2017-01-01

    Full Text Available Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced

  9. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures.

    Science.gov (United States)

    Weresh, M J; Hakanson, R; Stover, M D; Sims, S H; Kellam, J F; Bosse, M J

    2000-01-01

    To determine the effectiveness of exchange reamed nails for treatment of aseptic femoral delayed unions and nonunions. Retrospective chart review. Nineteen patients admitted to the Carolinas Medical Center Level I trauma center from 1990 to 1996 for repair of femoral shaft fracture nonunion following contemporary locked nailing performed at least six months previously. These patients showed no radiographic evidence of progression of fracture healing for three months and had clinical symptoms of nonunion. Exchange reamed nails to treat ununited femoral shaft fracture. Radiographic and clinical evidence of union of the fracture or of the necessity for additional procedures. In 53 percent of the patients the secondary procedure resulted in fracture union, whereas in 47 percent, one or more additional procedures were required. Eight of the nine fractures that did not unite with exchange nailing united after a subsequent procedure (bone grafting, compression plating, or nail dynamization). Neither the type of nonunion, the location of the shaft fracture, the use of static versus dynamic cross-locking, nor the use of tobacco products was statistically predictive of the need for additional procedures. Reevaluation of routine exchange nailing as the recommended treatment for aseptic femoral delayed union or nonunion may be required. A significant number of patients who undergo reamed exchange nailing will require additional procedures to achieve fracture healing.

  10. Sensitivities of biomechanical assessment methods for fracture healing of long bones.

    Science.gov (United States)

    Chen, G; Wu, F Y; Zhang, J Q; Zhong, G Q; Liu, F

    2015-07-01

    There is a controversy as to whether the biomechanical methods are feasible to assess fracture healing of long bones. This paper investigated the sensitivities of two biomechanical methods, torsion and bending, for assessing fracture healing of long bones; both a simplified beam model and finite element model of an artificial femur were employed. The results demonstrated that, in the initial healing stage, the whole-bone stiffness of the fractured bone is extremely sensitive to the variation of the callus stiffness at the fracture site; when the shear (or Young's) modulus of the callus reaches 15% that of the intact bone, the whole-bone stiffness rises up to 90% that of the intact bone. After that, the whole-bone torsional (or bending) stiffness increases slowly; it becomes less sensitive to the variation of the callus stiffness. These results imply that the whole-bone stiffness is of limited reliability to assess the healing quality particular at late stages of the healing process. The simplified model in this paper provided a theoretical framework to explain why the whole-bone stiffness is insensitive to the healing process of fractured long bones in the late stage of healing. The conclusions obtained from the simplified model were verified with the finite element simulations of the artificial femur. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  11. Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study

    Directory of Open Access Journals (Sweden)

    Ellen A. Almirol

    2016-09-01

    Conclusions: In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine the effects of TPTD treatment on stress fracture healing in premenopausal women.

  12. The Changed Route of Anterior Tibial Artery due to Healed Fracture

    Directory of Open Access Journals (Sweden)

    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  13. Acetylcholinesterase inhibitors and healing of hip fracture in Alzheimer's disease patients: a retrospective cohort study.

    Science.gov (United States)

    Eimar, H; Perez Lara, A; Tamimi, I; Márquez Sánchez, P; Gormaz Talavera, I; Rojas Tomba, F; García de la Oliva, T; Tamimi, F

    2013-12-01

    This study was designed to assess effects of cholinergic stimulation using acetylcholinesterase inhibitors (AChEIs), a group of drugs that stimulate cholinergic receptors and are used to treat Alzheimer's disease (AD), on healing of hip fractures. A retrospective cohort study was performed using 46-female AD patients, aged above 75 years, who sustained hip fractures. Study analyses included the first 6-months after hip fracture fixation procedure. Presence of AChEIs was used as predictor variable. Other variables that could affect study outcomes: age, body mass index (BMI), mental state or type of hip fracture, were also included. Radiographic union at fracture site (Hammer index), bone quality (Singh index) and fracture healing complications were recorded as study outcomes. The collected data was analyzed by student's-t, Mann-Whitney-U and chi-square tests. No significant differences in age, BMI, mental state or type of hip fracture were observed between AChEIs-users and nonusers. However, AChEIs-users had better radiographic union at the fracture site (relative risk (RR),2.7; 95%confidence interval (CI),0.9-7.8), better bone quality (RR,2.0; 95%CI,1.2-3.3) and fewer healing complications (RR,0.8; 95%CI,0.7-1.0) than nonusers. In elderly female patients with AD, the use of AChEIs might be associated with an enhanced fracture healing and minimized complications.

  14. Role of Medicinal Plants and Natural Products on Osteoporotic Fracture Healing

    Directory of Open Access Journals (Sweden)

    Mohd Azri Abd Jalil

    2012-01-01

    Full Text Available Popularly known as “the silent disease” since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases—hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world’s largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali, Labisia pumila (Kacip Fatimah, and Piper sarmentosum (Kaduk are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  15. Role of medicinal plants and natural products on osteoporotic fracture healing.

    Science.gov (United States)

    Abd Jalil, Mohd Azri; Shuid, Ahmad Nazrun; Muhammad, Norliza

    2012-01-01

    Popularly known as "the silent disease" since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases-hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world's largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali), Labisia pumila (Kacip Fatimah), and Piper sarmentosum (Kaduk) are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  16. Delayed fracture healing and increased callus adiposity in a C57BL/6J murine model of obesity-associated type 2 diabetes mellitus.

    Directory of Open Access Journals (Sweden)

    Matthew L Brown

    Full Text Available INTRODUCTION: Impaired healing and non-union of skeletal fractures is a major public health problem, with morbidity exacerbated in patients with diabetes mellitus (DM. DM is prevalent worldwide and affects approximately 25.8 million US adults, with >90% having obesity-related type 2 DM (T2DM. While fracture healing in type 1 DM (T1DM has been studied using animal models, an investigation into delayed healing in an animal model of T2DM has not yet been performed. METHODS: Male C57BL/6J mice at 5 weeks of age were placed on either a control lean diet or an experimental high-fat diet (HFD for 12 weeks. A mid-diaphyseal open tibia fracture was induced at 17 weeks of age and a spinal needle was used for intra-medullary fixation. Mice were sacrificed at days 7, 10, 14, 21, 28, and 35 for micro-computed tomography (μCT, histology-based histomorphometry and molecular analyses, and biomechanical testing. RESULTS: HFD-fed mice displayed increased body weight and impaired glucose tolerance, both characteristic of T2DM. Compared to control mice, HFD-fed mice with tibia fractures showed significantly (p<0.001 decreased woven bone at day 28 by histomorphometry and significantly (p<0.01 decreased callus bone volume at day 21 by μCT. Interestingly, fracture calluses contained markedly increased adiposity in HFD-fed mice at days 21, 28, and 35. HFD-fed mice also showed increased PPARγ immunohistochemical staining at day 14. Finally, calluses from HFD-fed mice at day 35 showed significantly (p<0.01 reduced torsional rigidity compared to controls. DISCUSSION: Our murine model of T2DM demonstrated delayed fracture healing and weakened biomechanical properties, and was distinctly characterized by increased callus adiposity. This suggests altered mesenchymal stem cell fate determination with a shift to the adipocyte lineage at the expense of the osteoblast lineage. The up-regulation of PPARγ in fracture calluses of HFD-fed mice is likely involved in the proposed

  17. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

    International Nuclear Information System (INIS)

    Dunn, Andrew J.; Campbell, Robert S.D.; Mayor, Peter E.; Rees, Dai

    2008-01-01

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  18. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, Andrew J.; Campbell, Robert S.D. [Royal Liverpool and Broadgreen University Teaching Hospitals, Department of Medical Imaging, Liverpool (United Kingdom); Mayor, Peter E. [Leighton Hospital, Department of Medical Imaging, Crewe, Cheshire (United Kingdom); Rees, Dai [Robert Jones and Agnes-Hunt Orthopaedic Hospital, Department of Orthopaedic Surgery, Oswestry, Shropshire (United Kingdom)

    2008-05-15

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  19. The effects of alpha-tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model

    Directory of Open Access Journals (Sweden)

    Sharlina Mohamad

    2012-09-01

    Full Text Available OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle, whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone.

  20. Low-energy extracorporeal shockwave therapy (ESWT) improves metaphyseal fracture healing in an osteoporotic rat model.

    Science.gov (United States)

    Mackert, Gina A; Schulte, Matthias; Hirche, Christoph; Kotsougiani, Dimitra; Vogelpohl, Julian; Hoener, Bernd; Fiebig, Teresa; Kirschner, Stefanie; Brockmann, Marc A; Lehnhardt, Marcus; Kneser, Ulrich; Harhaus, Leila

    2017-01-01

    As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT), was evaluated as a treatment option for the improvement of osteoporotic fracture healing. A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic) groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2) as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period) were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR) analysis, histomorphometric analysis and biomechanical analysis. The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2) ESWT and with fewer treatment applications per healing period. In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

  1. Low-energy extracorporeal shockwave therapy (ESWT improves metaphyseal fracture healing in an osteoporotic rat model.

    Directory of Open Access Journals (Sweden)

    Gina A Mackert

    Full Text Available As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT, was evaluated as a treatment option for the improvement of osteoporotic fracture healing.A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2 as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR analysis, histomorphometric analysis and biomechanical analysis.The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2 ESWT and with fewer treatment applications per healing period.In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

  2. Local manganese chloride treatment accelerates fracture healing in a rat model.

    Science.gov (United States)

    Hreha, Jeremy; Wey, Aaron; Cunningham, Catherine; Krell, Ethan S; Brietbart, Eric A; Paglia, David N; Montemurro, Nicholas J; Nguyen, Daniel A; Lee, Yung-Jae; Komlos, Daniel; Lim, Elisha; Benevenia, Joseph; O'Connor, J Patrick; Lin, Sheldon S

    2015-01-01

    This study investigated the effects of local delivery of manganese chloride (MnCl2), an insulin-mimetic compound, upon fracture healing using a rat femoral fracture model. Mechanical testing, histomorphometry, and immunohistochemistry were performed to assess early and late parameters of fracture healing. At 4 weeks post-fracture, maximum torque to failure was 70% higher (P<0.05) and maximum torsional rigidity increased 133% (P<0.05) in animals treated with 0.125 mg/kg MnCl2 compared to saline controls. Histological analysis of the fracture callus revealed percent new mineralized tissue was 17% higher (P<0.05) at day 10. Immunohistochemical analysis of the 0.125 mg/kg MnCl2 treated group, compared to saline controls, showed a 379% increase in the density of VEGF-C+ cells. In addition, compared to saline controls, the 0.125 mg/kg MnCl2 treated group showed a 233% and 150% increase in blood vessel density in the subperiosteal region at day 10 post-fracture as assessed by detection of PECAM and smooth muscle α actin, respectively. The results suggest that local MnCl2 treatment accelerates fracture healing by increasing mechanical parameters via a potential mechanism of amplified early angiogenesis leading to increased osteogenesis. Therefore, local administration of MnCl2 is a potential therapeutic adjunct for fracture healing. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Laboratory tests of hydraulic fracturing and swell healing

    DEFF Research Database (Denmark)

    Thunbo, Christensen Claes; Foged, Christensen Helle; Foged, Niels

    1998-01-01

    New laboratory test set-ups and test procedures are described - for testing the formation of hydraulically induced fractures as well as the potential for subsequent fracture closurefrom the relase of a swelling potential. The main purpose with the tests is to provide information on fracturing...... stresses and whether or not the material in question possesses the potential for fracture closure....

  4. Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review

    DEFF Research Database (Denmark)

    Hermund, Niels Ulrich; Hillerup, Søren; Kofod, Thomas

    2008-01-01

    The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus...... of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies...... showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies...

  5. Fracture healing: Quantitative three-phase bone scintigraphy as a prognostic factor

    International Nuclear Information System (INIS)

    Dodig, D.; Kasal, B.; Kragic-Pranic, A.; Predic, P.

    2002-01-01

    Aim: Careful clinical examination and conventional radiography, together with other standard methods for evaluation of bone fracture healing, are frequently inconclusive. Furthermore, it is difficult to predict the complications of healing on the basis of clinical and radiographic findings only. Bone scintigraphy plays an important role in detecting bone fractures. This method is very sensitive, but not enough specific. The aim of this work was to evaluate the role of three-phase bone scintigraphy in the healing prognosis of long bone fractures. Material and Methods: We evaluated the three elements (perfusion, blood pool and static image) of three-phase bone scintigraphy in early prognosis of the course of fracture healing in patients with fractures of femur or tibia. Three-phase bone scintigraphy was performed in 73 patients. The patients were divided into 4 groups according to X-ray and clinical examination: 1) Non operated patients with stable fracture, 2) Operated patients with unstable fracture (infection), 3) Fractures with delayed union, 4) Patients with pseudoarthrosis. Using region of interest (ROI) method we compared the activity on the site of fracture with the activity on the symmetrical place in the healthy bone. The relative indices for each group of patients and for each element of three-bone scintigraphy were calculated in order to make possible the follow up of the fracture healing and to obtain data for prognosis and evaluation of possible complications. Results: The most valuable results were obtained by quantitative analysis of perfusion data immediately after trauma and 2-3 weeks later. Our results show a high diagnostic accuracy in identifying infection by perfusion scintigrams immediately after trauma. The perfusion indices obtained immediately and after 2-3 weeks could predict delayed union after the trauma. Quantitative analysis of blood pool phase gave no data of clinical significance in distinguishing various pathologies. Conclusion: Our

  6. SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

    OpenAIRE

    A. N. Erokhin; V. T. Tarchokov

    2017-01-01

    Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age...

  7. Macrophages in bone fracture healing: Their essential role in endochondral ossification.

    Science.gov (United States)

    Schlundt, Claudia; El Khassawna, Thaqif; Serra, Alessandro; Dienelt, Anke; Wendler, Sebastian; Schell, Hanna; van Rooijen, Nico; Radbruch, Andreas; Lucius, Richard; Hartmann, Susanne; Duda, Georg N; Schmidt-Bleek, Katharina

    2018-01-01

    In fracture healing, skeletal and immune system are closely interacting through common cell precursors and molecular mediators. It is thought that the initial inflammatory reaction, which involves migration of macrophages into the fracture area, has a major impact on the long term outcome of bone repair. Interestingly, macrophages reside during all stages of fracture healing. Thus, we hypothesized a critical role for macrophages in the subsequent phases of bone regeneration. This study examined the impact of in vivo induced macrophage reduction, using clodronate liposomes, on the different healing phases of bone repair in a murine model of a standard closed femoral fracture. A reduction in macrophages had no obvious effect on the early fracture healing phase, but resulted in a delayed hard callus formation, thus severely altering endochondral ossification. Clodronate treated animals clearly showed delayed bony consolidation of cartilage and enhanced periosteal bone formation. Therefore, we decided to backtrack macrophage distribution during fracture healing in non-treated mice, focusing on the identification of the M1 and M2 subsets. We observed that M2 macrophages were clearly prevalent during the ossification phase. Therefore enhancement of M2 phenotype in macrophages was investigated as a way to further bone healing. Induction of M2 macrophages through interleukin 4 and 13 significantly enhanced bone formation during the 3week investigation period. These cumulative data illustrate their so far unreported highly important role in endochondral ossification and the necessity of a fine balance in M1/M2 macrophage function, which appears mandatory to fracture healing and successful regeneration. Copyright © 2016. Published by Elsevier Inc.

  8. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly.

    Science.gov (United States)

    Guo, Jiong Jiong; Yang, Huilin; Qian, Haixin; Huang, Lixin; Guo, Zhongxing; Tang, Tiansi

    2010-03-01

    It has been well recognized that malnutrition causes wounds to heal inadequately and incompletely. Malnutrition is often observed in the elderly, and it appears to be more severe in patients with hip fracture than in the general aging population. Few prospective studies give a detailed account of the identification and classification of nutritional status in the elderly. The objective of this study was to evaluate the effects of different nutritional measurements on wound healing status after hip fracture in the elderly. From September 2002 to December 2007, 207 hip fracture patients older than 60 y treated surgically were reviewed for preoperative nutritional status. There were 81 males and 126 females with an average age of 75.93 y (62-91 y); 131 cases with femoral neck fractures, 76 cases with intertrochanteric fractures. Parameters indicative of nutritional status (serum albumin, serum transferrin, serum pre-albumin, and total lymphocyte count levels) at the time of admission were assessed, along with anthropometric measurements, Rainey MacDonald nutritional index, and MNA tool. Suture removal was performed on postoperative day 14. Delayed wound healing complicated 46 (22.2%) of the 207 cases. The preoperative serum transferring total lymphocyte count levels, MNA total score, and Rainey MacDonald nutritional index were significantly lower for patients who subsequently had delayed wound healing. When all variables were subjected to multivariate analysis, only total lymphocyte count levels and MNA total score showed significant value in predicting which patients would have delayed wound healing. Through prophylactic antibiotics and adherence to strict aseptic precautions, on follow-up, wound healing was normal in all patients. Patients at risk for delayed wound healing problems after hip fracture can be identified using relatively inexpensive laboratory test such as TLC and MNA tool. The clinician must be aware of the risk values of both measurements. We believe

  9. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.

    Science.gov (United States)

    Park, Jin; Kim, Sul Gee; Yoon, Han Kook; Yang, Kyu Hyun

    2010-02-01

    The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. : Retrospective data analysis, November 1996-March 2006. A level I trauma center. Eighteen patients with 18 nonisthmal femoral nonunions. Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Union and complications. Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

  10. The effect of dexketoprofen trometamol on the healing of diaphysis fractures of rat tibia.

    Science.gov (United States)

    Sevimli, Raşit; Uzel, Murat; Sayar, Hamide; Kalender, Ali Murat; Dökmeci, Ozer

    2013-01-01

    The aim of this study was to analyze the effect of dexketoprofen trometamol, a non-steroidal anti-inflammatory drug, on fracture healing. Closed tibia fracture was created in the right tibia of 60 male Wistar albino rats. Fixation was achieved by closed reduction and 0.5 mm intramedullary nails. Intramuscular dexketoprofen trometamol was administered at a dose of 5 mg/kg daily to the 30 rats in the study group. Rats were sacrificed in groups of 10 at the 2nd, 4th, and 6th weeks following the fracture. Fracture healing was compared mechanically, radiologically, and histopathologically between the groups. There was no statistically significant difference between the study and control groups in terms of mean values of radiological or histopathological scores at the 2nd, 4th and 6th weeks (p>0.05). Biomechanical evaluation could not be conducted in all rats in the study and control groups at the 2nd week due to early stage fracture healing. Mean biomechanical examination values were not statistically significant at the 4th and 6th weeks between the study and control groups (p>0.05). No radiological, biomechanical, and histological effects were detected in the healing of closed fractures of the tibia fixed with intramedullary nail with the long-term use of dexketoprofen trometamol. Dexketoprofen trometamol may be used in patients undergoing surgical fixation for traumatic fractures, taking into account other drugs administered together.

  11. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion – A Rare Case Report and Review of Literature

    Science.gov (United States)

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Introduction: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. Case Report: A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere. The interesting intraoperative findings, noteworthy, are about the extensive metallosis and the gross cortical defect measuring 10cm x 1cm x 1cm, corresponding to the foot print of the previous plate with exposed medullary canal. It was managed by debridement, dual plate fixation using 9 holed and 12 holed stainless steel LCPs in an orthogonal fashion and autologous bone grafting. The nonunion healed in 5 months and she regained all the movements except for terminal 10° of elbow extension and 15° of shoulder abduction at her final follow up of 30 months. According to Stewart and Hundley classification the final result was found to be good. Conclusion: We recommend the judicious use of long and short plates in 90-90 orientation along with autogenous bone grafting in the management of a long standing humeral shaft nonunion having extensive cortical resorption following surgical stabilization by plating. PMID:27299099

  12. Histomorphometric study of trabecular bone remodeling during condylar process fracture healing in the growing period: experimental study.

    Science.gov (United States)

    Yasuoka, T; Oka, N

    1991-09-01

    Trabecular bone remodeling during condylar fracture healing in the growing period was analyzed by histomorphometry with a synchronous system. Data from the study showed displacement of the fractured condyle was compensated by the changes in remodeling ascribed to the pubertal spurt of growth, and that such remodeling still continued even after clinical healing. The regional acceleratory phenomenon, evolved to potentiate tissue healing, was observed 1 week after induction of the fracture. Mesenchymal cells were presumably modulated into chondroblasts that promoted endochondral ossification. It was concluded that trabecular bone remodeling plays an important role in healing of condylar fractures during the growth period.

  13. Immunosuppression with FK506 has no influence on fracture healing in the rat.

    Science.gov (United States)

    Voggenreiter, Gregor; Siozos, Patrizia; Hunkemöller, Eva; Heute, Stefan; Schwarz, Markus; Obertacke, Udo

    2005-08-01

    Immunosuppressant drugs like cyclosporine A and FK506 are widely used for solid organ transplantation. They are accelerating bone remodeling but cause net bone loss. The aim of this study was to investigate the effect of FK506 on fracture healing in the rat. Eighty Lewis rats were divided into four groups, which received FK506 (1 mg/kg BW) or no treatment for 2 or 4 weeks, beginning after production of a closed, nondisplaced unilateral tibial fracture. Radiographic, histological, and biomechanical studies were used to evaluate fracture healing and histomorphometric analysis of the tibial metaphysis of the intact contralateral side was performed. Radiographs revealed no difference of the healing of the control fractures compared with the fractures in the FK506-treated group at 2 and 4 weeks. The mechanical parameters of the tested contralateral intact tibiae and of the fracture callus demonstrated no difference between control and immunosuppressed animals. Tibial bone histomorphometry revealed increased measures of bone formation and bone resorption, accompanied by a significant reduction of percent trabecular area. At 4 weeks, the fractures showed osseous healing with woven bone at the fracture site and only minimal amounts of cartilage. Histological grading was not different between the control and the FK506 group at both time points. We conclude that systemic application of FK506 has no biomechanical and histological effects of experimental fracture healing in the rat. However, resorption far in excess of formation leads to a net bone loss in the trabecular bone of the tibia that has no effect on the stability of the intact bone.

  14. Laboratory tests of hydraulic fracturing and swell healing

    DEFF Research Database (Denmark)

    Thunbo, Christensen Claes; Foged, Christensen Helle; Foged, Niels

    1998-01-01

    New laboratory test set-ups and test procedures are described - for testing the formation of hydraulically induced fractures as well as the potential for subsequent fracture closurefrom the relase of a swelling potential. The main purpose with the tests is to provide information on fracturing...

  15. Absence of positive effect of black cohosh (Cimicifuga racemosa) on fracture healing in osteopenic rodent model.

    Science.gov (United States)

    Kolios, Leila; Daub, Florian; Sehmisch, Stephan; Frosch, Karl-Heinz; Tezval, Mohammed; Stuermer, Klaus Michael; Wuttke, Wolfgang; Stuermer, Ewa Klara

    2010-12-01

    The healing of predominantly metaphyseal fractures in postmenopausal osteoporosis is delayed and comparatively poor. Due to the potential side effects of HRT, natural alternatives are appealing. The aim of this study was to determine whether Cimicifuga racemosa extract BNO 1055 improves metaphyseal fracture healing in severe osteopenic bone in rats. Thirty-three 12-week-old female rats developed severe osteopenia during 10 weeks after ovariectomy. After metaphyseal tibial-osteotomy and standardized T-plate-osteosynthesis, the healing periods in ovariectomized rats (C), 17-α-estradiol (E) and Cimicifuga racemosa (CR) supplemented diets were assessed for 35 days. Changes in callus morphology were evaluated qualitatively by biomechanical testing and quantitatively in microradiographies and fluorochrome-labeled histological sections. The CR-supplementation slightly improved callus quality and trabecular bone formation. It significantly enhanced the endosteal callus density compared to C group (Cl.Dn.e C: 59.08 ± 21.89, E: 45.95 ± 18.39, CR: 60.85 ± 18.66*), though most of the other morphological parameters examined showed no improvement. The time course of fracture healing did not change due to CR. Estrogen-supplementation enhanced the biomechanical properties of the fracture site. Trabecular bone was improved indicating the physiological endosteal healing process. The CR-supplementation did not exhibit positive effects in severe (senile) osteopenic fracture healing as seen in early (postmenopausal) osteoporosis in rats. Callus formation was slightly improved under CR. Estrogen improved fracture healing in severe osteopenic bone, while the extent of callus formation played a minor role. Copyright © 2010 John Wiley & Sons, Ltd.

  16. Two-stage surgical treatment for septic non-union of the forearm.

    Science.gov (United States)

    Perna, Fabrizio; Pilla, Federico; Nanni, Matteo; Berti, Lisa; Lullini, Giada; Traina, Francesco; Faldini, Cesare

    2017-06-18

    To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union. Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years (19-57 years) and a mean follow-up of 6 years (2-10 years). All patients presented an atrophic non-union with a mean length of the bone defect of 1.8 cm (1.2-4 cm). Complications and clinical results after surgical treatment were recorded. Mean time to resolution of the infectious process was 8.2 wk (range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo (range 2-10 mo) after the second step surgery. Cultures on intraoperative samples were positive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5 (27.8%) patients, satisfactory in 10 (55.5%) and unsatisfactory in 3 (16.7%) patients. No activities of daily living (ADLs) limitations were reported by 12 (66.6%) patients, slight by 3 (16.6%) and severe limitation by 3 (16.6%) patients. Mean visual analog scale at the last follow-up was 1 (0-3). The two-step technique has proven to be effective to achieve resolution of the

  17. Backstroke technique: an effective way to improve the healing of tibia fracture.

    Science.gov (United States)

    Lee, Qi; Zeng, Bing-Fang; Luo, Cong-Feng; Wang, Jin-Wu; Lu, Nan-Ji

    2006-10-01

    To assess the method and results of applying a backstroke technique, we treated 43 patients with tibial shaft fracture using unreamed tibial nails (UTN). Of these patients, 27 suffered a closed fracture and 16 an open fracture. After the operation, the effect of treatment was evaluated: 42 of 43 cases were followed up from four to 18 months, averaging 13.6 months. The four-month and 12-month healing rates of open fracture were 54.6 and 80.9%, respectively, the former of which is significantly higher than the average rate of the AO/ASIF multicentre study. Our results indicate that applying a backstroke technique in treating tibial shaft fracture with UTN can improve the healing rate and reduce complications.

  18. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

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    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  19. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; Jong, M. de; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; Thiel, T.P. van; Rijcke, P.A. de; Soesman, N.M.; Hagenaars, T.; Boekhoudt, F.D.; Vries, M.R. de; Roukema, G.R.; Tanka, A.F.; Bremer, J. van den; Meulen, H.G. van der; Bronkhorst, M.W.; Dijkman, B.A. van; Zutphen, S.W. van; Vos, Dieuwke; Schep, N.W.; Eversdijk, M.G.; Olden, G.D.J. van; Brand, J.G. van den; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    BACKGROUND: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  20. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; de Jong, M.; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; van Thiel, T.P.H.; de Rijcke, P.A.R.; Soesman, N.M.R.; Hagenaars, T.; Boekhoudt, F.D.; de Vries, M.R.; Roukema, G.R.; Tanka, A.F.K.; van den Bremer, J.; van der Meulen, H.G.W.M.; Bronkhorst, M.W.G.A.; van Dijkman, B.A.; van Zutphen, S.W.A.M.; Vos, D.I.; Schep, N.W.L.; Eversdijk, M.G.; van Olden, G.D.J.; van den Brand, J.G.H.; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  1. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, Sylvia A.; de Jong, Mireille; Sier, Cornelis F. M.; Krijnen, Pieta; Duijff, Jan W.; van Thiel, Tom P. H.; de Rijcke, Piet A. R.; Soesman, Nicolaj M. R.; Hagenaars, Tjebbe; Boekhoudt, Freek D.; de Vries, Mark R.; Roukema, Gert R.; Tanka, Andras F. K.; van den Bremer, Jephta; van der Meulen, Hub G. W. M.; Bronkhorst, Maarten W. G. A.; van Dijkman, Bart A.; van Zutphen, Stephan W. A. M.; Vos, Dagmar I.; Schep, Niels W. L.; Eversdijk, Martin G.; van Olden, Ger D. J.; van den Brand, Johan G. H.; Hillen, Robert Jan; Frölke, Jan Paul M.; Schipper, Inger B.

    2011-01-01

    The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified

  2. Extracorporeal shockwave therapy: A systematic review of its use in fracture management

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    Petrisor B

    2009-01-01

    Full Text Available Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies′ overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures. However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.

  3. Altered expression of SDF-1 and CXCR4 during fracture healing in diabetes mellitus.

    Science.gov (United States)

    Arakura, Michio; Lee, Sang Yang; Takahara, Shunsuke; Okumachi, Etsuko; Iwakura, Takashi; Fukui, Tomoaki; Nishida, Kotaro; Kurosaka, Masahiro; Kuroda, Ryosuke; Niikura, Takahiro

    2017-06-01

    Diabetes mellitus (DM) is known to impair fracture healing. The purpose of this study was to elucidate and compare the gene expression patterns and localization of stromal cell-derived factor 1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) during fracture healing of the femur in rats with and without DM. Closed transverse fractures were created in the femurs of rats equally divided into a DM group and control group; DM was induced by streptozotocin. At post-fracture days five, seven, 11, 14, 21 and 28, total RNA was extracted from the fracture callus and mRNA expression levels of SDF-1 and CXCR4 were measured by real-time polymerase chain reaction. Localization of SDF-1 and CXCR4 proteins at the fracture site was determined by immunohistochemistry at days 21 and 28. SDF-1 expression was significantly lower in the DM group than in the healthy group on days 21 and 28, and showed a significant difference between days 14 and 21 in the healthy group. There was no significant difference in CXCR4 expression levels between the healthy and DM groups at any time point. On day 21 immunoreactivity of SDF-1 and CXCR4 was detected at the fracture site of the healthy group but no immunoreactivity was observed in the DM group. On day 28, immunoreactivity of SDF-1 and CXCR4 was detected at the fracture site in both groups. Gene expression and localization of SDF-1 and CXCR4 was altered during fracture healing, which may contribute to the impaired fracture healing in DM.

  4. Novel perfused compression bioreactor system as an in vitro model to investigate fracture healing

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    Waldemar eHoffmann

    2015-02-01

    Full Text Available Secondary bone fracture healing is a physiological process that leads to functional tissue regeneration via endochondral bone formation. In vivo studies have demonstrated that early mobilization and the application of mechanical loads enhances the process of fracture healing. However, the influence of specific mechanical stimuli and particular effects during specific phases of fracture healing remain to be elucidated. In this work, we have developed and provided proof-of-concept of an in vitro human organotypic model of physiological loading of a cartilage callus, based on a novel perfused compression bioreactor system (PCB. We then used the fracture callus model to investigate the regulatory role of dynamic mechanical loading. Our findings provide a proof-of-principle that dynamic mechanical loading applied by the PCB can enhance the maturation process of mesenchymal stromal cells towards late hypertrophic chondrocytes and the mineralization of the deposited extracellular matrix. The PCB provides a promising tool to study fracture healing and for the in vitro assessment of alternative fracture treatments based on engineered tissue grafts or pharmaceutical compounds, allowing for the reduction of animal experiments.

  5. Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

    Science.gov (United States)

    Kim, Sang-Min; Kang, Kyung-Chung; Kim, Ji Wan; Lim, Seung-Jae

    2017-01-01

    Background The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. Methods We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. Results This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. Conclusions Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials. PMID:28326303

  6. Analysis of ulnar variance as a risk factor for developing scaphoid nonunion.

    Science.gov (United States)

    Lirola-Palmero, S; Salvà-Coll, G; Terrades-Cladera, F J

    2015-01-01

    Ulnar variance may be a risk factor of developing scaphoid non-union. A review was made of the posteroanterior wrist radiographs of 95 patients who were diagnosed of scaphoid fracture. All fractures with displacement less than 1mm treated conservatively were included. The ulnar variance was measured in all patients. Ulnar variance was measured in standard posteroanterior wrist radiographs of 95 patients. Eighteen patients (19%) developed scaphoid nonunion, with a mean value of ulnar variance of -1.34 (-/+ 0.85) mm (CI -2.25 - 0.41). Seventy seven patients (81%) healed correctly, and the mean value of ulnar variance was -0.04 (-/+ 1.85) mm (CI -0.46 - 0.38). A significant difference was observed in the distribution of ulnar variance (pvariance less than -1mm, and ulnar variance greater than -1mm. It appears that patients with ulnar variance less than -1mm had an OR 4.58 (CI 1.51 to 13.89) with pvariance less than -1mm have a greater risk of developing scaphoid nonunion, OR 4.58 (CI 1.51 to 13.89) with p<.007. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  7. Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography

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    Ronnachat Rothom

    2017-01-01

    Full Text Available Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT, has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.

  8. Backstroke technique: an effective way to improve the healing of tibia fracture

    OpenAIRE

    Lee, Qi; Zeng, Bing-fang; Luo, Cong-Feng; Wang, Jin-Wu; Lu, Nan-Ji

    2006-01-01

    To assess the method and results of applying a backstroke technique, we treated 43 patients with tibial shaft fracture using unreamed tibial nails (UTN). Of these patients, 27 suffered a closed fracture and 16 an open fracture. After the operation, the effect of treatment was evaluated: 42 of 43 cases were followed up from four to 18 months, averaging 13.6 months. The four-month and 12-month healing rates of open fracture were 54.6 and 80.9%, respectively, the former of which is significantly...

  9. TGF-beta1 as a marker of delayed fracture healing.

    Science.gov (United States)

    Zimmermann, G; Henle, P; Küsswetter, M; Moghaddam, A; Wentzensen, A; Richter, W; Weiss, S

    2005-05-01

    Mitogens of the TGF-beta superfamily have been shown to be crucial local and systemic regulatory molecules involved in fracture healing. However, there exists only little information about systemic regulation of bone regeneration by growth factors and no reports comparing serum levels of bone growth factors between normal and failed fracture healing have been published so far. We hypothesized that quality of fracture healing might be reflected by systemic alterations of key regulatory growth factors involved in bone formation and remodeling. Therefore, the aim of this study was to evaluate possible differences in serum levels of BMP-2, BMP-4, and TGF-beta1 in patients with normal and delayed fracture healing. 103 patients with diaphyseal fractures of long bones were recruited prospectively. Peripheral blood samples were collected over a period of 6 months following a standardized time schedule. At the end of the individual investigation period, growth factor serum levels were measured using commercially available enzyme immunoassays. For the elimination of disturbing influences, patients in both groups were matched by gender, age, fracture type, and localization as well as applied technique of osteosynthesis. During a study period of 1 year, 10 patients with an atrophic type of delayed union could be retrieved and matched to 10 patients with normal fracture healing. The diagnosis of delayed union was assumed in case of failed consolidation 4 months after trauma. We found an increase of TGF-beta1 serum levels up to 2 weeks after fracture in both groups with a following return to the reference value within 6 weeks after trauma. However, decline of serum concentration occurred earlier in patients with delayed fracture healing. At 4 weeks after trauma, serum levels of TGF-beta1 were significantly lower in patients of the delayed union group. Serum levels of BMP-2 and BMP-4 were below detection level in all patients, respectively. These findings support the critical

  10. Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures.

    Science.gov (United States)

    Yin, Wenjing; Xu, Zhengliang; Sheng, Jiagen; Zhang, Changqing; Zhu, Zhenhong

    2016-05-16

    To evaluate the potential risk factors of the development of femoral head osteonecrosis after healed intertrochanteric fractures. We retrospectively reviewed all patients who were operated upon with closed reduction and internal fixation for intertrochanteric fractures by our medical group from December 1993 to December 2012. Patients with healed fractures were identified. Age, gender, comorbidities favouring osteonecrosis, causes of injuries, fracture patterns, the location of the primary fracture line, time from injury to surgery, fixation methods, and the development of femur head osteonecrosis of these patients were summarised. Univariate and multivariate logistic regression analysis were performed to evaluate the correlation between potential risk factors and the development of femoral head osteonecrosis. A total of 916 patients with healed intertrochanteric fractures were identified. Femoral head osteonecrosis was found in 8 cases (0.87%). According to the results of univariate logistic regression, a more proximal fracture line, fixation with dynamic hip screws and age were found to be statistically significant factors. The results of multivariate logistic regression analysis indicated that the statistically significant predictors of femoral head osteonecrosis were younger age (odds ratio [OR] = 17.103; 95% confidence interval [CI], 1.988-147.111), a more proximal fracture line (OR = 31.439; 95% CI, 3.700-267.119) and applying dynamic hip screw as the internal fixation (OR = 11.114; 95% CI, 2.064-59.854). Regular follow-up is commended in young patients with a proximal fracture line who underwent closed reduction and internal fixation with dynamic hip screw, even though the bone had healed.

  11. Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.

    Science.gov (United States)

    Snäll, Johanna; Kormi, Eeva; Lindqvist, Christian; Suominen, Anna Liisa; Mesimäki, Karri; Törnwall, Jyrki; Thorén, Hanna

    2013-12-01

    Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Vitamin E and the Healing of Bone Fracture: The Current State of Evidence

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    Boekhtiar Borhanuddin

    2012-01-01

    Full Text Available Background. The effect of vitamin E on health-related conditions has been extensively researched, with varied results. However, to date, there was no published review of the effect of vitamin E on bone fracture healing. Purpose. This paper systematically audited past studies of the effect of vitamin E on bone fracture healing. Methods. Related articles were identified from Medline, CINAHL, and Scopus databases. Screenings were performed based on the criteria that the study must be an original study that investigated the independent effect of vitamin E on bone fracture healing. Data were extracted using standardised forms, followed by evaluation of quality of reporting using ARRIVE Guidelines, plus recalculation procedure for the effect size and statistical power of the results. Results. Six animal studies fulfilled the selection criteria. The study methods were heterogeneous with mediocre reporting quality and focused on the antioxidant-related mechanism of vitamin E. The metasynthesis showed α-tocopherol may have a significant effect on bone formation during the normal bone remodeling phase of secondary bone healing. Conclusion. In general, the effect of vitamin E on bone fracture healing remained inconclusive due to the small number of heterogeneous and mediocre studies included in this paper.

  13. The role of impairment of mesenchymal stem cell function in osteoporotic bone fracture healing.

    Science.gov (United States)

    Zhang, Lihai; Miramini, Saeed; Richardson, Martin; Mendis, Priyan; Ebeling, Peter

    2017-09-01

    With demographic change and increasing life expectancy, osteoporotic fractures have become one of the most prevalent trauma conditions seen in daily clinical practice. A variety of factors are known to affect the rate of healing in osteoporotic conditions (e.g. both biochemical and biomechanical environment of callus cells). However, the influence of impairment of mesenchymal stem cell function in the osteoporotic condition on bone fracture healing has not been fully understood. In the present study, we develop a mathematical model that quantifies the change in biological processes within the fracture callus as a result of osteoporosis. The model includes special features of osteoporosis such as reduction in mesenchymal stem cell (MSC) number in osteoporotic bone, impaired response of osteoporotic MSCs to their biomechanical microenvironment and the effects of configuration of locking compression plate (LCP) system on healing in this context. The results presented here suggest that mechanically-mediated MSCs differentiation at early stages of healing are significantly affected under osteoporotic conditions, while it is predicted that the flexible fixation achieved by increasing bone-plate distance of LCP could alleviate the negative effects of osteoporosis on healing. The outcomes of this study could potentially lead to patient specific surgical solutions, and thus achieve optimal healing outcomes in osteoporotic conditions.

  14. The impact of clinical data on the evaluation of tibial fracture healing

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    Dijkman Bernadette G

    2011-11-01

    Full Text Available Abstract Background Radiographic healing is a common outcome measure in orthopedic trials and adjudication by outcome assessors is often conducted on the basis of plain films alone. The degree to which this process reflects clinical practice, in which both plain films and clinical notes are available, is uncertain. We explored the effect of adding clinical notes to radiographs in the adjudication process of a feasibility trial of tibial shaft fractures. Methods Radiographic and clinical data from a multicenter randomized controlled trial of 51 patients with operatively treated tibial fractures formed the basis of the study data. At the completion of the trial, serial radiographs (anteroposterior and lateral were independently evaluated for progression of fracture healing, defined as bridging of at least 3 of 4 cortices, by an adjudication committee comprised of 3 blinded orthopaedic trauma surgeons. Immediately after determination of radiographic time to healing, each surgeon was provided with clinical notes associated with each radiographic follow up visit and asked to re-visit their initial impression. Consensus was achieved for both adjudications. We calculated the percentage of time to healing consensus decisions that changed after evaluation of clinical notes. We further examined the contents of clinical notes and their relative influence on the committee's decisions. Results 47 of 51 patients were determined to have healed radiographically during the trial follow-up period, and consideration of clinical notes resulted in a change of 40% (19 of 47 of time to healing consensus decisions; however, revised decisions were equally likely to support an earlier or a later time to healing. Clinical notes that resulted in a change to either a 'healed' or a 'not healed' decision contained significantly more comments of either pain resolution or deterioration, respectively, resumption of or failure to resume weightbearing, or either return or no

  15. Exogenous PTHrP Repairs the Damaged Fracture Healing of PTHrP+/− Mice and Accelerates Fracture Healing of Wild Mice

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    Yinhe Wang

    2017-02-01

    Full Text Available Bone fracture healing is a complicated physiological regenerative process initiated in response to injury and is similar to bone development. To demonstrate whether an exogenous supply of parathyroid hormone–related protein (PTHrP helps in bone fracture healing, closed mid-diaphyseal femur fractures were created and stabilized with intramedullary pins in eight-week-old wild-type (WT PTHrP+/+ and PTHrP+/− mice. After administering PTHrP for two weeks, callus tissue properties were analyzed at one, two, and four weeks post-fracture (PF by various methods. Bone formation–related genes and protein expression levels were evaluated by real-time reverse transcriptase–polymerase chain reaction and Western blots. At two weeks PF, mineral density of callus, bony callus areas, mRNA levels of alkaline phosphatase (ALP, type I collagen, Runt-related transcription factor 2 (Runx-2, and protein levels of Runx-2 and insulin-like growth factor-1 decreased in PTHrP+/− mice compared with WT mice. At four weeks PF, total collagen-positive bony callus areas, osteoblast number, ALP-positive areas, and type I collagen-positive areas all decreased in PTHrP+/− mice. At both two and four weeks PF, tartrate-resistant acid phosphatase–positive osteoclast number and surface decreased a little in PTHrP+/− mice. The study indicates that exogenous PTHrP provided by subcutaneous injection could redress impaired bone fracture healing, leading to mutation of activated PTHrP by influencing callus areas, endochondral bone formation, osteoblastic bone formation, and bone turnover.

  16. Correlation between RUST assessments of fracture healing to structural and biomechanical properties.

    Science.gov (United States)

    Cooke, Margaret E; Hussein, Amira I; Lybrand, Kyle E; Wulff, Alexander; Simmons, Erin; Choi, Jeffrey H; Litrenta, Jody; Ricci, William M; Nascone, Jason W; O'Toole, Robert V; Morgan, Elise F; Gerstenfeld, Louis C; Tornetta, Paul

    2018-03-01

    Radiographic Union Score for Tibia (RUST) and modified RUST (mRUST) are radiographic tools for quantitatively evaluating fracture healing using a cortical scoring system. This tool has high intra-class correlation coefficients (ICCs); however, little evidence has evaluated the scores against the physical properties of bone healing. Closed, stabilized fractures were made in the femora of C3H/HeJ male mice (8-12 week-old) of two dietary groups: A control and a phosphate restricted diet group. Micro-computed tomography (µCT) and torsion testing were carried out at post-operative days (POD) 14, 21, 35, and 42 (n = 10-16) per group time-point. Anteroposterior and lateral radiographic views were constructed from the µCT scans and scored by five raters. The raters also indicated if the fracture were healed. ICCs were 0.71 (mRUST) and 0.63 (RUST). Both RUST scores were positively correlated with callus bone mineral density (BMD) (r = 0.85 and 0.80, p RUST scores positively correlated with callus strength (r = 0.35 and 0.26, p RUST ≥10 and had excellent relationship to structural and biomechanical metrics. Effect of delayed healing due to phosphate dietary restrictions was found at later time points with all mechanical properties (p RUST scores (p > 0.318). Clinical relevance of this study is both RUST scores showed high correlation to physical properties of healing and generally distinguished healed vs. non-healed fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:945-953, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  17. Teriparatide (human PTH1-34) compensates for impaired fracture healing in COX-2 deficient mice.

    Science.gov (United States)

    Yukata, Kiminori; Xie, Chao; Li, Tian-Fang; Brown, Matthew L; Kanchiku, Tsukasa; Zhang, Xinping; Awad, Hani A; Schwarz, Edward M; Beck, Christopher A; Jonason, Jennifer H; O'Keefe, Regis J

    2018-05-01

    Genetic ablation of cyclooxygenase-2 (COX-2) in mice is known to impair fracture healing. To determine if teriparatide (human PTH 1-34 ) can promote healing of Cox-2-deficient fractures, we performed detailed in vivo analyses using a murine stabilized tibia fracture model. Periosteal progenitor cell proliferation as well as bony callus formation was markedly reduced in Cox-2 -/- mice at day 10 post-fracture. Remarkably, intermittent PTH 1-34 administration increased proliferation of periosteal progenitor cells, restored callus formation on day 7, and enhanced bone formation on days 10, 14 and 21 in Cox-2-deficient mice. PTH 1-34 also increased biomechanical torsional properties at days 10 or 14 in all genotypes, consistent with enhanced bony callus formation by radiologic examinations. To determine the effects of intermittent PTH 1-34 for callus remodeling, TRAP staining was performed. Intermittent PTH 1-34 treatment increased the number of TRAP positive cells per total callus area on day 21 in Cox-2 -/- fractures. Taken together, the present findings indicate that intermittent PTH 1-34 treatment could compensate for COX-2 deficiency and improve impaired fracture healing in Cox-2-deficient mice. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Histomorphometrical analysis on the effects of two therapeutic ultrasound intensities on fracture healing in aged rats

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    Jeronimo Rafael Skau

    Full Text Available Introduction Experimental studies conducted in young animals show that therapeutic ultrasound (TUS has been successfully used to shorten the healing time of bone fractures. However, they were not found in the literature, studies comparing the effect of different intensities of UST in aged animals. Objective To test the efficacy of intensity 1.0 W/cm2 and of 0.5 W/cm2 in the consolidation of experimental fracture of the tibia from aged Wistar rats. Materials and methods Three groups of 15 month old rats were submitted to a midshaft osteotomy of the tibia and then, the hind member was immobilized with a metal splint and plaster of Paris, wrapping the knee and ankle joint. One group (L, received ultrasound at 0.5 W/cm2; the other group (I, were exposed to ultrasound at 1.0 W/cm2. One control group (C, did not receive the ultrasound. Fifteen animals (five from each group were euthanatized at the end of the first week and fifteen (five from each group at the end of the third week. The progress of the fracture healing was performed for each group by morphometric analysis of histological sections of the fracture region. Results and conclusion The results showed that fractures treated with ultrasound at 1.0 W/cm2 healed significantly faster than did the fractures treated with ultrasound at 0.5 W/cm2 and the control.

  19. [Parathyroid hormone injection to counteract delayed bone fractures].

    Science.gov (United States)

    Brunnemann, C E; Reisinger, E C; Ganzer, D; Schober, H C

    2010-08-01

    Two women, aged 71 and 53 years with periprosthetic fractures of the left femur and an 18 year old man with a non-union of fracture of the left radius presented for assessment and treatment. Serial radiographs showed that osteosynthesis and/or autogenous bone-grafting and multiple revisions had not resulted in healing of the fractures. In all three patients parathyroid hormone (teriparatide), 20 to 60 microg, was injected subcutaneously once daily for 6 - 10 weeks. Subsequently a stable consolidation of the bone occurred in all of them. Administration of parathyroid hormone can induce stable consolidation of the bone in non-unions and delayed healing of bone fractures. Georg Thieme Verlag KG Stuttgart, New York.

  20. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

    Science.gov (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  1. Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

    OpenAIRE

    Subhash Puri; Samar Kumar Biswas; Anil Salgia; Sahil Sanghi; Tushar Agarwal; Rohit Malhotra

    2013-01-01

    Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in heal...

  2. Distal phalanx fractures in horses: a survey of 274 horses with radiographic assessment of healing in 36 horses

    International Nuclear Information System (INIS)

    Honnas, C.M.; O'Brien, T.R.; Linford, R.L.

    1988-01-01

    The case records of 274 horses with fractures of the distal phalanx were reviewed. Fifty-two horses had bilateral forelimb fractures, for a total of 326 distal phalanx fractures. The fractures were classified into one of five previously described types, based on the radiographic anatomic configuration of the fracture. Solar margin fractures, which have been briefly described in other reports and previously classified as type V fractures, were identified in 132 horses. This type of fracture is distinct from other distal phalanx fractures. Due to the high incidence of solar margin fractures, these fractures were classified as a separate type (type VI). Follow-up radiographic examinations to assess fracture healing were available for 36 horses. Twenty-two horses with distal phalanx fractures (three type I, nine type II, two type III, one type IV, one type V, and six type VI) had radiographic evidence of complete bony union of the fracture at a mean of 11 months after injury. Eight horses with conplete type II fractures involving the articular surface had bony union of the body and solar margin, but not the subchondral bone at the articular surface, a mean of 11 months after injury. Six horses (four type II and two type IV) had little radiographic evidence of bony healing during the follow-up period. All fractures that eventually healed had evidence of progression toward bony union by 6 months after injury

  3. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2004-01-01

    A convenience sample based on availability of tibial stress fracture cases a% local Sports Medicine Clinics will be selected over 4 years until forty subjects (20 male, 20 female) have been treated...

  4. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2002-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  5. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2003-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  6. Bone Morphogenetic Protein for the Healing of Tibial Fracture: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Jiezhi Dai

    Full Text Available To review the evidence from RCTs on clinical outcomes and benefit of acute tibial fracture and nonunion treated with and without BMPs.We searched multiple databases (MEDLINE, EMABSE, BIOSIS and Cochrane central as well as reference lists of articles and contacted authors. Evaluated outcomes included union rate, revision rate, hardware failure and infection. The weighted and standard mean difference (WMD and SMD or the relative risk (RR was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration's REVMAN 5.0 software.Eight RCTs involving 1113 patients were included. For acute tibial fracture, BMP group was associated with a higher rate of union (RR, 1.16; 95% CI, 1.04 to 1.30 and a lower rate of revision (RR, 0.68; 95% CI, 0.54 to 0.85 compared with control group. No significant differences were found in rate of hardware failure and infection. The pooled RR for achieving union for tibial fracture nonunion was 0.98 (95% CI, 0.86 to 1.13. There was no significant difference between the two groups in the rate of revision (RR, 0.48; 95% CI, 0.13 to 1.85 and infection (RR, 0.61; 95% CI, 0.37 to 1.02.Study on acute tibial fractures suggests that BMP is more effective that controls, for bone union and for decreasing the rate of surgical revision to achieve union. For the treatment of tibial fracture nonunion, BMP leads to similar results to as autogenous bone grafting. Finally, well-designed RCTs of BMP for tibial fracture treatment are also needed.

  7. Laboratory study of fracture healing in Topopah Spring tuff: Implications for near field hydrology

    International Nuclear Information System (INIS)

    Lin, Wunan; Daily, W.D.

    1989-09-01

    Seven Topopah Spring tuff samples were studied to determine water permeability in this rock under pressure and temperature conditions similar to those expected in the near field of a nuclear waste package. Six of the seven samples were studied under isothermal condition; the other was subjected to a thermal gradient. Four of the six fractured samples contained a reopened, healed, natural fracture; one contained an induced tensile fracture and the other contained a saw-cut. The fracture surfaces were examined using scanning electron microscope (SEM) before and after the experiments and the water that flowed through the samples was sampled for chemical analysis. The experimental durations ranged from about 3 months to almost 6 months. Water permeability of the fractured samples was found to decrease by more than three orders of magnitude when the sample temperature increased to 150 degree C. The sharpest decrease in permeability occurred when the temperature was increased above 90 degree C. Permeability of the intact sample did not change significantly under the similar experimental conditions. When the temperature returned to room conditions, the water permeability did not recover. The mechanical strength of one healed sample was about half that of the intact rock. SEM studies of the fracture surfaces and water chemical analysis of the water suggested that both dissolution and deposition occurred on the fracture surfaces. Smoothing of fracture asperities because of dissolution and deposition was probably the main cause of the permeability decrease. Deposition of dissolved silica was probably the main cause of fracture healing. 12 refs., 6 figs., 1 tab

  8. Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

    Science.gov (United States)

    Xie, Xue Tao; Gao, You Shui; Zhang, Chang Qing

    2011-11-01

    With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult. We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable. Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

  9. Indications for implant removal after fracture healing: a review of the literature

    NARCIS (Netherlands)

    D.I. Vos (Dagmar); M.H.J. Verhofstad (Michiel)

    2013-01-01

    textabstractIntroduction: The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist. Methods: A literature search was performed. Results: Though there are several

  10. [Research on promotory effect of traditional Chinese medicine on fracture healing in cell and molecular level].

    Science.gov (United States)

    Zhang, Kun; Niu, Liang-Chen; Yuan, Fu-Jie; Liu, Shen-Peng

    2017-08-25

    Traditional Chinese medicine is widely used in the treatment of fractures, osteoporosis, other bone related diseases for thousands of years. There are many animal experiments and clinical trials demonstrating that the traditional Chinese medicine such as epimedium, Drynaria and other traditional Chinese medicine can stimulate bone regeneration and inhibit bone resorption, accelerating the fracture healing. In recent years many cell experiments have shown that these herbal ingredients up-regulated the expression of intracellular osteogenic transcription factors and osteogenic related genes, and then induced osteoblastic differentiation and stimulated the proliferation of osteoblasts, bone nodule formation and matrix mineralization. Meanwhile these herbal ingredients up-regulated the expression of intracellular osteoclastic transcription factors and osteoclast related genes, inhibited osteoclast differentiation and bone resorption of osteoclasts. In addition, intracellular signaling pathways regulated these herbal ingredients by might be involved in the above effects. We can have a conclusion that the genes expression regulated by transcription factors in pre-osteoblast and pre-osteoclast and these signaling pathways are the major molecular mechanisms and research hotspots of traditional Chinese medicine in promoting fracture healing. Based on these molecular mechanisms to review, this review provides not only the foundation for the study of traditional Chinese medicine in promoting fracture healing, but also the basis for clinical treatment of fracture. Copyright© 2017 by the China Journal of Orthopaedics and Traumatology Press.

  11. Changes of Bone Turnover Markers in Long Bone Nonunions Treated with a Regenerative Approach

    Directory of Open Access Journals (Sweden)

    Donatella Granchi

    2017-01-01

    Full Text Available In this clinical trial, we investigated if biochemical bone turnover markers (BTM changed according to the progression of bone healing induced by autologous expanded MSC combined with a biphasic calcium phosphate in patients with delayed union or nonunion of long bone fractures. Bone formation markers, bone resorption markers, and osteoclast regulatory proteins were measured by enzymatic immunoassay before surgery and after 6, 12, and 24 weeks. A satisfactory bone healing was obtained in 23 out of 24 patients. Nine subjects reached a good consolidation already at 12 weeks, and they were considered as the “early consolidation” group. We found that bone-specific alkaline phosphatase (BAP, C-terminal propeptide of type I procollagen (PICP, and beta crosslaps collagen (CTX changed after the regenerative treatment, BAP and CTX correlated to the imaging results collected at 12 and 24 weeks, and BAP variation along the healing course differed in patients who had an “early consolidation.” A remarkable decrease in BAP and PICP was observed at all time points in a single patient who experienced a treatment failure, but the predictive value of BTM changes cannot be determined. Our findings suggest that BTM are promising tools for monitoring cell therapy efficacy in bone nonunions, but studies with larger patient numbers are required to confirm these preliminary results.

  12. Changes of Bone Turnover Markers in Long Bone Nonunions Treated with a Regenerative Approach

    Science.gov (United States)

    Granchi, Donatella; Rojewski, Markus; Rosset, Philippe; Layrolle, Pierre; Spazzoli, Benedetta; Donati, Davide Maria

    2017-01-01

    In this clinical trial, we investigated if biochemical bone turnover markers (BTM) changed according to the progression of bone healing induced by autologous expanded MSC combined with a biphasic calcium phosphate in patients with delayed union or nonunion of long bone fractures. Bone formation markers, bone resorption markers, and osteoclast regulatory proteins were measured by enzymatic immunoassay before surgery and after 6, 12, and 24 weeks. A satisfactory bone healing was obtained in 23 out of 24 patients. Nine subjects reached a good consolidation already at 12 weeks, and they were considered as the “early consolidation” group. We found that bone-specific alkaline phosphatase (BAP), C-terminal propeptide of type I procollagen (PICP), and beta crosslaps collagen (CTX) changed after the regenerative treatment, BAP and CTX correlated to the imaging results collected at 12 and 24 weeks, and BAP variation along the healing course differed in patients who had an “early consolidation.” A remarkable decrease in BAP and PICP was observed at all time points in a single patient who experienced a treatment failure, but the predictive value of BTM changes cannot be determined. Our findings suggest that BTM are promising tools for monitoring cell therapy efficacy in bone nonunions, but studies with larger patient numbers are required to confirm these preliminary results. PMID:28744314

  13. [Clinical observation on the influence of earthquake crush injury on postoperative wound healing of extremity fractures].

    Science.gov (United States)

    Chen, Fu-hong; Chen, Ze; Duan, Heng-qiong; Wan, Zhong-xian

    2008-10-01

    To observe the influence of earthquake crush injury on postoperative wound healing of extremity fractures. The study involved 85 patients with extremities fracture underwent internal fixation operation in 3 group, including 28 earthquake casualties with crush injuries in observation group, 27 earthquake casualties without crush injuries in control I group and 30 local patients during the same period in control II group. Urine routine, blood creatine kinase (CK) and wound conditions of patients in 3 groups were observed respectively. There was no significant difference in Urine routine and blood CK between 3 groups and was significant difference in wound conditions between observation group and each control group. Earthquake crush injuries can influence the postoperative wound healing of extremity fractures.

  14. Are atrophic long-bone nonunions associated with low-grade infections?

    Directory of Open Access Journals (Sweden)

    Dapunt U

    2015-12-01

    Full Text Available Ulrike Dapunt,1 Ole Spranger,2 Simone Gantz,1 Irene Burckhardt,3 Stefan Zimmermann,3 Gerhard Schmidmaier,2 Arash Moghaddam2 1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, 2HTRG–Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 3Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg, Germany Abstract: Impaired fracture healing, especially when associated with bacterial infection, is a severe complication following long-bone fractures and requires special treatment. Because standard diagnostic techniques might provide falsely negative results, we evaluated the sonication method for detection of bacteria on implants of patients with fracture nonunions. A total of 49 patients with a nonunion (group NU and, for comparison, 45 patients who had undergone routine removal of osteosynthetic material (group OM, were included in the study. Five different diagnostic methods (culture of tissue samples, culture of intraoperative swabs, histopathology of tissue samples, culture of sonication fluid, and 16S ribosomal DNA polymerase chain reaction of sonication fluid were compared and related to clinical data. Among the diagnostic tests, culture of sonication fluid demonstrated by far the highest detection rate of bacteria (57% in group NU, and rather unexpectedly 40% in group OM. Culture of sonication samples also revealed a broad spectrum of bacteria, in particular Propionibacterium spp. In conclusion, our results indicate that more bacteria can be detected on implants of patients with atrophic nonunions of long-bone fractures by means of the sonication procedure, which provides a valuable additional diagnostic tool to decide on a surgical procedure (eg, two-step procedure and to further specify antimicrobial therapy. Keywords: sonication, osteosynthetic material, osteomyelitis 

  15. Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures.

    Science.gov (United States)

    Litrenta, Jody; Tornetta, Paul; Mehta, Samir; Jones, Clifford; OʼToole, Robert V; Bhandari, Mohit; Kottmeier, Stephen; Ostrum, Robert; Egol, Kenneth; Ricci, William; Schemitsch, Emil; Horwitz, Daniel

    2015-11-01

    To determine the reliability of the Radiographic Union Scale for Tibia (RUST) score and a new modified RUST score in quantifying healing and to define a value for radiographic union in a large series of metadiaphyseal fractures treated with plates or intramedullary nails. Healing was evaluated using 2 methods: (1) evaluation of interrater agreement in a series of radiographs and (2) analysis of prospectively gathered data from 2 previous large multicenter trials to define thresholds for radiographic union. Part 1: 12 orthopedic trauma surgeons evaluated a series of radiographs of 27 distal femur fractures treated with either plate or retrograde nail fixation at various stages of healing in random order using a modified RUST score. For each radiographic set, the reviewer indicated if the fracture was radiographically healed. Part 2: The radiographic results of 2 multicenter randomized trials comparing plate versus nail fixation of 81 distal femur and 46 proximal tibia fractures were reviewed. Orthopaedic surgeons at 24 trauma centers scored radiographs at 3, 6, and 12 months postoperatively using the modified RUST score above. Additionally, investigators indicated if the fracture was healed or not healed. The intraclass correlation coefficient (ICC) with 95% confidence intervals was determined for each cortex, the standard and modified RUST score, and the assignment of union for part 1 data. The RUST and modified RUST that defined "union" were determined for both parts of the study. ICC: The modified RUST score demonstrated slightly higher ICCs than the standard RUST (0.68 vs. 0.63). Nails had substantial agreement, whereas plates had moderate agreement using both modified and standard RUST (0.74 and 0.67 vs. 0.59 and 0.53). The average standard and modified RUST at union among all fractures was 8.5 and 11.4. Nails had higher standard and modified RUST scores than plates at union. The ICC for union was 0.53 (nails: 0.58; plates: 0.51), which indicates moderate

  16. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.

    Science.gov (United States)

    Hierholzer, Christian; Friederichs, Jan; Glowalla, Claudio; Woltmann, Alexander; Bühren, Volker; von Rüden, Christian

    2017-08-01

    The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome. Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

  17. Tooth in the line of angle fractures: the impact in the healing process. A retrospective study of 112 patients.

    Science.gov (United States)

    Zanakis, Stylianos; Tasoulas, Jason; Angelidis, Ioannis; Dendrinos, Christos

    2015-01-01

    There is no consensus regarding the prophylactic removal of mandibular third molars (TM) in fracture lines to facilitate healing. Recent evidence suggests that poor healing is attributed to the limited use of antimicrobials, delayed care and semi-rigid fixation as a treatment method, favoring retention of TM. A retrospective cohort study of all patients presenting with mandibular angle fractures at the Hippokration General Hospital of Athens (2006-2011) was designed to examine the association between the presence versus absence of TMs in the line of mandibular fractures and the fracture healing process. Development of complications during the healing process was the outcome of interest. Additional factors considered were patient age, sex, and fracture etiology. Data were extracted from a retrospective chart review, including information from clinical and radiological examinations. The analytical sample included 112 patients with 121 angle fractures. Bivariate methods including Fisher's exact and chi-square tests were used to test the association between TM presence in the fracture line and healing complications. This study found no association between the presence of mandibular TM in the fracture line and postoperative complications and the healing process when combined with light intermaxillary fixation for 15 days. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Assessment of crushed salt consolidation and fracture healing processes in a nuclear waste repository in salt

    International Nuclear Information System (INIS)

    1984-11-01

    For a nuclear waste repository in salt, two aspects of salt behavior are expected to contribute to favorable conditions for waste isolation. First, consolidation of crushed salt backfill due to creep closure of the underground openings may result in a backfill barrier with low permeability. Second, fractures created in the salt by excavation may heal under the influence of stress and temperature following sealing. This report reviews the status of knowledge regarding crushed salt consolidation and fracture healing, provides analyses which predict the rates at which the processes will occur under repository conditions, and develops requirements for future study. Analyses of the rate at which crushed salt will consolidate are found to be uncertain because of unexplained wide variation in the creep properties of crushed salt obtained from laboratory testing, and because of uncertainties in predictions of long term closure rates of openings in salt. This uncertainty could be resolved to a large degree by additional laboratory testing of crushed salt. Similarly, additional testing of fracture healing processes is required to confirm that healing will be effective under repository conditions. Extensive references, 27 figures, 5 tables

  19. Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study.

    Science.gov (United States)

    Iwata, Akira; Kanayama, Masahiro; Oha, Fumihiro; Hashimoto, Tomoyuki; Iwasaki, Norimasa

    2017-04-07

    Teriparatide (recombinant human parathyroid hormone 1-34) is increasingly used for the treatment of severe osteoporosis because it stimulates bone formation and may potentially enhance fracture healing. The objective of this study was to investigate the effects of teriparatide versus a bisphosphonate on radiographic outcomes in the treatment of osteoporotic vertebral compression fractures (OVCF). A total of 98 patients undergoing non-operative treatment for recent single-level OVCF were reviewed retrospectively. Thirty-eight patients were treated by a once-daily subcutaneous injection of 20 micrograms of teriparatide (TPD group), whereas 60 patients received 35 mg of alendronate weekly (BP group). Except for these medications, the same treatment protocol was applied to both groups. The radiographic assessments included union status, vertebral kyphosis, and mid-vertebral body height. The rates of fracture site surgical intervention were also compared between the two groups. The mean follow-up period was 27 months (median 22.5, range 2 - 75 months). Cox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 - 2.83). The union rate at six months after treatment was 89% in the TPD group and 68% in the BP group; the surgical intervention rate was significantly higher in the TPD group (p = 0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 - 43.33). The change in local kyphosis was 4.6° in the TPD group and 3.8° in the BP group (p = 0.495, paired t-test). The change of mid-vertebral body height was 4.4 mm in the TPD group and 3.4 mm in the BP group (p = 0.228, paired t-test). Fracture site surgical interventions were not required in the TPD group; however, two patients in the BP group eventually underwent surgical treatment for symptomatic non-union or vertebral collapse. This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

  20. [Hip fractures].

    Science.gov (United States)

    Weisová, Drahomíra; Salášek, Martin; Pavelka, Tomáš

    2013-01-01

    Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH - proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails - PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP - locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.

  1. Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial.

    Science.gov (United States)

    Bhandari, Mohit; Jin, Ling; See, Kyoungah; Burge, Russel; Gilchrist, Nigel; Witvrouw, Richard; Krohn, Kelly D; Warner, Margaret R; Ahmad, Qasim I; Mitlak, Bruce

    2016-05-01

    There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo(®)/ Forsteo(®), recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing. We wished to test the hypotheses that treatment with teriparatide versus placebo would improve femoral neck fracture healing after internal fixation as measured by (1) frequency of revision surgery, (2) radiographic fracture healing, and (3) other outcomes including pain control, gait speed, and safety. We initiated two separate, but identically designed, clinical trials to meet FDA requirements to provide substantial evidence to support approval of a new indication. The two prospective, randomized double-blind, placebo-controlled Phase III studies were designed to evaluate the effect of subcutaneous teriparatide (20 μg/day) for 6 months versus placebo on fracture healing at 24 months. The trials were conducted concurrently with a planned enrollment of 1220 patients per trial. However, enrollment was stopped owing to very slow patient accrual, and an a priori decision was made to pool the results of those studies for statistical analyses before study completion; pooling was specified in both protocols. Randomization was stratified by fixation (sliding hip screw or multiple cancellous screws) and fracture type (displaced or nondisplaced). An independent Central Adjudication Committee reviewed revision surgical procedures and radiographs. A total of 159 patients were randomized in the two trials (81 placebo, 78 teriparatide). The combined program had very low power to detect the originally expected treatment effect but had approximately 80% power to detect a larger difference of 12% between treatment groups for risk of revision surgery. The proportion of

  2. Determining the Role of Sost and Sostdc1 During Fracture Healing

    Energy Technology Data Exchange (ETDEWEB)

    Yee, Cristal Sook Ngei [Univ. of California, Merced, CA (United States)

    2016-01-01

    The bone is a dynamic organ, often changing throughout the course of the human lifespan with its continuous remodeling, laying down new bone and resorbing old bone. With age, the bone becomes increasingly porous and mechanically unstable, leading to the development of osteoporosis in some individuals. Elderly patients with osteoporosis are at an increased risk of fracturing their bones which contributes to a higher mortality rate. Recent studies have revealed that type 1 diabetic mellitus (T1DM) patients also have an osteoporotic bone phenotype and impaired fracture healing, independent of age. Currently, there is a lack of available treatments that can improve impaired healing and directly enhance bone formation. Therefore, there is a great need for developing new therapies that can not only aid type 1 diabetic patients with osteoporosis to improve bone phenotype, but that could also aid patients with difficult or impaired fracture healing. In this thesis, I will be discussing the role of Wnt signaling and Sclerostin, a Wnt antagonist that negatively regulates bone formation, in the content of fracture repair.

  3. Exposure to 100% Oxygen Abolishes the Impairment of Fracture Healing after Thoracic Trauma.

    Directory of Open Access Journals (Sweden)

    Julia Kemmler

    Full Text Available In polytrauma patients a thoracic trauma is one of the most critical injuries and an important trigger of post-traumatic inflammation. About 50% of patients with thoracic trauma are additionally affected by bone fractures. The risk for fracture malunion is considerably increased in such patients, the pathomechanisms being poorly understood. Thoracic trauma causes regional alveolar hypoxia and, subsequently, hypoxemia, which in turn triggers local and systemic inflammation. Therefore, we aimed to unravel the role of oxygen in impaired bone regeneration after thoracic trauma. We hypothesized that short-term breathing of 100% oxygen in the early post-traumatic phase ameliorates inflammation and improves bone regeneration. Mice underwent a femur osteotomy alone or combined with blunt chest trauma 100% oxygen was administered immediately after trauma for two separate 3 hour intervals. Arterial blood gas tensions, microcirculatory perfusion and oxygenation were assessed at 3, 9 and 24 hours after injury. Inflammatory cytokines and markers of oxidative/nitrosative stress were measured in plasma, lung and fracture hematoma. Bone healing was assessed on day 7, 14 and 21. Thoracic trauma induced pulmonary and systemic inflammation and impaired bone healing. Short-term exposure to 100% oxygen in the acute post-traumatic phase significantly attenuated systemic and local inflammatory responses and improved fracture healing without provoking toxic side effects, suggesting that hyperoxia could induce anti-inflammatory and pro-regenerative effects after severe injury. These results suggest that breathing of 100% oxygen in the acute post-traumatic phase might reduce the risk of poorly healing fractures in severely injured patients.

  4. Experimental study on healing process of rat mandibular bone fracture examined by radiological procedures

    Energy Technology Data Exchange (ETDEWEB)

    Iuchi, Yukio; Furumoto, Keiichi (Nippon Dental Univ., Tokyo (Japan))

    1994-06-01

    The healing process of rat mandibular fractures was stereoscopically observed daily, using plain roentgenography in the lateral-oblique and tooth axis directions and bone scintigraphy using 99m-Tc-methylene diphosphoric acid (Tc-99m-MDP). The findings were compared with microradiograms of regional polished specimens. X-ray findings included the following. Up to 3 days after bone fracture, the fracture mesiodistally showed distinct radiolucency, with sharp and irregular fracture stump. Radiopacity of the fracture site gradually increased 7 days or later, and bone trabecular formation by callus and stump bridging started to occur at 14 days. Findings similar to those in the control group were observed 49 days or later. The inside was difficult to differentiate, irrespective of the observation time. Bone scans in the mesiodistal and buccolingual planes revealed tracer uptake in the areas of mandibular and soft tissue damage one day after bone fracture. Tracer uptake began to be seen in the fracture site 3 days later, and became marked at 14 days. Then Tc-99m DMP began to be localized and returned to the findings similar to those at 49 days. Bone scanning tended to show wider areas earlier than roentgenography. Microradiographic mesiodistal examination revealed distinct radiopacy of the fracture line for 3 days after bone fracture. Seven days later, bone resorption cavity occurred in the cortical bone around the fracture stump, along with neogenesis of callus. Neogenesis and calcification began to occur gradually, and 14 days later, the fracture osteoremodeling of the internal bone trabeculae was observed. Bone trabecular formation within the bone, however, occurred later. (N.K.).

  5. Effect of Asparagus racemosus on fracture healing in rabbits: a radiographic and angiographic study

    International Nuclear Information System (INIS)

    Singh, Sunil; Singh, H.N.; Gangwar, A.K.; Devi, Kh. Sangeeta; Waghay, J.Y.

    2009-01-01

    New Zealand white rabbits (18) were randomly divided into groups I and II (control) having 9 animals in each group. The fracture of ulna was created in each animal under general anaesthesia using thiopental sodium (2.5%). Radius acted as a natural splint. The animals of group I were fed with powdered Asparagus racemosus along with rabbit feed throughout the study period. However, in group II animals only powdered rabbit feed was given. Healing at the fracture site was assessed by plain radiography and angiography at 7th, 14th, 21st and 28th day interval. Radiographical observation revealed a well organized and dense callus at 21st day in animals of group I whereas in animals of group II, callus of slightly less radiographic density was observed at this interval. Angiographic observation revealed hypervascularity at the fracture site at 7th and 14th day interval in group I animals. On day 14, in group II animals major vessels lack continuity along with reduced vascularity around the fracture site. The results of present study suggest that feeding of dry root powder of Asparagus racemosus promotes early fracture healing in rabbits

  6. Evaluation of simvastatin in the process of fracture healing in tibiae of rats

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-04-01

    Full Text Available OBJECTIVE: Evaluate the effects of simvastatin in the process of fracture healing in rat tibia. METHODS: Thirty-six rats were subjected to diaphyseal fracture of the leg bones and divided in the statin group (GE and control group (GC, being subdivided into three subgroups according to days post-fracture (7th, 14th and 28th day to assess bone healing. In GE was administered by gavage a solution of simvastatin to the sacrifice. In the control group was administered saline by the same route of SG. Immobilization was not used. After the sacrifice was made to limb amputation in the distal femur and conducted the clinical, radiological and histological analysis. Clinical evaluation was made as to the mobility of the fracture. Then the samples were radiographed and evaluated for callus diameter. Histological examination was performed with cuts of 5 micrometers and stained with hematoxylin-eosin, Masson's trichrome and Alcian blue pH 2.5. The level of significance to exclude the null hypothesis was 5%. RESULTS: All GE animals showed greater stability of the fracture and higher callus area. There were no significant changes in the histological study. CONCLUSION: Simvastatin accelerates the consolidation process by increasing the callus, but does not alter the histology of the newly formed bone.

  7. MRT letter: Contrast-enhanced computed tomographic imaging of soft callus formation in fracture healing.

    Science.gov (United States)

    Hayward, Lauren Nicole Miller; de Bakker, Chantal Marie-Jeanne; Lusic, Hrvoje; Gerstenfeld, Louis Charles; Grinstaff, Mark W; Morgan, Elise Feng-I

    2012-01-01

    Formation of a cartilaginous soft callus at the site of a bone fracture is a pivotal stage in the healing process. Noninvasive, or even nondestructive, imaging of soft callus formation can be an important tool in experimental and pre-clinical studies of fracture repair. However, the low X-ray attenuation of cartilage renders the soft callus nearly invisible in radiographs. This study utilized a recently developed, cationic, iodinated contrast agent in conjunction with micro-computed tomography to identify cartilage in fracture calluses in the femora of C57BL/6J and C3H/HeJ mice. Fracture calluses were scanned before and after incubation in the contrast agent. The set of pre-incubation images was registered against and then subtracted from the set of post-incubation images, resulting in a three-dimensional map of the locations of cartilage in the callus, as labeled by the contrast agent. This map was then compared to histology from a previous study. The results showed that the locations where the contrast agent collected in relatively high concentrations were similar to those of the cartilage. The contrast agent also identified a significant difference between the two strains of mice in the percentage of the callus occupied by cartilage, indicating that this method of contrast-enhanced computed tomography may be an effective technique for nondestructive, early evaluation of fracture healing. Copyright © 2011 Wiley Periodicals, Inc.

  8. Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing: an experimental study.

    Science.gov (United States)

    Xu, Wei-zhou; Guo, Xiao-dong; Zhao, Ju-cai; Wang, Yi-jin

    2006-06-01

    To investigate the effect of autocontrol micromotion locking nail (AMLN) on experimental fracture healing and its mechanism. 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail, respectively. The follow-up time was 7, 14, 28 and 56 days. Roentgenographic, biomechanical, histological, scanning electromicroscopic and biochemical analyses were done. (1) The strength of anticompression, antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P<0.01). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group (P<0.05). (3) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the fracture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P<0.05). (4) 7-14 days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding. Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt. None of the above findings was observed in the GK nail-fixed group. The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable, the disturbance to the physical stress

  9. Self-healing of Fractures in Argillaceous Media from the Geomechanical Point of View

    International Nuclear Information System (INIS)

    Horseman, Steve

    2001-01-01

    Presently, there is no established theory describing fracture self-healing and self-sealing processes in mud-rocks (clays, mud-stones and shales) and no methodology to assess the conditions under which these processes might be important. The author suggests that the modified Cam-Clay approach provides a useful conceptual and theoretical framework for the analysis of the largely hydro-mechanical process of self-sealing. Three basic hypotheses are proposed and applied to the problem of fracture self-sealing in the repository EDZ and to the more general question of fault sealing. (author)

  10. An ultrasound wearable system for the monitoring and acceleration of fracture healing in long bones.

    Science.gov (United States)

    Protopappas, Vasilios C; Baga, Dina A; Fotiadis, Dimitrios I; Likas, Aristidis C; Papachristos, Athanasios A; Malizos, Konstantinos N

    2005-09-01

    An ultrasound wearable system for remote monitoring and acceleration of the healing process in fractured long bones is presented. The so-called USBone system consists of a pair of ultrasound transducers, implanted into the fracture region, a wearable device and a centralized unit. The wearable device is responsible to carry out ultrasound measurements using the axial-transmission technique and initiate therapy sessions of low-intensity pulsed ultrasound. The acquired measurements and other data are wirelessly transferred from the patient-site to the centralized unit, which is located in a clinical setting. The evaluation of the system on an animal tibial osteotomy model is also presented. A dataset was constructed for monitoring purposes consisting of serial ultrasound measurements, follow-up radiographs, quantitative computed tomography-based densitometry and biomechanical data. The animal study demonstrated the ability of the system to collect ultrasound measurements in an effective and reliable fashion and participating orthopaedic surgeons accepted the system for future clinical application. Analysis of the acquired measurements showed that the pattern of evolution of the ultrasound velocity through healing bones over the postoperative period monitors a dynamic healing process. Furthermore, the ultrasound velocity of radiographically healed bones returns to 80% of the intact bone value, whereas the correlation coefficient of the velocity with the material and mechanical properties of the healing bone ranges from 0.699 to 0.814. The USBone system constitutes the first telemedicine system for the out-hospital management of patients sustained open fractures and treated with external fixation devices.

  11. Influence of 1800 MHz GSM-like electromagnetic radiation exposure on fracture healing.

    Science.gov (United States)

    Aslan, Ahmet; Kırdemır, Vecihi; Kocak, Ahmet; Atay, Tolga; Baydar, Metin Lütfi; Özerdemoglu, Remzi Arif; Aydogan, Nevres Hürriyet

    2014-02-01

    In this study, we aimed to investigate whether 1800 MHz frequency electromagnetic radiation (EMR) has an effect on bone healing. A total of 30 Wistar albino rats were divided into two equal groups. Fractures were created in the right tibias of all rats; next, intramedullary fixations with K-wire were performed. A control group (Group I) was kept under the same experimental conditions except without EMR exposure. Rats in Group II were exposed to an 1800 MHz frequency EMR for 30 min a day for 5 days a week. Next, radiological, mechanical, and histological examinations were performed to evaluate tibial fracture healing. Radiological, histological and mechanical scores were not significantly different between groups (respectively, p = 0.114, p = 0.184 and p = 0.083), and all of these scores were lower than those of the controls. EMR at 1800 MHz frequency emitted from cellular phones has no effect on bone fracture healing. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

  12. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2017-02-01

    Conclusion: PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial hematoma effect in the initial phase of healing in open or failed closed intramedullary nailing.

  13. A new hypothesis on the mechanism of atrophic non-union.

    Science.gov (United States)

    Sun, Deyi; Yuan, Ding; Zhang, Xiangsheng

    2011-07-01

    Non-union after bone fracture is rather common with an increasing frequency of incidence rate due to poorly treated early operations, among which the mechanism of atrophic non-union remains unclear. Previous opinions showed that impaired blood supply of affected limbs might mostly contribute to the atrophic non-union, which discriminated it with hypertrophic non-union. Nevertheless, there had been increasingly adequate evidences supporting that normal blood supplies existed in atrophic non-unions, as well as in hypertrophic non-unions or healthy bone fractures. Our hypothesis, based on the newly acquired evidences of atrophic non-union, was that there existed mesenchymal stem cells in the area of atrophic non-union. These mesenchymal stem cells, which remained temporally quiescent, could perform re-ossification under certain growth conditions, such as pressure during callus distraction with external fixator. According to the hypothesis, treatment for atrophic non-union should focus on the stimulation and reactivation of endogenetic mesenchymal stem cells or transplantation of autologous normal mesenchymal stem cells. This hypothesis may shed some light on the mechanism of atrophic non-union. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Failed treatment of long bone nonunions with low intensity pulsed ultrasound.

    Science.gov (United States)

    Biglari, Bahram; Yildirim, Timur Mert; Swing, Tyler; Bruckner, Thomas; Danner, Wolfgang; Moghaddam, Arash

    2016-08-01

    The use of low intensity pulsed ultrasound (LIPUS) in the treatment of nonunions is still controversial. The present study is concerned with whether this procedure has a clinical use and which cofactors influence its therapeutic results. In this prospective, single institution, observational study, data from October 2010 to October 2013 from 61 nonunions in 60 patients treated with EXOGEN(®) LIPUS therapy were analysed. The average age was 45.4 ± 9.81 (18-63) years. Treatment was primarily done on long bones of the lower extremity (75.4 %). All 61 nonunions were examined after treatment, and the rate of healing as well as functional and subjective results were evaluated. Based on clinical and radiological findings, patients were divided into two groups: G1-successful treatment; and G2-unsuccessful treatment. Groups were compared to one another to identify possible factors influencing treatment. Twenty (32.8 %) patients showed bone consolidation with an average time of healing of 5.3 (2-7) months. In patients without successful treatment, who underwent revision surgery instead, full weight bearing took on average 3.7 months longer, and they were able to return to work 6.8 months later. Most of the treated patients (70.5 %) reported no improvement in pain. In G2, 12 (29.3 %) patients suffered in their previous history from osteitis; in G1 there were only two patients (10 %) (p = 0.012). There were further significant differences in the age of the fracture, the type of osteosynthesis, the gap size, as well as the NUSS score. Despite patients being chosen strictly according to EXOGEN(®) indications, only a small number of patients with nonunions who underwent LIPUS therapy experienced successful treatment (32.8 %). Overall, its use resulted in a clear delay in the time of treatment, so that according to our results, the use of LIPUS should be seen critically in long bone nonunions and use should be made on a case-by-case basis.

  15. Locally applied simvastatin improves fracture healing at late period in osteoporotic rat

    Science.gov (United States)

    Tian, Faming; Zhang, Liu; Kang, Yuchuan; Zhang, Junshan; Ao, Jiao; Yang, Fang

    effect of simvastatin locally applied from a bioactive polymer coating of implants on osteoporotic fracture healing at late period. Methods:Femur fracture model was established on normal or osteotoporotic mature female SD rats, intramedullary stabilization was achieved with uncoated titanium Kirschnerwires in normal rats(group A),with polymer-only coated vs. polymer plus simvastatin coated titanium Kirschner wires in osteoporotic rats(group B and C, respectively).Femurs were harvested after 12 weeks, and underwent radiographic and histologic analysis, as well as immunohistochemical evaluation for BMP-2 expression. Results:Radiographic results demonstrated progressed callus in the simvastatin-treated groups compared to the uncoated group.The histologic analysis revealed a significantly processed callus with irregular-shaped newly formed bone trabeculae in simvastatin-treated group. Immunohistochemical evaluation showed markedly higher expression levels of B:MP-2 in simvastatin-treated group.Conclusions: The present study revealed a improved fracture healing under local application of simvastatin in osteoporotic rat,which might partially from upregulation of the B:MP-2 expression at fractured site.

  16. Fracture Healing Is Delayed in Immunodeficient NOD/scid‑IL2Rγcnull Mice.

    Directory of Open Access Journals (Sweden)

    Anna E Rapp

    Full Text Available Following bone fracture, the repair process starts with an inflammatory reaction at the fracture site. Fracture healing is disturbed when the initial inflammation is increased or prolonged, whereby, a balanced inflammatory response is anticipated to be crucial for fracture healing, because it may induce down-stream responses leading to tissue repair. However, the impact of the immune response on fracture healing remains poorly understood. Here, we investigated bone healing in NOD/scid-IL2Rγcnull mice, which exhibit severe defects in innate and adaptive immunity, by biomechanical testing, histomorphometry and micro-computed tomography. We demonstrated that NOD/scid-IL2Rγcnull mice exhibited normal skeletal anatomy and a mild bone phenotype with a slightly reduced bone mass in the trabecular compartment in comparison to immunocompetent Balb/c mice. Fracture healing was impaired in immunodeficient NOD/scid-IL2Rγcnull mice. Callus bone content was unaffected during the early healing stage, whereas it was significantly reduced during the later healing period. Concomitantly, the amount of cartilage was significantly increased, indicating delayed endochondral ossification, most likely due to the decreased osteoclast activity observed in cells isolated from NOD/scid-IL2Rγcnull mice. Our results suggest that--under aseptic, uncomplicated conditions--the immediate immune response after fracture is non-essential for the initiation of bone formation. However, an intact immune system in general is important for successful bone healing, because endochondral ossification is delayed in immunodeficient NOD/scid-IL2Rγcnull mice.

  17. Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report

    Directory of Open Access Journals (Sweden)

    Ciurlia Emanuele

    2017-01-01

    Conclusion: We assume that an aggressive revision surgery done with bone autograft implant and a bone healing therapy administering teriparatide off-label can reduce the convalescence in non-unions and can improve prognosis.

  18. The treatment of low-grade septic non-unions.

    Science.gov (United States)

    Verdoni, F; D’Amato, R D; Mangiavini, L; Lombardo, M D; Peretti, G M

    Non-union (or pseudoarthrosis) is defined as a fracture that fails to consolidate after 6 months from the trauma. Current conservative treatments consist of biological (i.e. with calcium, Vitamin D) and mechanical stimulation. Moreover, surgical approaches include the use of endomidollar nail osteosynthesis, compression plates that are often associated with bone grafts. External fixation is a valid surgical alternative especially in case of septic non-unions. Indeed, compression-distraction osteosynthesis results in a significant improvement in bone vascularisation and exerts a powerful osteoinductive stimulus on the non-union site. In this review, we will describe a cohort of patients affected by low-grade septic non-unions and treated with external fixation.

  19. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  20. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers.

    Science.gov (United States)

    1995-08-11

    activities. Pulsing electromagnetic fields ( PEMFs )have been shown to speed the healing of non-union fractures and we have used them successfully to...and then randomized into actual PEMF and placebo PEMF groups and treated for one hour per day until they return to duty. Changes in the bone scan are...musculoskeletal groups. Results to date indicate that pelvic stress fractures are being misdiagnosed. If these results are confirmed, treatments for

  1. Possible benefits of strontium ranelate in complicated long bone fractures.

    Science.gov (United States)

    Alegre, Duarte Nuno; Ribeiro, Costa; Sousa, Carlos; Correia, João; Silva, Luís; de Almeida, Luís

    2012-02-01

    Osteoporosis drugs are prescribed to prevent fragility fractures, which is the principal aim of the management of osteoporosis. However, if fracture does occur, then it is also important to promote a fast and uneventful healing process. Despite this, little is known about the effect of osteoporosis drugs on bone healing in humans. Strontium ranelate is an osteoporosis agent that increases bone formation and reduces bone resorption and may therefore be beneficial in fracture healing. We report four cases of fracture non-union for up to 20 months. Treatment with strontium ranelate (2 g/day) for between 6 weeks and 6 months appeared to contribute to bone consolidation in the four cases. Animal studies support beneficial effects of strontium ranelate on bone healing via improvement of bone material properties and microarchitecture in the vicinity of the fracture. The clinical cases described herein provide new information on these effects, in the absence of randomized controlled studies on the clinical efficacy of pharmacological treatments in osteoporosis in fracture repair. Further studies are necessary. Fracture healing is an important topic in orthopedic research and is also a concern for patients with postmenopausal osteoporosis. Evidence from case reports and animal studies suggests that strontium ranelate improves bone microarchitecture and accelerates fracture healing. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research.

  2. Effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius

    Directory of Open Access Journals (Sweden)

    Jian-Nian Wang

    2016-10-01

    Full Text Available Objective: To analyze the effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius. Methods: A total of 200 elderly patients with fracture of distal radius treated from September 2010 to September 2015 were randomly divided into observation group and control group (n=100. Control group received routine surgical treatment, and observation group underwent Gukang capsule-assisted surgical treatment. Fracture healing was compared between two groups, serum microcirculation and bone metabolism indexes were detected 1 week after operation, X-ray examination was performed 6 months after operation and imaging parameters were measured. Results: Regression time of postoperative affected-side limb swelling and radiographic healing time of broken ends of fractured bone of observation group were significantly shorter than those of control group; 1 week after operation, serum TXB2, CTX-I, CTX-II, RANK, RANKL and TRACP5b levels as well as TXB-2/6-Keto-PGF1α ratio of observation group were significantly lower than those of control group, and 6-Keto-PGF1α, ALP, OPG, PICP, BGP and 1,25(OH2D3 levels were significantly higher than those of control group. Conclusions: Gukang capsule-assisted surgery helps promote the fracture healing in elderly patients with fracture of distal radius and can improve microcirculation and bone metabolism.

  3. Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions.

    Science.gov (United States)

    Reigstad, Ole; Grimsgaard, Christian; Thorkildsen, Rasmus; Reigstad, Astor; Røkkum, Magne

    2012-01-01

    Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. One-third of the non-unions were located in the proximal part of the scaphoid and the remaining two-thirds in the middle part. Of the 146 patients (55%) who contacted a doctor at the time of injury, 53 fractures where diagnosed (20%). Fourteen (5%) were operated primarily while 39 (15%) (seven dislocated) were immobilized in plaster casts. Thirty-two (12%) were under the age of 16 at the time of injury. The average time from the injury to the initial non-union surgery was 1.5 years with 2.8 years to the second procedure. The risk of osteoarthritis increased time from injury to surgery (both primary and secondary procedures). The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.

  4. Fracture and healing of elastomers: A phase-transition theory and numerical implementation

    Science.gov (United States)

    Kumar, Aditya; Francfort, Gilles A.; Lopez-Pamies, Oscar

    2018-03-01

    A macroscopic theory is proposed to describe, explain, and predict the nucleation and propagation of fracture and healing in elastomers undergoing arbitrarily large quasistatic deformations. The theory, which can be viewed as a natural generalization of the phase-field approximation of the variational theory of brittle fracture of Francfort and Marigo (1998) to account for physical attributes innate to elastomers that have been recently unveiled by experiments at high spatio-temporal resolution, rests on two central ideas. The first one is to view elastomers as solids capable to undergo finite elastic deformations and capable also to phase transition to another solid of vanishingly small stiffness: the forward phase transition serves to model the nucleation and propagation of fracture while the reverse phase transition models the possible healing. The second central idea is to take the phase transition to be driven by the competition between a combination of strain energy and hydrostatic stress concentration in the bulk and surface energy on the created/healed new surfaces in the elastomer. From an applications point of view, the proposed theory amounts to solving a system of two coupled and nonlinear PDEs for the deformation field and an order parameter, or phase field. A numerical scheme is presented to generate solutions for these PDEs in N = 2 and 3 space dimensions. This is based on an efficient non-conforming finite-element discretization, which remains stable for large deformations and elastomers of any compressibility, together with an implicit gradient flow solver, which is able to deal with the large changes in the deformation field that can ensue locally in space and time from the nucleation of fracture. The last part of this paper is devoted to presenting sample simulations of the so-called Gent-Park experiment. Those are confronted with recent experimental results for various types of silicone elastomers.

  5. An experimental study of mandibular fracture wound healing in the calcium deficient rat

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Wang, Eui Hwan; Lee, Sang Rae

    1997-01-01

    The purpose of this study was to investigate effects of osteoporosis on fracture wound healing in the calcium deficient rat. To research the experiment some ten-week old Wistar strain rats with approximately 300 gms weight were selected. Then, the rats were divided into two groups : Normal diet group (rats given a normal diet before and after bone fracture) and Low calcium diet group (rats given a low calcium diet before and after bone fracture). Both groups had been provided with each diet for three weeks. When the rats became thirteen weeks old, the mandibular angle of rats in both groups was artificially fractured for test. The healing of fracture wounds was reviewed by using soft x-ray radiography and 99m Tc-MDP bone scan and also histopathologic examination. The obtained results were as follows : 1. The radiolucency of the fracture site for the Normal diet group started to decrease from the 14th day since the experiment was made, while the Low calcium diet group began decrease in the radiolucency from the 21st day of the experiment . The radiolucency for the normal diet group disappeared at the 42nd day, but one for the Low calcium diet group disappeared at the 56th day of the experiment. 2. The highest uptake rate of 99m Tc-MDP stood at the 14th day of the experiment in the Normal diet group and the Low calcium diet group's maximum rate was recorded at the 21st day of the experiment. These both groups were gradually experiencing decrease in the uptake rate as the experiment time was going on. However, the uptake rate in the Low calcium diet group was lower than one in the Normal diet group. 3. For the Normal diet group, the newly formed trabecular, which were similar to one of the surrounding bone, were seen at the 42nd day of the experiment. On the other hand, the Low claium diet group showed at the 56th day of the experiment that the osteoporotic findings looked weak, irregular trabecular, and also large bone marrow space were observed clearly. As a result

  6. Risk profile of patients developing nonunion of the clavicle and outcome of treatment

    DEFF Research Database (Denmark)

    Ban, Ilija; Troelsen, Anders

    2016-01-01

    treatment of clavicle nonunions. METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment...

  7. SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

    Directory of Open Access Journals (Sweden)

    A. N. Erokhin

    2017-01-01

    Full Text Available Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age of patients ranged from 21 to 60 years (median – 37 years, there were 19 male and 22 female patients. The authors worked out the formulas using Weasis software for quantitative characteristics of diaphyseal humerus fractures: distance of the fracture site from proximal metaphysis of the humerus, extension of the fracture line and degree of bone fragments displacement. During statistical analysis of the recorded data the average standard deviation, median, minimum, maximum, 25th percentile and 75th percentile were calculated. The Shapiro-Wilk test was used to check consistency of recorded data with normal distribution of characteristics. Correlation analysis was performed by calculation of Kendall and Pearson coefficients. Statistical processing of reported data was done by means of unpaired criteria: non-parametric Wilcoxon test and parametric Student t-test. When comparing two samples a null hypothesis was rejected at the level of test significance p≤0.05. The authors utilized Microsoft Office Excel 2007 and AtteStat, version 13.1.Results. Statistical analysis of the samples including comminuted and spiral fractures of humeral diaphysis demonstrated that the level of the fracture was within 40.9±19.9% and distributed from 11.6% to 72.4% along the diaphysis. Correlation analysis demonstrated statistically valid moderate negative relation between the level of fracture site and consolidation period (Pearson correlation coefficient r = -0.46; р = 0

  8. Tibial shaft fractures treated with functional braces. Experience with 780 fractures.

    Science.gov (United States)

    Sarmiento, A; Gersten, L M; Sobol, P A; Shankwiler, J A; Vangsness, C T

    1989-08-01

    We have reviewed our recent results with functional bracing of tibial shaft fractures in adults in order to define its role in management. We also analysed several parameters of these fractures to discover those which influence healing. A total of 780 tibial fractures treated in prefabricated functional braces were followed to union; shortening of less than 10 mm and angulation of less than 5 degrees in any plane were our parameters for successful treatment. The average time before applying a brace was 3.8 weeks for closed fractures and 5.2 weeks for open ones. Closed fractures healed in an average of 17.4 weeks and open fractures in an average of 21.7 weeks, 90% of them with 10 mm of shortening or less. Varus angulation and posterior angulation were the most common deformities encountered at union. There were 20 nonunions (2.5%) and 46 braces were discontinued during treatment. We found no association between fracture healing and the patient's age, the mechanism of injury or the fracture location. The degree of soft tissue injury appeared to have most influence on the speed of fracture healing. Fracture comminution and initial displacement, the condition of the fibula and the time from injury to bracing also appeared to affect the speed of union.

  9. Indications for implant removal after fracture healing: a review of the literature.

    Science.gov (United States)

    Vos, D I; Verhofstad, M H J

    2013-08-01

    The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist. A literature search was performed. Though there are several presumed benefits of implant removal, such as functional improvement and pain relief, the surgical procedure can be very challenging and may lead to complications or even worsening of the complaints. Research has focused on the safety of metal implants (e.g., risk of corrosion, allergy, and carcinogenesis). For these reasons, implants have been removed routinely for decades. Along with the introduction of titanium alloy implants, the need for implant removal became a subject of debate in view of potential (dis)advantages since, in general, implants made of titanium alloys are more difficult to remove. Currently, the main indications for removal from both the upper and lower extremity are mostly 'relative' and patient-driven, such as pain, prominent material, or simply the request for removal. True medical indications like infection or intra-articular material are minor reasons. This review illustrates the great variety of view points in the literature, with large differences in opinions and practices about the indications for implant removal after fracture healing. Since some studies have described asymptomatic patients developing complaints after removal, the general advice nowadays is to remove implants after fracture healing only in symptomatic patients and after a proper informed consent. Well-designed prospective studies on this subject are urgently needed in order to form guidelines based on scientific evidence.

  10. Clay club initiative: self-healing of fractures in clay-rich host rocks

    International Nuclear Information System (INIS)

    Horseman, S.T.; Cuss, R.J.; Reeves, H.J.

    2004-01-01

    The capacity of fractures in argillaceous rocks to self-heal (or become, with the passage of time, less conductive to groundwater) is often cited as a primary factor favouring the choice of such materials as host rocks for deep disposal. The underlying processes which contribute to self-healing can be broadly subdivided into: (a) mechanical and hydro-mechanical processes linked to the change in the stress field, movement of pore water, swelling, softening, plastic deformation and creep, and (b) geochemical processes linked to chemical alterations, transport in aqueous solution and the precipitation of minerals. Since chemical alteration can cause profound changes to the mechanical properties of argillaceous rocks, it is often difficult to draw a firm line between these two subdivisions. Based on the deliberations of the recent Cluster Conference in Luxembourg, there would appear to be some support for the use of the term 'self-sealing' for processes affecting fracture conductivity in argillaceous rock that are largely mechanical or hydro-mechanical in their origin. There are four main areas in which the self-healing capacity of the host rock becomes relevant to repository design and performance assessment: - potential for radionuclide transport within the excavation damage zone (EDZ); - design and performance of repository sealing systems; - potential impact of gas migration; - long-term performance considering erosional unloading, seismicity and fault reactivation. The presence of an EDZ is acknowledged to be a particularly important issue in performance assessment. Interconnection of fractures in the EDZ could lead to the development of a preferential flow path extending along the emplacement holes, access tunnels and shafts of a repository towards overlying aquifers and the biosphere. In the preliminary French Safety Analyses, for example, the treatment of scenarios relating to early seal failure have highlighted the hydraulic role of the damaged zone as a

  11. Scaphoid nonunion treated with vascularised bone graft from dorsal radius.

    Science.gov (United States)

    Özalp, Taçkın; Öz, Çağlar; Kale, Gürler; Erkan, Serkan

    2015-07-01

    The main aim of this retrospective study was to present our experience on scaphoid nonunion treated with vascularised bone graft. Between 2006 and 2012, 58 patients presenting with symptomatic scaphoid nonunion were eligible to participate in this study. Topography of the nonunion included 29 proximal, 25 waist and 4 distal scaphoid nonunions. Vascularised bone graft from distal dorsal radius was used in all cases which were stabilised with the headless cannulated compression screws. Scapholunate angles, Natrass carpal height ratio were evaluated pre and postoperatively. Range of motion of the affected side was compared to that of the contralateral side after the surgery. Radiographic union was achieved in 50, out of 58 cases with an average time of 9.9 weeks (range, 6-18 weeks). Out of all the non-united cases, four of them were in proximal, three in the waist and one was in distal scaphoid. In nine proximal nonunions treated by 4+5 ECA graft all but one were united. The mean follow up was 21.7 months (12-62 months). The flexion was 91.6%, the extension was 91.5%, the radial deviation was 81.2%, and the ulnar deviation was 89.5% compared to the other side. The grip strength was 93%. Preoperative DASH score was 61.5 diminishing to 28.7 postoperatively. There was no significant change in Natrass carpal height ratio but a slight improvement occurred in scapholunate angles both pre and postoperatively. Vascularised bone graft is a good solution for scaphoid nonunion to enhance the healing rate especially in the presence of avascular necrosis. Proximal pole nonunions, humpback deformity and smoking are important negative factors for scaphoid nonunion despite the use of a vascularised bone graft. A trapezoidal wedge graft is necessary for the volar type nonunions with humpback deformity. 1,2 ICSRA offer an advantage with its proximity to scaphoid in all nonunion locations. Nonetheless, 4+5 ECA graft is also a good solution for proximal nonunions. Copyright © 2015

  12. Histopathological evaluation of the effect of locally administered strontium on healing time in mandibular fractures: An experimental study.

    Science.gov (United States)

    Durmuş, Kasım; Turgut, Nergiz Hacer; Doğan, Mehtap; Tuncer, Ersin; Özer, Hatice; Altuntaş, Emine Elif; Akyol, Melih

    2017-10-01

    Mandibular fractures are the most common facial fractures. They can be treated by conservative techniques or by surgery. The authors hypothesized that the application of a single local dose of strontium chloride would accelerate the healing of subcondylar mandibular fractures, shorten the recovery time and prevent complications. The aim of the present pilot study was to evaluate the effects of a single local dose of strontium chloride on the healing of subcondylar mandibular fractures in rats. This randomized experimental study was carried out on 24 male Wistar albino rats. The rats were randomly divided into 3 groups: experimental group 1, receiving 3% strontium chloride; experimental group 2, receiving 5% strontium chloride; and the control group. A full thickness surgical osteotomy was created in the subcondylar area. A single dose of strontium solution (0.3 cc/site) was administered locally by injection on the bone surfaces of the fracture line created. Nothing was administered to the control group. The mandibles were dissected on postoperative day 21. The fractured hemimandibles were submitted to histopathological examination. The median bone fracture healing score was 9 (range: 7-9) in experimental group 1; 8 (range: 7-10) in experimental group 2; and 7.50 (range: 7-8) in the control group. When the groups were compared in terms of bone healing scores, there was a statistically significant difference between experimental group 1 and the control group (p fractures. In the authors' opinion, 3% strontium was beneficial for accelerating facial skeleton consolidation and bone regeneration in rat subcondylar mandibular fractures. This treatment procedure may be combined with closed fracture treatment or a conservative approach.

  13. Healing patterns of clavicular birth injuries as a guide to fracture dating in cases of possible infant abuse

    International Nuclear Information System (INIS)

    Walters, Michele M.; Forbes, Peter W.; Buonomo, Carlo; Kleinman, Paul K.

    2014-01-01

    Dating fractures is critical in cases of suspected infant abuse. There are little scientific data to guide radiologists, and dating is generally based on personal experience and conventional wisdom. Since birth-related clavicular fractures are not immobilized and their age is known, we propose that an assessment of these injuries may serve as a guide for dating inflicted fractures in young infants, acknowledging that patterns observed in the clavicle may not be entirely generalizable to other bones injured in the setting of abuse. One hundred thirty-one radiographs of presumed birth-related clavicular fractures in infants between 0 and 3 months of age were reviewed by two pediatric radiologists with 30 and 15 years' experience. Readers were asked to evaluate images based on several parameters of fracture healing, with a focus on subperiosteal new bone formation (SPNBF) and callus formation. SPNBF and callus were each evaluated with regard to presence, thickness and character. Responses were correlated with known fracture ages. SPNBF was rarely seen in fractures less than 7 days old and was most often present by 10 days. Callus formation was rarely seen in fractures less than 9 days old and was most often present by 15 days. SPNBF thickness increased with fracture age and the character of SPNBF evolved from single-layered to solid/multilayered. Callus thickness decreased with fracture age and callus matrix evolved from soft to intermediate to hard in character. There is an evolution in clavicular fracture healing in young infants that follows a predictable pattern. These findings afford the prospect that predictable patterns of infant clavicular fracture healing can provide an evidence base that may be applicable in cases of suspected infant abuse. (orig.)

  14. A MicroRNA-124 Polymorphism is Associated with Fracture Healing via Modulating BMP6 Expression

    Directory of Open Access Journals (Sweden)

    Lin Zou

    2017-04-01

    Full Text Available Background: miR-124-3p has been reported to be involved in the pathogenesis of many diseases by modulating a variety of signaling pathways. In this study, we aimed to understand the impact of miR-124-3p expression level on the fracture healing in the patients of metaphyseal fracture of distal tibia, who received minimal invasive percutaneous plate osteosynthesis. Methods: We firstly collected 195 patients of metaphyseal fracture of distal tibia, and the genotype of rs531564 was determined: GG (n=124 and GC+CC (n=71. We collected information of the participants including age, gender, total in-hospital time, smoking and alcohol consumption. Subsequently, we searched the miRNA database online to identify the possible binding sequence of miR-124-3p located within the 3’-UTR of the target gene. We did correlation analysis and luciferase to understand the regulatory relationship between miR-124-3p and BMP6. Meanwhile, we also conducted real time PCR and western blotting analysis to study the mRNA and protein expression level of BMP6 in different genotype groups. We then treated the cells with scramble control, miR-124-3p mimics, BMP6 siRNA and miR-124-3p inhibitors to investigate the influence of miR-124-3p on the expression of BMP6, viability and apoptosis of cells. Results: Total in-hospital time was significantly longer in GC+CC group than GG group. MiR-124-3p was up-regulated in GG group than GC and CC groups. BMP6 was virtual target of miR-124-3p. There existed negative regulatory relationship betweenmiR-124-3p and BMP6. The mRNA and protein expression level of BMP6 decreased in GG group. MiR-124-3p decreased the expression of BMP6. MiR-124-3p negatively interfered with the viability of cells and BMP6 positively interfered with the viability of cells. MiR-124-3p reduced apoptosis and BMP6 promoted apoptosis. Conclusion: These data proved the expression of miR-124-3p was associated with the healing of metaphyseal fracture of distal tibia, and

  15. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial.

    OpenAIRE

    Hannemann, P.; Gottgens, K.W.; Wely, B.J. van; Kolkman, K.A.; Werre, A.J.; Poeze, M.; Brink, P.R.

    2011-01-01

    Abstract Background The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%), non-union (5-21%) and early osteo-arthritis (up to 32%) ...

  16. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures.

    Science.gov (United States)

    Huang, Kui-Chou; Tong, Kwok-Man; Lin, Yu-Min; Loh, El-Wui; Hsu, Cheng-En

    2012-10-01

    Dynamisation is a simple method for treating femoral shaft fractures (FSFs) in patients with delayed healing after intramedullary nailing. However, only around half of patients with a slow-healing FSF have been successfully treated with this strategy. Although it is thought that dynamisation with a screw preserved in the dynamic locking hole improves treatment outcome in these patients, to date, no studies have demonstrated empirical evidence supporting this technique. In this study, we investigated the effects of dynamisation with and without rotation and length control as well as timing of dynamisation on treatment outcomes in FSF patients with delayed healing. Thirty-nine consecutive acute FSF patients with static locking intramedullary nails who subsequently underwent dynamisation were recruited between January 2000 and June 2011. The indication for dynamisation was the presence of gap caused by bone absorption or over-traction at the fracture site when the locking screws were placed. Age, gender, dynamisation method, fracture classification, duration from nail insertion to dynamisation (i.e., timing of dynamisation) and dynamisation outcome were included in the statistical analysis. Patients whose nail was dynamised with a screw preserved in the dynamic locking hole had a significantly higher successful bone union rate (14/15 vs. 14/24, p=0.028) compared with those with all screws removed from one end of the nail. The patients treated in 10-24 weeks had a significantly increased chance of bone union than those treated after 24 weeks (p=0.027). A significantly higher bone union rate (p=0.036) was observed in 10-24 weeks (83.3%) than after 24 weeks (33.3%) in the group of dynamisation with all screws removed from one end of the nail. No statistical difference in bone union success rate was found between patients at 10-24 weeks and after 24 weeks in the group of dynamisation with a screw preserved in the dynamic locking hole. There were no significant differences

  17. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature

    Science.gov (United States)

    2012-01-01

    Background Pulsed electromagnetic fields (PEMF) stimulation for the treatment of bone nonunion or delayed union have been in use for several years, but on a limited basis. The aim of this study was to assess the overall efficacy of the method in tibial delayed unions and nonunions and identify factors that could affect the final outcome. Methods We prospectively reviewed 44 patients (27 men) with a mean age of 49.6 ± 18.4 years that received PEMF therapy due to tibial shaft delayed union or nonunion. In all cases, fracture gap was less than 1 cm and infection or soft tissue defects were absent. Results Fracture union was confirmed in 34 cases (77.3%). No relationship was found between union rate and age (p = 0.819), fracture side (left or right) (p = 0.734), fracture type (simple or comminuted, open or closed) (p = 0.111), smoking (p = 0.245), diabetes (p = 0.68) and initial treatment method applied (plates, nail, plaster of paris) (p = 0.395). The time of treatment onset didn’t affect the incidence of fracture healing (p = 0.841). Although statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (p = 0.081). Conclusion PEMF stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. Its success is not associated with specific fracture or patient related variables and it couldn’t be clearly considered a time-dependent phenomenon. PMID:22681718

  18. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature

    Directory of Open Access Journals (Sweden)

    Assiotis Aggelos

    2012-06-01

    Full Text Available Abstract Background Pulsed electromagnetic fields (PEMF stimulation for the treatment of bone nonunion or delayed union have been in use for several years, but on a limited basis. The aim of this study was to assess the overall efficacy of the method in tibial delayed unions and nonunions and identify factors that could affect the final outcome. Methods We prospectively reviewed 44 patients (27 men with a mean age of 49.6 ± 18.4 years that received PEMF therapy due to tibial shaft delayed union or nonunion. In all cases, fracture gap was less than 1 cm and infection or soft tissue defects were absent. Results Fracture union was confirmed in 34 cases (77.3%. No relationship was found between union rate and age (p = 0.819, fracture side (left or right (p = 0.734, fracture type (simple or comminuted, open or closed (p = 0.111, smoking (p = 0.245, diabetes (p = 0.68 and initial treatment method applied (plates, nail, plaster of paris (p = 0.395. The time of treatment onset didn’t affect the incidence of fracture healing (p = 0.841. Although statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (p = 0.081. Conclusion PEMF stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. Its success is not associated with specific fracture or patient related variables and it couldn’t be clearly considered a time-dependent phenomenon.

  19. Management of infected non-union tibia by intercalary bone transport

    International Nuclear Information System (INIS)

    Pirwani, M.A.; Siddiqui, A.; Soomro, Y.H.

    2008-01-01

    To evaluate the efficacy of ilizarov ring fixator in treating infected non-union tibia by intercalary bone transport. Sixteen patients, all males, aged 20-60 years (mean 32 years), with infected non-union tibia (Lax/Cierney Type IV Osteomyelitis); the commonest cause being open fracture and the commonest site being lower 1/3rd. In infected non-union of tibia with draining sinus, wound swab was sent for culture and sensitivity, and sinogram done. Debridement and sequestrectomy was done, leaving behind a gap ranging from 2-8 cms (mean 4.5 cms) and ilizarov ring fixator, a transport assembly, applied. A navigation wire was passed through medial malleolus, irrigation system set up and the wound closed in a single layer. Proximal metaphyseal corticotomy was done. Irrigation with 2-3 litres of normal saline with appropriate antibiotic was continued for five days. On the 5th day irrigation system was removed and the transport started. Patients remained on partial weight bearing till soft tissue healing occured. Transport took place over the navigation wire at the rate of 1mm/day till docking achieved. Full weight bearing was allowed after soft tissue healing; knee and ankle physiotherapy was started from day one. Navigation wire was removed after 2-3 weeks of docking. Follow up ranged from 12-27 months (mean 16 months). Union was achieved at the docking site in all the cases at the time of frame removal i.e. 8-13 months. The duration of union at docking site ranged from 3.5 months to 6 months (mean 4.5 months). Two patients needed bone graft at the docking site. The regenerate was broken in one case due to fall which was treated in cast. All the patients were satisfied except a 60 years old who had severe osteoarthritis of knee. Pin tract infection occurred on and off in all the patients; appropriate antibiotic was given. The infection subsided in all the cases except two in whom debridement was followed by application of a local flap. Intercalary bone transport by

  20. Carbon dioxide sequestration induced mineral precipitation healing of fractured reservoir seals

    Science.gov (United States)

    Welch, N.; Crawshaw, J.

    2017-12-01

    Initial experiments and the thermodynaic basis for carbon dioxide sequestration induced mineral precipitation healing of fractures through reservoir seals will be presented. The basis of this work is the potential exists for the dissolution of reservoir host rock formation carbonate minerals in the acidified injection front of CO2 during sequestration or EOR. This enriched brine and the bulk CO2 phase will then flow through the reservoir until contact with the reservoir seal. At this point any fractures present in the reservoir seal will be the preferential flow path for the bulk CO2 phase as well as the acidified brine front. These fractures would currently be filled with non-acidified brine saturated in seal formation brine. When the acidifeid brine from the host formation and the cap rock brine mix there is the potential for minerals to fall out of solution, and for these precipitated minerals to decrease or entirely cut off the fluid flow through the fractures present in a reservoir seal. Initial equilibrium simulations performed using the PHREEQC1 database drived from the PHREEQE2 database are used to show the favorable conditions under which this mineral precipitation can occurs. Bench scale fluid mixing experiments were then performed to determine the kinetics of the mineral precipitation process, and determine the progress of future experiemnts involving fluid flow within fractured anhydrite reservoir seal samples. 1Parkhurst, D.L., and Appelo, C.A.J., 2013, Description of input and examples for PHREEQC version 3—A computer program for speciation, batch-reaction, one-dimensional transport, and inverse geochemical calculations: U.S. Geological Survey Techniques and Methods, book 6, chap. A43, 497 p., available only at https://pubs.usgs.gov/tm/06/a43/. 2Parkhurst, David L., Donald C. Thorstenson, and L. Niel Plummer. PHREEQE: a computer program for geochemical calculations. No. 80-96. US Geological Survey, Water Resources Division,, 1980.

  1. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  2. Hedgehog signaling mediates woven bone formation and vascularization during stress fracture healing.

    Science.gov (United States)

    Kazmers, Nikolas H; McKenzie, Jennifer A; Shen, Tony S; Long, Fanxin; Silva, Matthew J

    2015-12-01

    Hedgehog (Hh) signaling is critical in developmental osteogenesis, and recent studies suggest it may also play a role in regulating osteogenic gene expression in the post-natal setting. However, there is a void of studies directly assessing the effect of Hh inhibition on post-natal osteogenesis. This study utilized a cyclic loading-induced ulnar stress fracture model to evaluate the hypothesis that Hh signaling contributes to osteogenesis and angiogenesis during stress fracture healing. Immediately prior to loading, adult rats were given GDC-0449 (Vismodegib - a selective Hh pathway inhibitor; 50mg/kg orally twice daily), or vehicle. Hh signaling was upregulated in response to stress fracture at 3 days (Ptch1, Gli1 expression), and was markedly inhibited by GDC-0449 at 1 day and 3 days in the loaded and non-loaded ulnae. GDC-0449 did not affect Hh ligand expression (Shh, Ihh, Dhh) at 1 day, but decreased Shh expression by 37% at 3 days. GDC-0449 decreased woven bone volume (-37%) and mineral density (-17%) at 7 days. Dynamic histomorphometry revealed that the 7 day callus was composed predominantly of woven bone in both groups. The observed reduction in woven bone occurred concomitantly with decreased expression of Alpl and Ibsp, but was not associated with differences in early cellular proliferation (as determined by callus PCNA staining at 3 days), osteoblastic differentiation (Osx expression at 1 day and 3 days), chondrogenic gene expression (Acan, Sox9, and Col2α1 expression at 1 day and 3 days), or bone resorption metrics (callus TRAP staining at 3 days, Rankl and Opg expression at 1 day and 3 days). To evaluate angiogenesis, vWF immunohistochemistry showed that GDC-0449 reduced fracture callus blood vessel density by 55% at 3 days, which was associated with increased Hif1α gene expression (+30%). Dynamic histomorphometric analysis demonstrated that GDC-0449 also inhibited lamellar bone formation. Lamellar bone analysis of the loaded limb (directly adjacent

  3. A comparison of effi cacy of femoral and tibial fractures healing treated by static and dynamic intramedullary nails

    Directory of Open Access Journals (Sweden)

    Đemil Omerović

    2012-12-01

    Full Text Available Introduction: Intramedullary nailing is synthesis and  consolidation of fracture fragments with the main goalto gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.Methods: The study was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B. Patients were divided into two groups, based on the applied operating method, static or dynamic intramedullary osteosynthesis.Results: The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382. The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978.Conclusion: We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Static intramedullary ostesinthesys resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

  4. Lack of endogenous parathyroid hormone delays fracture healing by inhibiting vascular endothelial growth factor‑mediated angiogenesis.

    Science.gov (United States)

    Ding, Qingfeng; Sun, Peng; Zhou, Hao; Wan, Bowen; Yin, Jian; Huang, Yao; Li, Qingqing; Yin, Guoyong; Fan, Jin

    2018-04-03

    Intermittent low‑dose injections of parathyroid hormone (PTH) have been reported to exert bone anabolic effects and to promote fracture healing. As an important proangiogenic cytokine, vascular endothelial growth factor (VEGF) is secreted by bone marrow mesenchymal stem cells (BMSCs) and osteoblasts, and serves a crucial regulatory role in the process of vascular development and regeneration. To investigate whether lack of endogenous PTH causes reduced angiogenic capacity and thereby delays the process of fracture healing by downregulating the VEGF signaling pathway, a PTH knockout (PTHKO) mouse fracture model was generated. Fracture healing was observed using X‑ray and micro‑computerized tomography. Bone anabolic and angiogenic markers were analyzed by immunohistochemistry and western blot analysis. The expression levels of VEGF and associated signaling pathways in murine BMSC‑derived osteoblasts were measured by quantitative polymerase chain reaction and western blot analysis. The expression levels of protein kinase A (PKA), phosphorylated‑serine/threonine protein kinase (pAKT), hypoxia‑inducible factor‑1α (HIF1α) and VEGF were significantly decreased in BMSC‑derived osteoblasts from PTHKO mice. In addition, positive platelet endothelial cell adhesion molecule staining was reduced in PTHKO mice, as determined by immunohistochemistry. The expression levels of HIF1α, VEGF, runt‑related transcription factor 2, osteocalcin and alkaline phosphatase were also decreased in PTHKO mice, and fracture healing was delayed. In conclusion, lack of endogenous PTH may reduce VEGF expression in BMSC‑derived osteoblasts by downregulating the activity of the PKA/pAKT/HIF1α/VEGF pathway, thus affecting endochondral bone formation by causing a reduction in angiogenesis and osteogenesis, ultimately leading to delayed fracture healing.

  5. [High bone consolidation rates after humeral head-preserving revision surgery in non-unions of the proximal humerus].

    Science.gov (United States)

    Aytac, S D; Schnetzke, M; Hudel, I; Studier-Fischer, S; Grützner, P A; Gühring, T

    2014-12-01

    Fractures of the subcapital and proximal humerus shaft region are common fractures of the human skeleton. Their treatment should provide an early functional after-care of the shoulder joint, that is prone to arthrofibrosis. Although the upper extremity is not weight-bearing the occurrence of proximal humerus non-unions leads to severe impairment with inability to work and restrictions of activity of daily life. The aim of this study was to investigate whether an operative revision of proximal humerus non-unions with reosteosynthesis and application of distant autologous bone grafts can lead to sufficient bone healing. The second aim was to find out whether patients achieved an acceptable functional outcome, as alternatively patients could be treated by reconstruction with a shoulder prosthesis. 27 patients (female = 15, male = 12) with reosteosynthesis of the proximal humerus and proximal humeral shaft due to non-union after initially operative fracture treatment were included between 2008 and 2014. Average age of patients was 56 years (23-87), 48% had no comorbidities, while 52% of the patients had at least 1 comorbidity such as diabetes, hypertension or nicotine abusus. The mean number of prior surgical intervention was 1.2 (1-3). The mean time between initial surgery and re-osteosynthesis was 12.3 months. Patients with signs of infection pseudarthrosis were excluded. The initial type of osteosynthesis was with plates (n = 16; thereof PHILOS Plate n = 14), and intramedullary nails (T2, Targon Nail, PHN, Seidel Nail; n = 11). Revision surgery was done with plate osteosynthesis (n = 26; thereof PHILOS Plate n = 4; LC Plate n = 10; angle plate n = 12). In 23 patients (89%) a distant bone transplantation was done from the iliac crest, and 1 patient received allogenous bone. Three patients (11%) received bone morphogenetic protein 7 (BMP 7) in combination with distant bone graft. Intraoperative swabs from the pseudarthrosis area

  6. Effect of amino acids lysine and arginine on fracture healing in rabbits: A radiological and histomorphological analysis

    Directory of Open Access Journals (Sweden)

    Sinha Shivam

    2009-01-01

    Full Text Available Background: Amino acids like arginine and lysine have been suggested to hasten the process of fracture healing by improving the local blood supply, supplementing growth factors, and improving collagen synthesis. We studied the role of lysine and arginine in the fracture repair process with regard to the rate of healing, probable mechanisms involved in the process, and mutual synergism between these agents. Materials and Methods: In an experimental study, 40 rabbits were subjected to ulnar osteotomy. They were distributed in control (14 and test groups (26. Twenty-six animals in the test group were fed with a diet rich in lysine and arginine. Both the groups were followed radiologically and histologically till union. Results: There was better healing of osteotomy in terms of better vascularization, callus formation, and mineralization in the test group. The time of healing in the test group was reduced by a period of 2 weeks. Conclusion: We conclude that amino acids like arginine and lysine may hasten fracture healing.

  7. Studying the effect of photodynamic therapy (PDT) to enhance healing of femur fractures using polarimetric second-harmonic generation microscopy

    Science.gov (United States)

    Golaraei, Ahmad; Raja, Vaishnavi; Akens, Margarete K.; Wilson, Brian C.; Barzda, Virginijus

    2017-07-01

    Linear polarization-in, polarization-out second-harmonic generation microscopy was used to study the effect of Photodynamic therapy treatment on enhancing the healing of femur fracture by investigating the ultrastructure of collagen as a major component of bone matrix.

  8. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Lou, Shenghan; Lv, Houchen; Wang, Guoqi; Zhang, Licheng; Li, Ming; Li, Zhirui; Zhang, Lihai; Tang, Peifu

    2016-01-01

    Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] -4.54 days, 95% confidence interval [CI] -8.80 to -0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD -6.24 days, 95% CI -7.20 to -5.29), but upper limb group did not (MD -1 days, 95% CI -2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] -1.02, 95% CI -1.81 to -0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD -1.68, 95% CI -2.07 to -1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.

  9. Effect of bone marrow and low power lasers on fracture healing with destruction of both periosteum and endosteum in rabbits

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    M. G. Thanoon

    2010-01-01

    Full Text Available Ten mature rabbits of local breed were used in this study; weighing between 1.5 to 1.75 kg and aged about 1–2 years. These animals were divided into two equal groups; in group A destruction of both periosteum and endosteum was done one centimeter from each side of mid-shaft femoral bone fracture, then sufficient amount of autogenously bone marrow was injected directly at the fracture site after immobilization by intramedullary pin. In group B a similar procedure was achieved as in group A, but in additional to that He-Ne infrared laser therapy was used for several sessions. The result of radiological findings indicated that, the fracture healing occurred within group B at fifteen weeks, whereas in group A the healing occurred at eighteen weeks after operation. The implantation of autologous bone marrow enhanced the fracture healing, whereas using of combinations of autologous bone marrow and He-Ne infrared laser therapy hastened the healing.

  10. Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting.

    Science.gov (United States)

    Dedeoğlu, S S; İmren, Y; Çabuk, H; Tekin, A C; Türe, Y C; Gürbüz, H

    2018-02-01

    Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union. Twenty-nine patients with scaphoid non-union were included in this prospective study. There were 27 male and 2 female patients with an average age of 29 years (range 18-45 years). Mean time from the injury to surgery was 18.3 months. The Slade and Geissler classification was used to classify the non-unions. Wrist range of motion (ROM), pain based on a visual analog scale (VAS), and the Mayo wrist score were used to assess the clinical outcomes. Postoperative radiographs and CT-scans were reviewed to assess fracture union, carpal alignment and screw position. The average clinical follow-up was 76 weeks (range: 74-87 weeks) postoperatively. Mean time to union was 11 weeks (range: 7-18 weeks). There was no humpback/no DISI in any of the cases. Twenty-six patients healed successfully with no additional procedures. Three patients with failed union underwent revision surgery with grafting. At the final follow-up, average wrist ROM was 61° (range: 30-80) in extension and 61° (range: 35-80) in flexion, the average Mayo wrist score was 66±20 (range: 20-90), and the mean VAS was 2±2 (range: 0-7). Percutaneous fixation without grafting associated with distal radius core decompression can provide satisfactory outcomes in surgical management of scaphoid non-unions. II. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All

  11. Radiographic configuration and healing of 121 fractures of the proximal phalanx in 120 Thoroughbred racehorses (2007-2011).

    Science.gov (United States)

    Smith, M R W; Wright, I M

    2014-01-01

    Although fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred horses in training, limited details on variations in morphology and radiological progression have been published. To describe in detail the configuration of parasagittal fractures of the proximal phalanx in a group of Thoroughbred racehorses, to report fracture distribution within this group of horses and to document radiological progression of fracture healing in cases treated by internal fixation. Restrospective case series. Case records and radiographs of Thoroughbred racehorses with parasagittal fractures of the proximal phalanx admitted to Newmarket Equine Hospital between 2007 and 2011 were analysed. One hundred and twenty-one fractures were identified in 120 Thoroughbred racehorses. Fractures were frequently more complex than was appreciated immediately following injury; a feature that has not been reported previously. There was seasonality of fractures in 2- and 3-year-old horses, but not in older horses. Fractures of the proximal phalanx may be more complex than recognised previously, although often their complexity cannot be identified radiographically immediately following injury. The seasonality observed in 2- and 3-year-old horses is most likely to be a consequence of the timing of the turf-racing season in the UK. The Summary is available in Chinese - see Supporting information. © 2013 EVJ Ltd.

  12. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study

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    Mohamed Abdalla Estai

    2011-01-01

    fracture healing, as assessed by the reduced callus volumes and reduced callus scores. This extract is beneficial for fractures in osteoporotic states.

  13. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-01-01

    Background: Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. Objectives: This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. Materials and Methods: This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Results: Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Conclusions: Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group. PMID:26756019

  14. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation.

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-12-01

    Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group.

  15. Osteoblast-specific Krm2 overexpression and Lrp5 deficiency have different effects on fracture healing in mice.

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    Astrid Liedert

    Full Text Available The canonical Wnt/β-catenin pathway plays a key role in the regulation of bone remodeling in mice and humans. Two transmembrane proteins that are involved in decreasing the activity of this pathway by binding to extracellular antagonists, such as Dickkopf 1 (Dkk1, are the low-density lipoprotein receptor related protein 5 (Lrp5 and Kremen 2 (Krm2. Lrp 5 deficiency (Lrp5-/- as well as osteoblast-specific overexpression of Krm2 in mice (Col1a1-Krm2 result in severe osteoporosis occurring at young age. In this study, we analyzed the influence of Lrp5 deficiency and osteoblast-specific overexpression of Krm2 on fracture healing in mice using flexible and semi-rigid fracture fixation. We demonstrated that fracture healing was highly impaired in both mouse genotypes, but that impairment was more severe in Col1a1-Krm2 than in Lrp5-/- mice and particularly evident in mice in which the more flexible fixation was used. Bone formation was more reduced in Col1a1-Krm2 than in Lrp5-/- mice, whereas osteoclast number was similarly increased in both genotypes in comparison with wild-type mice. Using microarray analysis we identified reduced expression of genes mainly involved in osteogenesis that seemed to be responsible for the observed stronger impairment of healing in Col1a1-Krm2 mice. In line with these findings, we detected decreased expression of sphingomyelin phosphodiesterase 3 (Smpd3 and less active β-catenin in the calli of Col1a1-Krm2 mice. Since Krm2 seems to play a significant role in regulating bone formation during fracture healing, antagonizing KRM2 might be a therapeutic option to improve fracture healing under compromised conditions, such as osteoporosis.

  16. Osteoblast-specific Krm2 overexpression and Lrp5 deficiency have different effects on fracture healing in mice.

    Science.gov (United States)

    Liedert, Astrid; Röntgen, Viktoria; Schinke, Thorsten; Benisch, Peggy; Ebert, Regina; Jakob, Franz; Klein-Hitpass, Ludger; Lennerz, Jochen K; Amling, Michael; Ignatius, Anita

    2014-01-01

    The canonical Wnt/β-catenin pathway plays a key role in the regulation of bone remodeling in mice and humans. Two transmembrane proteins that are involved in decreasing the activity of this pathway by binding to extracellular antagonists, such as Dickkopf 1 (Dkk1), are the low-density lipoprotein receptor related protein 5 (Lrp5) and Kremen 2 (Krm2). Lrp 5 deficiency (Lrp5-/-) as well as osteoblast-specific overexpression of Krm2 in mice (Col1a1-Krm2) result in severe osteoporosis occurring at young age. In this study, we analyzed the influence of Lrp5 deficiency and osteoblast-specific overexpression of Krm2 on fracture healing in mice using flexible and semi-rigid fracture fixation. We demonstrated that fracture healing was highly impaired in both mouse genotypes, but that impairment was more severe in Col1a1-Krm2 than in Lrp5-/- mice and particularly evident in mice in which the more flexible fixation was used. Bone formation was more reduced in Col1a1-Krm2 than in Lrp5-/- mice, whereas osteoclast number was similarly increased in both genotypes in comparison with wild-type mice. Using microarray analysis we identified reduced expression of genes mainly involved in osteogenesis that seemed to be responsible for the observed stronger impairment of healing in Col1a1-Krm2 mice. In line with these findings, we detected decreased expression of sphingomyelin phosphodiesterase 3 (Smpd3) and less active β-catenin in the calli of Col1a1-Krm2 mice. Since Krm2 seems to play a significant role in regulating bone formation during fracture healing, antagonizing KRM2 might be a therapeutic option to improve fracture healing under compromised conditions, such as osteoporosis.

  17. A modified Matti-Russe technique of grafting scaphoid non-unions.

    Science.gov (United States)

    Dustmann, Moritz; Bajinski, Ralf; Tripp, Alexander; Gülke, Joachim; Wachter, Nikolaus

    2017-06-01

    In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated. A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti-Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score. The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen. The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone

  18. Sandwich allografts for long-bone nonunions in patients with osteogenesis imperfecta: a retrospective study.

    Science.gov (United States)

    Puvanesarajah, Varun; Shapiro, Jay R; Sponseller, Paul D

    2015-02-18

    Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years). All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function. Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the

  19. Low intensity pulsed ultrasound enhanced mesenchymal stem cell recruitment through stromal derived factor-1 signaling in fracture healing.

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    Fang-Yuan Wei

    Full Text Available Low intensity pulsed ultrasound (LIPUS has been proven effective in promoting fracture healing but the underlying mechanisms are not fully depicted. We examined the effect of LIPUS on the recruitment of mesenchymal stem cells (MSCs and the pivotal role of stromal cell-derived factor-1/C-X-C chemokine receptor type 4 (SDF-1/CXCR4 pathway in response to LIPUS stimulation, which are essential factors in bone fracture healing. For in vitro study, isolated rat MSCs were divided into control or LIPUS group. LIPUS treatment was given 20 minutes/day at 37 °C for 3 days. Control group received sham LIPUS treatment. After treatment, intracellular CXCR4 mRNA, SDF-1 mRNA and secreted SDF-1 protein levels were quantified, and MSCs migration was evaluated with or without blocking SDF-1/CXCR4 pathway by AMD3100. For in vivo study, fractured 8-week-old young rats received intracardiac administration of MSCs were assigned to LIPUS treatment, LIPUS+AMD3100 treatment or vehicle control group. The migration of transplanted MSC to the fracture site was investigated by ex vivo fluorescent imaging. SDF-1 protein levels at fracture site and in serum were examined. Fracture healing parameters, including callus morphology, micro-architecture of the callus and biomechanical properties of the healing bone were investigated. The in vitro results showed that LIPUS upregulated SDF-1 and CXCR4 expressions in MSCs, and elevated SDF-1 protein level in the conditioned medium. MSCs migration was promoted by LIPUS and partially inhibited by AMD3100. In vivo study demonstrated that LIPUS promoted MSCs migration to the fracture site, which was associated with an increase of local and serum SDF-1 level, the changes in callus formation, and the improvement of callus microarchitecture and mechanical properties; whereas the blockade of SDF-1/CXCR4 signaling attenuated the LIPUS effects on the fractured bones. These results suggested SDF-1 mediated MSCs migration might be one of the

  20. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur.

    Science.gov (United States)

    Singh, Roop; Rohilla, Rajesh; Gawande, Jeetesh; Kumar Sehgal, Paramjit

    2017-02-01

    New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation, tissue repair, and the process of bone mineralization. The present study aims to evaluate the role of platelet-rich plasma (PRP) in healing of acute femoral shaft fractures radiologically. We hypothesize that it provides artificial hematoma and releases various growth factors. This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails (closed or open). Patients were divided into two groups: study group A (n = 33) treated with intramedullary nailing & PRP injection/gel application in the same setting; and control group B (n = 39) treated with intramedullary nailing without PRP application. Both groups were further divided into two subgroups. Study group included subgroup A1 (n = 14) operated with closed intramedullary nailing and PRP injection at the fracture site under radiological control, and subgroup A2 (n = 19) operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site; while control group included subgroup B1 (n = 16) operated with closed intramedullary nailing, and subgroup B2 (n = 23) operated with open intramedullary nailing. Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months. Measurements of mean cortex to callus ratio revealed significant difference between the groups A & B at third and fourth months. Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months. A statistically significant difference was observed between subgroups A1 & B2 and B1 & B2 at the

  1. Stimulation of fracture healing by local application of humoral factors integrated in biodegradable implants.

    Science.gov (United States)

    Illi, O E; Feldmann, C P

    1998-08-01

    Growth stimulation by growth hormones or by IGF-1 is well known whereas publications about stimulation of fracture healing with these substances are rare. One of the main effects of IGF-1 is angiopoiesis which consequently may be expected to induce and accelerate the soft tissue callus formation. BMP-2 is a stimulator for osteoclasts and osteoblasts and prepares the osseous reparation. RhBMPs, mostly BMP-2, are already used in the reconstruction of the cranial vault. The main disadvantage of these proteins is the quick inactivation after about 20-30 minutes. Local stimulation without systemic effects might be avoided by releasing a low but constant dose of IGF-1 or BMP. We speculate that the combination of a reasonable implant with an integrated drug release system may enlarge the field of application of biodegradable implants in the treatment of fractures. Such an implant might remarkably reduce the time for fracture healing and also lower the costs of postoperative treatment. In this paper we report our animal models in which we have tested constructive principles of biodegradable implants, we present the first clinical experiences with polyactates (PLLA) in the osteosynthesis of children, and we describe our inventions concerning drug releasing implants. 1) PLLA-implants a) The animal models We performed on oblique osteotomy of the right metacarpal bone in 48 juvenile calves and osteoplastic reconstructions of the cranial vault in 28 juvenile Göttinger minipigs. Biodegradable osteosynthesis with PLLA implants led to results as good as with conventional materials in both animal models, so that we proceeded to clinical evaluation in children. b) The clinical application in children 35 children, aged 6 weeks to 17 years, had resorbable osteosynthesis of their cranioplasties for correction of congenital malformations and posttraumatic reconstructions. The follow-up ranged from 5-15 years. 2) Invention of a drug-releasing system IGF-1 or BMP-2 is planned to be

  2. Treatment of Atypical Ulnar Fractures Associated with Long-Term Bisphosphonate Therapy for Osteoporosis: Autogenous Bone Graft with Internal Fixation

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    Yohei Shimada

    2017-01-01

    Full Text Available Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and an increased risk of atypical fractures. Fractures of this nature commonly occur in the femur, and relatively few reports exist to show that they occur in other bones. Among eight previous reports of atypical ulnar fractures associated with bisphosphonate use, one report described nonunion in a patient who was treated with cast immobilization and another described ulna nonunion in one of three patients, all of whom were treated surgically with a locking plate. The remaining two surgical patients achieved bone union uneventfully following resection of the osteosclerotic lesion and iliac bone grafting before rigid fixation. We hypothesized that the discontinuation of bisphosphonate therapy, the use of teriparatide treatment, and low-intensity pulsed ultrasound (LIPUS might have been associated with fracture healing.

  3. Ipsilateral humeral neck and shaft fractures

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    Zhu Bin

    2017-01-01

    Full Text Available Background/Aim. Fractures of the proximal humerus or shaft are common, however, ipsilateral neck and shaft humerus fracture is a rare phenomenon. This combination injury is challenging for orthopaedic surgeons because of its complex treatment options at present. The purpose of this study was to review a series of ipsilateral humeral neck and shaft fractures to study the fracture pattern, complications and treatment outcomes of each treatment options used. Methods. A total of six patients (four female and two male with the average age of 42.8 years (range: 36–49 years was collected and reviewed retrospectively. Two of them were treated with double plates and four with antegrade intramedullary nail. According to the Neer’s classification, all proximal fractures were two-part surgical neck fractures. All humeral shaft fractures were located at the middle of one third. Five fractures were simple transverse (A3, one fragmented wedge fracture (B3. One patient had associated radial nerve palsy. Results. All surgical neck fractures except one united uneventfully in the average time span of 8.7 weeks. Four humeral shaft fractures healed in near anatomic alignment. The remaining two patients had the nonunion with no radiological signs of fracture healing. The average University of California, Los Angeles End-Results (UCLA score was 23.1. On the contrary, the average American Shoulder and Elbow Surgeon's (ASES score was 73.3. The patients treated with antegrade intramedullary nails presented 70.5 points. The ASES scores were 79 in the double plates group. Conclusions. Ipsilateral humeral shaft and neck fracture is extremely rare. Both antegrade intramedullar nailing and double plates result in healing of fractures. However the risk of complication is lower in the double plating group.

  4. A new variant of scaphoid reconstruction: Treatment of scaphoid non-union with avascular bone interponate and high compression screw (Synthes

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    Eder, Christian

    2015-08-01

    Full Text Available Scaphoid fractures as frequently overseen injuries often result in scaphoid non-unions, that need to be treated to prevent carpal collapse and secondary cartilage damage. Vital bone tissue and compression of fracture and bone graft ends seem to be crucial in for ossification and final bone healing. In the present study we compare our results using a high compression screw (HCS Synthes to results in the literature using different kinds of internal fixation including compression screws of various types. We present 22 patients with scaphoid non-unions treated with a bone graft and a HCS Synthes. We evaluated our post-operative results. The Manchester-Modified Disability of the Shoulder, Arm and Hand–Score (M-Dash imposed with an average of 29.8 points (MD=29 / SD=9.46 / MIN=18 / MAX=48. None of the re-evaluated patients sorrowed for pain in rest. Five patients stated pain (ranging from 4 to 8 on numeric analogue scale after heavy burden (e.g. boxing, weight lifting.In exploring the range of motion of the operated hand we deliver the following results: dorsal extension: average 72.73° (MD=80° / SD=17.23° / MIN=30° / MAX=85°, flexion: average 73.64° (MD=80° / SD=8.97° / MIN=60° / MAX=80°, ulnar deviation: average 39.09°, (MD=40° / SD=2.02° / MIN=35° / MAX=40°, radial deviation: average 29.09°, (MD=30° / SD=3.01° / MIN=20° / MAX=30°. Additionally a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 100%, moderate pain in n=1 (8.33%, opposition digitus manus I–V complete in 100%, moderate pain n=2 (16.67%. Three patients with persisting fracture gap had a scaphoid bone fractured in the proximal third; one patient even with a very small proximal fragment. One persisting non-union was localized in the middle third (period between injury and operation = . In conclusion, our patients showed better healing rates compared to results presented in the literature. Non-unions

  5. Experimental investigations for prevention and improvement of surgical therapy of tibia shaft non-unions

    OpenAIRE

    Schwabe, Philipp

    2015-01-01

    Non-unions after fractures of the tibia shaft show an incidence of 3-54%. The treatment of tibial shaft non-unions is time consuming and demanding for the surgeon and the patient. We could demonstrate that even sucessfully treated patients in terms of an adequate bone and soft tissue consolidation are suffering from a significant loss of function and reduction in quality of life. Therefore experimental approaches for prevention and treatment of tibial non-union have been introduced and evalua...

  6. A study of radiological features of healing in long bone fractures among infants less than a year

    Energy Technology Data Exchange (ETDEWEB)

    Warner, Christopher; Miller, Angie; Weinman, Jason; Fadell, Michael [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Maguire, Sabine; Trefan, Laszlo [Cardiff University, Institute of Primary Care and Child Health, Cardiff (United Kingdom)

    2017-03-15

    To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing. A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted. The level of agreement among the three radiologists was high (0.64-0.85). The sequence in which the features were seen was: periosteal reaction range 7-130 (present in the majority of cases between 9 and 49 days); callus range 9-130 (present in the majority of cases between days 9-26); bridging range 15-130 (seen in the majority of cases between 15 and 67 days); remodeling range 51-247 days. This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures. (orig.)

  7. A study of radiological features of healing in long bone fractures among infants less than a year

    International Nuclear Information System (INIS)

    Warner, Christopher; Miller, Angie; Weinman, Jason; Fadell, Michael; Maguire, Sabine; Trefan, Laszlo

    2017-01-01

    To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing. A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted. The level of agreement among the three radiologists was high (0.64-0.85). The sequence in which the features were seen was: periosteal reaction range 7-130 (present in the majority of cases between 9 and 49 days); callus range 9-130 (present in the majority of cases between days 9-26); bridging range 15-130 (seen in the majority of cases between 15 and 67 days); remodeling range 51-247 days. This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures. (orig.)

  8. To fix or not to fix? The role of fibular fixation in distal shaft fractures of the leg.

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    Berlusconi, M; Busnelli, L; Chiodini, F; Portinaro, N

    2014-02-01

    The role of stabilisation of the fibula in distal two-bone fractures of the leg is controversial. Some studies indicate the need for fibular stabilisation in 43 AO fractures, but few studies consider the role of the fibula in 42 AO fractures. The aim of the current paper is to explain the role of stabilisation of the fibula in 42 AO fractures, correlating the rates of healing and non-union between patients with and without fibula fixation. A total of 60 patients with 42 AO (distal) shaft fracture of the tibia with associated fracture of the fibula were selected. Patients were divided into two groups according to whether or not the fibula was fixed: Group I (n=26) comprised patients who had their fibula fixed while Group II (n=34) comprised patients who did not. The fibular fracture was classified according to the AO and related to the level of the tibial fracture. Other parameters examined were the union rate of the two groups correlated to the fracture pattern and position of the fibular fracture; the demographic data, such as age and gender; the presence of an open fracture, and the type of tibial fixation device used (nail or plate). None of the parameters considered (open injury, AO classification, device used and level of the fibular fracture relative to the tibial) were shown to have an influence on the development of a non-union. This study showed a higher non-union rate when the fracture of the tibia and fibula were at the same level, the tibia was fixed with a bridging plate and the fibula left untouched. For this reason, we recommend fibular fixation in all 42 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilised. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture.

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    Jiang-Jun, Zhou; Min, Zhao; Ya-Bo, Yan; Wei, Lei; Ren-Fa, Lv; Zhi-Yu, Zhu; Rong-Jian, Chen; Wei-Tao, Yu; Cheng-Fei, Du

    2014-03-01

    Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not.

  10. Histological evaluation of frakture healing after unreamed nail versus fixateur intern osteosynthesis of simple mid-shaft tibia fractures in sheep

    OpenAIRE

    Teschner, Steffi

    2010-01-01

    Introduction: Complication of conventional open reduction and internal fixation of fraktures are believed to be in part due to disruption of perfusion by the surgical approach and/or implant. Recently, an internal fixator has been developed wtch has only punctual contact to the periosteum and does not further damage the fracture healing process. Furthermore, the internal fixator can be applied through minimal invasive approach. This study compares the ease of fracture healing ater internal fi...

  11. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

    Science.gov (United States)

    Laflamme, G-Yves; Belzile, Etienne L; Fernandes, Julio C; Vendittoli, Pascal A; Hébert-Davies, Jonah

    2015-02-01

    Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Effect of nicotine and tobacco administration method on the mechanical properties of healing bone following closed fracture.

    Science.gov (United States)

    Hastrup, Sidsel Gaarn; Chen, Xinqian; Bechtold, Joan E; Kyle, Richard F; Rahbek, Ole; Keyler, Daniel E; Skoett, Martin; Soeballe, Kjeld

    2010-09-01

    We previously showed different effects of tobacco and nicotine on fracture healing, but due to pump reservoir limits, maximum exposure period was 4 weeks. To allow flexibility in pre- and post-fracture exposure periods, the objective of this study was to compare a new oral administration route for nicotine to the established pump method. Four groups were studied: (1) pump saline, (2) pump saline + oral tobacco, (3) pump saline/nicotine + oral tobacco, and (4) pump saline + oral nicotine/tobacco. Sprague-Dawley rats (n = 84) received a transverse femoral fracture stabilized with an intramedullary pin 1 week after initiating dosing. After 3 weeks, no difference was found in torsional strength or stiffness between oral nicotine/tobacco or pump nicotine + tobacco, while energy absorption with oral nicotine/tobacco was greater than pump nicotine + tobacco (p < 0.05). Compared to saline control, strength for oral nicotine/tobacco was higher than control (p < 0.05), and stiffnesses for pump nicotine + tobacco and oral nicotine/tobacco were higher than control (p < 0.05). No differences in energy were found for either nicotine-tobacco group compared to saline control. Mean serum cotinine (stable nicotine metabolite) was different between pump and oral nicotine at 1 and 4 weeks, but all groups were in the range of 1-2 pack/day smokers. In summary, relevant serum cotinine levels can be reached in rats with oral nicotine, and, in the presence of tobacco, nicotine can influence mechanical aspects of fracture healing, dependent on administration method. Caution should be exercised when comparing results of fracture healing studies using different methods of nicotine administration. (c) 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  13. Effectiveness of exchange K-nail and augmented plating in aseptic femoral diaphyseal non-union.

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    Sancheti, K H; Pradhan, Chetan; Patil, Atul; Puram, Chetan; Bharti, Parkalp; Sancheti, Parag; Shyam, Ashok

    2017-08-01

    Femoral diaphyseal non-unions present difficult scenario to manage. There are multiple options but most of them still report varying incidences of failure. We combined the principles of augmented plating and exchange nailing and aim to study the effectiveness of this technique. A retrospective study at a tertiary trauma centre was conducted. Seventy patients (60 men, 10 women), average age 40.7±15.27 years (range 18-81 years) with diaphyseal femoral fracture non-unions treated between July 2010 and January 2015 were reviewed. The average interval between first and the last surgery was 18.07±17.65 months (range 4-96 months). Forty six patients had hypertrophic non-union and 24 patients had atrophic non-union. Twenty one patients had undergone a prior surgery for non-union, 13 dynamisation, 4 bone grafting, 1 augmented plating and 3 exchange nailing. Non-unions were treated with implant removal, freshening of bone edges and exchange K-nailing and augmented plating. Autologous bone grafting and raising of osteoperiosteal flaps was done in all cases. Outcome measures were radiographic evidence of fracture union at minimum three out of four cortices, knee range of motion as compared to opposite knee, and study of complications. All patients demonstrated radiographic evidence of fracture union with an average time of 16.77±2.38 weeks (range 12-26 weeks). Mean knee range of motion of unaffected limb was 126±9.76° (range 90-140°) while in operated limb it was 121.1±11.36° (range 80-140°), p>0.01. Patients with hypertrophic non-unions, prior surgery for non-union and supra- or infra-isthmal non-unions had shorter union time. Two patients had superficial infection which was managed by superficial debridement and two patients had pain at proximal nail tip site which was managed by anti-inflammatory medication. None of the patients required additional surgery for implant removal. Exchange K nailing with Bone graft and additional plating technique for non-union

  14. Experimental osteoporosis induced by ovariectomy and vitamin D deficiency does not markedly affect fracture healing in rats.

    Science.gov (United States)

    Melhus, Gunhild; Solberg, Lene B; Dimmen, Sigbjoern; Madsen, Jan E; Nordsletten, Lars; Reinholt, Finn P

    2007-06-01

    The question of whether fracture healing and mechanical properties of the callus are influenced by osteoporosis (OP) is still not settled. We therefore studied this issue in vitamin D-depleted ovariectomized (OVX) rats, an OP model previously shown to induce weakening of the femoral neck, and thus thought to be closer to the human condition than the classic OVX rat model. 72 female Wistar rats were randomized into two groups: ovariectomy and vitamin D-deficient diet (Ovx-D group) or sham operation and normal rat chow (Sham group). After 12 weeks, a closed tibial midshaft fracture was performed on the right side and fixed with an intramedullary nail. Bone loss and callus formation were monitored with DXA; serum levels of estradiol and vitamin D3 were measured and histomorphometric analyses were performed. Mechanical properties of callus, tibia, femoral shaft, and femoral neck were examined in 3-point cantilever bending 6 weeks after fracture. The Ovx-D group showed reduced BMD in the spine and femoral neck, and reduced trabecular bone volume in the femoral head. There were no differences in BMD and mechanical properties of callus between the groups. Except for reduced stiffness of the right femoral neck in the Ovx-D group (p = 0.02), no differences in the mechanical strength of long bones were detected. Our results suggest that the systemic effects of estrogen and vitamin D deficiency are not crucial for fracture healing or mechanical properties of the callus.

  15. A cohesive elements based model to describe fracture and cohesive healing in elastomers

    NARCIS (Netherlands)

    Baldi, A.; Grande, A.M.; Bose, R.K.; Airoldi, A.; Garcia Espallargas, S.J.; Di Landro, L.; Van der Zwaag, S.

    2013-01-01

    Several polymeric systems with intrinsic Self-Healing (SH) capabilities have been reported in literature. Many of them showed healing upon contact across the crack interface. Different parameters such as contact time, temperature, pressure or chemical activity determine the degree of healing

  16. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  17. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report

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    Ismail Hadisoebroto Dilogo

    2017-01-01

    Conclusion: The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect.

  18. Autologous Bone Grafting and Revision Plating in a Case of Persistent High Tibial Osteotomy Non-Union.

    Science.gov (United States)

    Ming, Tan Shi; Koon, Wong Merng

    2016-01-01

    Uni-compartmental knee arthritis may be treated with several surgical options including uni-compartmental knee arthroplasty, total knee arthroplasty and high tibial osteotomy. Non-union is a well-established and common complication that may arise from the latter option and few reports have shown successful treatment of persistent non-union of high tibial osteotomy. We present a case of persistent non-union after high tibial osteotomy treated with autologous iliac crest bone grafting and revision plating. At 1 year post-operative interval, successful union was achieved after revision internal fixation. In addition, a good functional outcome was achieved. In this patient with persistent non-union following high tibial osteotomy, the aim of revision was to restore alignment and effect bone healing while preserving adequate tibial bone stock. Revision plating with autologous bone grafting is a good surgical strategy in the treatment ofpersistent non-union with hardware failure.

  19. Upregulation of inflammatory genes and downregulation of sclerostin gene expression are key elements in the early phase of fragility fracture healing.

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    Joana Caetano-Lopes

    Full Text Available BACKGROUND: Fracture healing is orchestrated by a specific set of events that culminates in the repair of bone and reachievement of its biomechanical properties. The aim of our work was to study the sequence of gene expression events involved in inflammation and bone remodeling occurring in the early phases of callus formation in osteoporotic patients. METHODOLOGY/PRINCIPAL FINDINGS: Fifty-six patients submitted to hip replacement surgery after a low-energy hip fracture were enrolled in this study. The patients were grouped according to the time interval between fracture and surgery: bone collected within 3 days after fracture (n = 13; between the 4(th and 7(th day (n = 33; and after one week from the fracture (n = 10. Inflammation- and bone metabolism-related genes were assessed at the fracture site. The expression of pro-inflammatory cytokines was increased in the first days after fracture. The genes responsible for bone formation and resorption were upregulated one week after fracture. The increase in RANKL expression occurred just before that, between the 4(th-7(th days after fracture. Sclerostin expression diminished during the first days after fracture. CONCLUSIONS: The expression of inflammation-related genes, especially IL-6, is highest at the very first days after fracture but from day 4 onwards there is a shift towards bone remodeling genes, suggesting that the inflammatory phase triggers bone healing. We propose that an initial inflammatory stimulus and a decrease in sclerostin-related effects are the key components in fracture healing. In osteoporotic patients, cellular machinery seems to adequately react to the inflammatory stimulus, therefore local promotion of these events might constitute a promising medical intervention to accelerate fracture healing.

  20. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts.

    Science.gov (United States)

    Kogan, Natalya M; Melamed, Eitan; Wasserman, Elad; Raphael, Bitya; Breuer, Aviva; Stok, Kathryn S; Sondergaard, Rachel; Escudero, Ana V Villarreal; Baraghithy, Saja; Attar-Namdar, Malka; Friedlander-Barenboim, Silvina; Mathavan, Neashan; Isaksson, Hanna; Mechoulam, Raphael; Müller, Ralph; Bajayo, Alon; Gabet, Yankel; Bab, Itai

    2015-10-01

    Cannabinoid ligands regulate bone mass, but skeletal effects of cannabis (marijuana and hashish) have not been reported. Bone fractures are highly prevalent, involving prolonged immobilization and discomfort. Here we report that the major non-psychoactive cannabis constituent, cannabidiol (CBD), enhances the biomechanical properties of healing rat mid-femoral fractures. The maximal load and work-to-failure, but not the stiffness, of femurs from rats given a mixture of CBD and Δ(9) -tetrahydrocannabinol (THC) for 8 weeks were markedly increased by CBD. This effect is not shared by THC (the psychoactive component of cannabis), but THC potentiates the CBD stimulated work-to-failure at 6 weeks postfracture followed by attenuation of the CBD effect at 8 weeks. Using micro-computed tomography (μCT), the fracture callus size was transiently reduced by either CBD or THC 4 weeks after fracture but reached control level after 6 and 8 weeks. The callus material density was unaffected by CBD and/or THC. By contrast, CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures, encoding an enzyme that catalyzes lysine hydroxylation, which is in turn involved in collagen crosslinking and stabilization. Using Fourier transform infrared (FTIR) spectroscopy we confirmed the increase in collagen crosslink ratio by CBD, which is likely to contribute to the improved biomechanical properties of the fracture callus. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes. © 2015 American Society for Bone and Mineral Research.

  1. Effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture

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    Yan-Kui Bai

    2016-11-01

    Full Text Available Objective: To analyze the effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture. Methods: A total of 70 elderly patients with femoral intertrochanteric fracture were randomly divided into observation group and control group (n=35, control group received minimally invasive surgery alone and observation group received minimally invasive surgery combined with postoperative placenta polypeptide injection therapy. The differences in postoperative bone mineral density as well as serum inflammatory indexes, bone metabolism indexes, hemorheology parameters, femoral neck length, neck-shaft angle value and so on were compared between two groups of patients. Results: Serum TNF-α, IL-6, PCT and MCP-1 content of observation group 2 weeks after treatment were lower than those of control group while IL-10 and TGF-β content were higher than those of control group; serum PINP and 25(OHD3 content were higher than those of control group while CTX and PCT content were lower than those of control group; whole blood high shear, middle shear and low shear viscosity, plasma viscosity as well as ESR and Fib content were lower than those of control group; the femoral neck length and neck-shaft angle levels 3 months after treatment were higher than those of control group. Conclusions: Minimally invasive surgery combined with postoperative placenta polypeptide injection therapy has advantages in promoting fracture healing, restoring physiological function of lower limbs and other aspects in elderly patients with femoral intertrochanteric fracture.

  2. Estrogen receptor α- (ERα), but not ERβ-signaling, is crucially involved in mechanostimulation of bone fracture healing by whole-body vibration.

    Science.gov (United States)

    Haffner-Luntzer, Melanie; Kovtun, Anna; Lackner, Ina; Mödinger, Yvonne; Hacker, Steffen; Liedert, Astrid; Tuckermann, Jan; Ignatius, Anita

    2018-05-01

    Mechanostimulation by low-magnitude high frequency vibration (LMHFV) has been shown to provoke anabolic effects on the intact skeleton in both mice and humans. However, experimental studies revealed that, during bone fracture healing, the effect of whole-body vibration is profoundly influenced by the estrogen status. LMHFV significantly improved fracture healing in ovariectomized (OVX) mice being estrogen deficient, whereas bone regeneration was significantly reduced in non-OVX, estrogen-competent mice. Furthermore, estrogen receptors α (ERα) and β (ERβ) were differentially expressed in the fracture callus after whole-body vibration, depending on the estrogen status. Based on these data, we hypothesized that ERs may mediate vibration-induced effects on fracture healing. To prove this hypothesis, we investigated the effects of LMHFV on bone healing in mice lacking ERα or ERβ. To study the influence of the ER ligand estrogen, both non-OVX and OVX mice were used. All mice received a femur osteotomy stabilized by an external fixator. Half of the mice were sham-operated or subjected to OVX 4 weeks before osteotomy. Half of each group received LMHFV with 0.3 g and 45 Hz for 20 min per day, 5 days per week. After 21 days, fracture healing was evaluated by biomechanical testing, μCT analysis, histomorphometry and immunohistochemistry. Absence of ERα or ERβ did not affect fracture healing in sham-treated mice. Wildtype (WT) and ERβ-knockout mice similarly displayed impaired bone regeneration after OVX, whereas ERα-knockout mice did not. Confirming previous data, in WT mice, LMHFV negatively affected bone repair in non-OVX mice, whereas OVX-induced compromised healing was significantly improved by vibration. In contrast, vibrated ERα-knockout mice did not display significant differences in fracture healing compared to non-vibrated animals, both in non-OVX and OVX mice. Fracture healing in ERβ-knockout mice was similarly affected by LMHFV as in WT

  3. [Treatment for ipsilateral fractures of the femoral neck and shaft].

    Science.gov (United States)

    Liu, Shao-Jun; He, Wei; Zhang, De-Xing; Fan, Yue-Guang

    2008-05-01

    To investigate the curative effect of different internal fixation for ipsilateral fractures of the femoral neck and shaft. By retrospective study of 27 patients who sustained ipsilateral femoral shaft and neck fractures from June 1993 to March 2004. There were 22 male and 5 female, with an average age of 35 years (range in 14 to 65 years). The femoral neck and shaft fractures were stabilized with dynamic hip screw system (DHS) in 3 cases,with dynamic compression plate and cannulated lag screw in 12 cases, with constructive nail in 8 cases, with antegrade intramedullary locking nail and cannulated lag screw in 4 cases. There were 13 cases used of the temporary fixation of Kirschner wire before the pexia of the femoral neck fractures. All of the patients were followed up for 36 to 75 months, with an average of 44 months. The average healing period of femoral neck fracture was 4.5 months in 25 cases, nonunion of femoral neck fractures in 2. The average healing period of femoral shaft fracture was 6 months in 27 cases. In 14 cases that not using temporary fixation of femoral neck with Kirschner wire, there were nonunion of femoral neck in 2 and slight coxa vara in 3. There are a wide choice of internal fixation method for treatment of ipsilateral fracture of the femoral neck and shaft, the fixation with dynamic compression plate and cannulated lag screw is a handy method. It would be avoided to the replacement and trauma, emporary fixing the fracture with Kirschner wire before the pexia of the femoral neck fracture.

  4. Management of complex long bone nonunions using limb reconstruction system

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    Hiranya Kumar Seenappa

    2013-01-01

    Full Text Available Background: Management of complex nonunions is difficult due to the presence of infection, deformities, shortening and multiple surgeries in the past. Complex nonunions are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 30 long bone complex nonunions treated by the limb reconstruction system (LRS. Materials and Methods: Between April 2009 and September 2012, we treated 30 cases of complex nonunion of long bone with the LRS. 28 were male and 2 females. Average shortening was 5.06 cm and 14 cases presented with infected implants. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 9.68 months. We compressed the fracture site at the rate of 0.25 mm per day for 1-2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved. Result: The union occurred in 89.28% cases and eradication of infection in 91.66% cases. Average lengthening done was 4.57 cm. We had 79% excellent, 11% good and 10% poor bony result and fnctional result was excellent in 40% cases, good in 50% and failure in 10% cases using ASAMI scoring system. Conclusion: LRS is an alternative to the Ilizarov fixation in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.

  5. The Effects of Targeted Deliveries of Lovastatin and Tocotrienol on Ossification-Related Gene Expressions in Fracture Healing in an Osteoporosis Rat Model

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    Nurul ‘Izzah Ibrahim

    2015-10-01

    Full Text Available Osteoporotic drugs are used to prevent fragility fractures, but their role in fracture healing still remains unknown. Thus, alternative agents with suitable mode of delivery are needed to promote fracture healing. This study was performed to investigate the effects of direct deliveries of lovastatin and tocotrienol to fracture sites on ossification-related gene expression in fracture healing in a postmenopausal osteoporosis model. Forty-eight Sprague Dawley female rats were divided into six groups. Group I comprised the sham-operated rats, while Groups II–VI were ovariectomized rats. After 8 weeks, the right tibiae of all rats were fractured and stabilized. Group I and Group II were given two single injections of lovastatin and tocotrienol carriers. Group III was given an estrogen preparation at 64.5 µg/kg daily via oral gavages. Group IV was injected with lovastatin particles (750 µg/kg, while Group V was injected with tocotrienol particles (60 mg/kg. Group VI received two single injections of 750 µg/kg lovastatin particles and 60 mg/kg tocotrienol particles. After 4 weeks, the gene expressions were measured. Group VI showed significantly higher gene expressions of osteocalcin, BMP-2, VEGF-α, and RUNX-2 compared to Group II. In conclusion, combined treatment of lovastatin and tocotrienol upregulated the expression of genes related to fracture healing.

  6. Time course of 25(OHD3 vitamin D3 as well as PTH (parathyroid hormone during fracture healing of patients with normal and low bone mineral density (BMD

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    Wöfl Christoph

    2013-01-01

    Full Text Available Abstract Background Until now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OHD3 (Vitamin D as well as PTH (Parathyroid Hormone the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing. Methods In the presented study, we analyse the time course of 25(OHD3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OHD3 and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant. Results Serum levels of 25(OHD3 showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study. Conclusions The time course of 25(OHD3 and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for

  7. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion.

    Science.gov (United States)

    Smith, Michael L; Bain, Gregory I; Chabrel, Nick; Turner, Perry; Carter, Chris; Field, John

    2009-01-01

    The primary aim of our study was to investigate use of long axis computed tomography (CT) in predicting avascular necrosis of the proximal pole of the scaphoid and subsequent fracture nonunion after internal fixation. In addition, we describe a new technique of measuring the position of a scaphoid fracture and provide data on its reproducibility. Thirty-one patients operated on by the senior author for delayed union or nonunion of scaphoid fracture were included. Preoperative CT scans were independently assessed for increased radiodensity of the proximal pole, converging trabeculae, degree of deformity, comminution, and fracture position. Intraoperative biopsies of the proximal pole were obtained and histologically assessed for evidence of avascular necrosis. The radiologic variables were statistically compared with the histologic findings. The presence of avascular necrosis was also compared with postoperative union status, identified on longitudinal CT scans. Preoperative CT features that statistically correlated with histologic evidence of avascular necrosis were increased radiodensity of the proximal pole and the absence of any converging trabeculae between the fracture fragments. The radiologic changes of avascular necrosis and the histologic confirmation of avascular necrosis were associated with persistent nonunion. Preoperative longitudinal CT of scaphoid nonunion is of great value in identifying avascular necrosis and predicting subsequent fracture union. If avascular necrosis is suspected based on preoperative CT, management options include vascularized bone grafts and bone morphogenic protein for younger patients and limited wrist arthrodesis for older patients. Diagnostic II.

  8. Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

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    B.W. Minto

    2015-08-01

    Full Text Available Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.

  9. Bilateral clavicle non-unions treated with anteroinferior locking compression plating (LCP": a case report

    NARCIS (Netherlands)

    Kloen, Peter

    2004-01-01

    The author reports the case of a 30-year-old female patient with bilateral atrophic non-union of the clavicle; the latter both healed after internal fixation with a locking compression plate fixed on the anteroinferior aspect of the clavicle, combined with autologous cancellous bone grafting. The

  10. Time-Dependent Changes in T1 during Fracture Healing in Juvenile Rats: A Quantitative MR Approach.

    Directory of Open Access Journals (Sweden)

    Katharina Baron

    Full Text Available Quantitative magnetic resonance imaging (qMRI offers several advantages in imaging and determination of soft tissue alterations when compared to qualitative imaging techniques. Although applications in brain and muscle tissues are well studied, its suitability to quantify relaxation times of intact and injured bone tissue, especially in children, is widely unknown. The objective observation of a fracture including its age determination can become of legal interest in cases of child abuse or maltreatment. Therefore, the aim of this study is the determination of time dependent changes in intact and corresponding injured bones in immature rats via qMRI, to provide the basis for an objective and radiation-free approach for fracture dating. Thirty-five MR scans of 7 Sprague-Dawley rats (male, 4 weeks old, 100 ± 5 g were acquired on a 3T MRI scanner (TimTrio, Siemens AG, Erlangen, Germany after the surgical infliction of an epiphyseal fracture in the tibia. The images were taken at days 1, 3, 7, 14, 28, 42 and 82 post-surgery. A proton density-weighted and a T1-weighted 3D FLASH sequence were acquired to calculate the longitudinal relaxation time T1 of the fractured region and the surrounding tissues. The calculation of T1 in intact and injured bone resulted in a quantitative observation of bone development in intact juvenile tibiae as well as the bone healing process in the injured tibiae. In both areas, T1 decreased over time. To evaluate the differences in T1 behaviour between the intact and injured bone, the relative T1 values (bone-fracture were calculated, showing clear detectable alterations of T1 after fracture occurrence. These results indicate that qMRI has a high potential not only for clinically relevant applications to detect growth defects or developmental alterations in juvenile bones, but also for forensically relevant applications such as the dating of fractures in cases of child abuse or maltreatment.

  11. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates.

    Science.gov (United States)

    Hoffmann, M F; Lotzien, S; Schildhauer, T A

    2016-04-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures in the increasing older population. According to the AAOS, approximately 19,200 Americans are actually living with ipsilateral prosthetic hip and knee leading to 240 interprosthetic fractures annually. Few reviews and case reports give an idea of the obvious problem to achieve consolidation in interprosthetic fractures. Preconfigured plates have been shown to be superior compared with other treatments in patients with stable components. Utilization of internal fixators for interprosthetic fractures might be advantageous. The purpose of this study was to evaluate interprosthetic femoral fractures with polyaxial locking plate treatment in regard to surgical procedure, complications, and clinical outcome. Between 2005 and 2012, 143 patients underwent surgical treatment for periprosthetic femur fractures. Thirty-two fractures were identified as interprosthetic fractures. Five patients were excluded. Fractures were classified according to OTA/AO system, Vancouver, Rorabeck, Soenen and Pires. Trauma fellowship trained orthopaedic surgeons performed the surgeries using a NCB-construct (Zimmer Inc., Warshaw, IN). Plate choice was determined according to radiographic classification. Submuscular plate insertion was performed if possible. Complications were recorded concerning infection, union, fixation failure, and revision surgery. Twenty-seven patients were identified. There were 92.6% females. Follow-up by regular outpatient clinic visits was 24 months. Surface replacements were found in 18 TKA. Nine patients had a stemmed femur component of their TKA. 89% healed after the index procedure. Three patients developed a nonunion with 1 construct leading to hardware failure. Previous revision THA or Pires/modified Vancouver classification did not influence nonunion formation, but all patients with nonunion formation were classified as AO/OTA type B (p=0.001). These fractures were treated with

  12. A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures.

    Science.gov (United States)

    Braga-Silva, J; Peruchi, F M; Moschen, G M; Gehlen, D; Padoin, A V

    2008-10-01

    We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1-5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

  13. Potent anti-inflammatory agent escin does not affect the healing of tibia fracture and abdominal wound in an animal model.

    Science.gov (United States)

    Zhang, Leiming; Wang, Hongsheng; Wang, Tian; Jiang, Na; Yu, Pengfei; Liu, Feiyan; Chong, Yating; Fu, Fenghua

    2012-04-01

    Escin, a potent anti-inflammatory and anti-edematous agent, has been widely used clinically in preventing inflammatory edema after trauma, such as fracture and surgery. The aim of this study was to investigate whether escin has an inhibitory effect on fracture healing, and whether escin has an inhibitory effect on wound healing after surgery. Male New Zealand white rabbits underwent tibial mid-diaphyseal osteotomy, and were administered escin once per day for 10 days. At weeks 2, 4 and 6, bone fracture healing and bone mineral density were measured. The histologic examination of callus, osteocalcin, alkaline phosphatase, calcium and phosphate in the serum were also assayed. In another experiment, the rats underwent midline laparotomy, and received escin once prior to or after the operation. Six days later, the abdominal incision wounds were excised for measuring hydroxyproline levels. The results showed that there were no significant differences in fracture healing between the model and rabbits administered escin, and escin did not affect the hydroxyproline levels in the abdominal incision wounds of the rats. These findings suggest that escin has no inhibitory effect on fracture and wound healing in animal models.

  14. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial.

    Science.gov (United States)

    Hannemann, Pascal; Göttgens, Kevin W A; van Wely, Bob J; Kolkman, Karel A; Werre, Andries J; Poeze, Martijn; Brink, Peter R G

    2011-05-06

    The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%), non-union (5-21%) and early osteo-arthritis (up to 32%) which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences.Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning).Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory.Study parameters are clinical consolidation, radiological consolidation evaluated by CT-scanning, functional

  15. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial

    Directory of Open Access Journals (Sweden)

    Poeze Martijn

    2011-05-01

    Full Text Available Abstract Background The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%, non-union (5-21% and early osteo-arthritis (up to 32% which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences. Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. Methods/Design This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning. Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory. Study parameters are clinical consolidation

  16. Double plating for the treatment of distal tibia and fibula fractures: case series of twenty five patients.

    Science.gov (United States)

    Ma, H; Wang, C; Wei, Q; Li, Z H; Yu, B Q

    2013-08-01

    The treatment of fractures of the distal third of the tibia and fibula usually involves two incisions, thus raising the risk of wound dehiscence, wound necrosis, infection, and the delayed union or non-union of distal tibial fractures. To decrease and prevent aforementioned serious complications, one-incision double-plating technique was advocated here. The aim of this work was to evaluate the results and effects of the one-incision, double-plating technique in the fractures of distal third of the tibia-fibula and fibula. Twenty-five patients with fractures of the distal third of the tibia-fibula, were treated with one incision, double plating between June 2007 and January 2009. The reduction and fixation of the tibia and fibula were conducted in all patients using one incision. The type of fractures based on AO classification were A1 (n = 6), A2 (n = 4), B1 (n = 12) and C1 (n = 3). All patients were followed-up at least until the patient was fully weight-bearing and the soft tissues had healed (median, 15 months; range, 12-24). Postoperative follow-up showed that 24 fractures healed within the range of the normal healing time. Only one patient with delayed union healed without surgical intervention by 7 months postoperatively. There were no cases of malunion or non-union. Importantly, at their last follow-up visit, the fracture was in excellent position and healed radiographically, and the patient could walk without pain and support. One-incision double-plating is a safe and effective alternative for treatment of distal tibia and fibula fractures.

  17. Local application of a gentamicin-loaded thermo-responsive hydrogel allows for fracture healing upon clearance of a high Staphylococcus aureus load in a rabbit model.

    Science.gov (United States)

    Ter Boo, G J; Schmid, T; Zderic, I; Nehrbass, D; Camenisch, K; Richards, R G; Grijpma, D W; Moriarty, T F; Eglin, D

    2018-03-02

    Antibiotic-loaded biomaterials (ALBs) have emerged as a potential useful adjunctive antimicrobial measure for the prevention of infection in open fracture care. A biodegradable thermo-responsive poly(N-isopropylacrylamide) grafted hyaluronic acid (HApN) hydrogel loaded with gentamicin has recently been shown to prevent implant-related infection in a rabbit osteosynthesis model. The primary aim of this study was to determine the influence of this HApN hydrogel on bone healing at an early stage (4 weeks). A rabbit humeral osteotomy model with plating osteosynthesis was used to compare fracture healing in rabbits receiving the hydrogel as compared with control animals. The secondary aim was to observe fracture healing in groups treated with and without antibiotic-loaded hydrogel in the presence of bacterial contamination. In all groups, outcome measures were mechanical stability and histological score, with additional quantitative bacteriology in the inoculated groups. Application of the HApN hydrogel in non-inoculated rabbits did not significantly influence humeral stiffness or histological scores for fracture healing in comparison to controls. In the inoculated groups, animals receiving the bacterial inoculum without hydrogel were culture-positive at euthanasia and found to display lower humeral stiffness values and higher histopathological scores for bacterial presence in comparison with equivalents receiving the gentamicin-loaded HApN hydrogel, which were also infection-free. In summary, our data showed that HApN was an effective antibiotic carrier that did not affect fracture healing. This data supported its suitability for application in fracture care. Addition of osteopromotive compounds could provide further support for accelerating fracture healing in addition to successful infection prophylaxis.

  18. Monotherapy vs. polytherapy in the treatment of forearm non-unions and bone defects.

    Science.gov (United States)

    Calori, G M; Colombo, M; Mazza, E; Ripamonti, C; Mazzola, S; Marelli, N; Mineo, G V

    2013-01-01

    To determinate the efficacy of "polytherapy", a surgical technique that utilize all the components of the diamond concept (mesenchymal stem cells, bone morphogenetic proteins and scaffold) versus a "monotherapy", a surgical technique that utilize only one component of the diamond conceptin the treatment of severe forearm non-unions. We studied a database of 52 patients with 52 forearm non-unions; we classified the patients with the NUSS SCORE and we divided the patients in two group according to the treatment received. So we distinguished a group of patients treated according to the principles of "monotherapy" (33 patients) and a group of patients treated according to the principles of "polytherapy" (19 patients). The minimum follow up was 12 months. In the monotherapy group 21/33 non-unions (63.64%) went on to develop a radiographic and clinical healing within a period of 12 months, the calculated DASH SCORE showed a mean value of 55.15 points. In the polytherapy group 17/19 (89.47%) nonunions went on to develop clinical and radiographic healing within 12 months, and the average DASH score showed a mean value of 45.47 points. The polytherapy technique with the use of recombinant morphogenetic proteins, autologous MSCs and scaffold in the same surgical time appears to be an effective treatment for patients with severe forearm non-unions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Treatment of infected non-unions of the femur and tibia in a French referral center for complex bone and joint infections: Outcomes of 55 patients after 2 to 11 years.

    Science.gov (United States)

    Bauer, T; Klouche, S; Grimaud, O; Lortat-Jacob, A; Hardy, P

    2018-02-01

    An infected non-union is a major complication following bone fracture. While bone union can be obtained in 70% to 100% of cases, treatment of osteomyelitis is less predictable, with reported healing rates ranging from 40% to 100%. The primary aim of this study was to assess the success rate of treating infected non-unions of the tibia and femur by a team specializing in complex bone and joint infections. This single-center retrospective study included all patients operated between 2002 and 2012 due to an infected non-union of the femur or tibia using standardized surgical methods. The procedure was typically done in two phases: excision of the infected site and stabilization, followed by bone reconstruction after a waiting period. Additional procedures (lavage and/or bone grafting) were performed in some cases. A minimum 6-week course of antibiotic therapy was given. The primary endpoint was successful medical and surgical treatment after a minimum 2 years' follow-up defined as healing of the infection (no local clinical signs of infection, ESR≤20mm and CRP≤10mg/L, no mortality attributed to the infection) and radiological and clinical bone union, with the lower limb spared. Fifty-five patients (39 men, 16 women) were included with an average age of 37±11 years. There were 40 tibial fractures and 15 femur fractures. A polymicrobial infection was present in 47% of cases. Repeat surgery was required in 56.4% of patients. At an average of 4±2 years from the first surgical procedure, the treatment was successful in 49 patients (89%): 36 tibia (90%) and 13 femur (87%). The mean time to union was 9±4 months. There were six failures: 3 amputations at 5, 6 and 16 months; 1 mechanical and infection-related failure; 2 failed union. This study found that 89% of patients with an infected tibial or femoral non-union treated by a team specialized in complex bone and joint infections using a standardized surgical protocol had bone union and healing of the infection in an

  20. The interplay of transcriptional and post-transcriptional regulation of migration of mesenchymal stem cells during early stages of bone fracture healing.

    Science.gov (United States)

    Dong, C-H; Deng, Y-S; Yang, X-J; Liu, J; Liu, R; Hou, F-Y; Li, S-S; Zhen, P

    2017-12-01

    Bone fractures are a medical condition where the continuity of the bone is broken due to a fall or accident. The fracture may also be the result of medical conditions such as osteoporosis, cancers of bone or osteogenesis imperfect. During the bone fracture healing process, the mesenchymal stem cells (undifferentiated connective tissue cells) are recruited from local and systemic sources. The modulation of mesenchymal cell migration to the fractured site is the desired goal. Still, there are many processes that are still required to be studied and analyzed. We aimed to consolidate and review the available information on this topic.

  1. [The risk non-union following closed-focus nailing and reaming. Results of 1059 interventions using the Kunstcher method].

    Science.gov (United States)

    Babin, S R; Graf, P; Vidal, P; Sur, N; Schvingt, E

    1983-01-01

    The authors have studied a series of 1059 compound and closed fractures of the diaphysis of long bones treated by intramedullary nailing according to the technique of Kuntscher, to assess the incidence of non-union. Between January 1st 1967 and December 31st 1980, 503 fractures of the tibia, 440 of the femur and 116 of the humerus were so treated in both adolescents and adults. The fractures were mostly sustained in road traffic accidents. The risk of aseptic non-union was small, but occurred more readily when the skin was damaged and when the site of the fracture was at the junction of the lower two quarters of the tibia; the incidence was highest when the technique of nailing was incorrect or when the going was undertaken too late. The incidence of non-union and infection are compared with those of other series using the same closed technique and with reports describing insertion of the nail of the plate by opening the fracture. It is concluded that intramedullary nailing using the Kuntscher technique is the most reliable treatment for this type of injury for routine use in an acute fracture service. In this series the incidence of aseptic non-union was approximately 1%, of infection with non-union less than 0.5% and of early infection with eventual union less than 1.5%.

  2. Use of teriparatide in osteoporotic fracture patients.

    Science.gov (United States)

    Collinge, Cory; Favela, Juan

    2016-01-01

    Teriparatide [PTH (1-34)] is a genetically engineered analog of human parathyroid hormone that acts as an anabolic drug by increasing activity in both osteoblasts and osteoclasts. Intermittent (once-daily) doses of teriparatide seem to stimulate osteoblast activity and therefore result in a net increase of bone formation. It is recommended for use in post-menopausal women (PMW), men with hypogonadal osteoporosis, as well as men and women with glucocorticoid-induced osteoporosis. In vivo studies have generated important findings regarding teriparatide's role in the enhancement of fracture healing. The intention of this article is to review the clinical findings of teriparatide to stimulate fracture healing. The drug was shown in a prospective randomized, double blind study to achieve earlier radiographic cortical bridging of three of four cortices (7.4 weeks) compared to patients who were assigned to the placebo group (9.1 weeks). Another study compared mean time for healing and functional outcome in two groups of elderly women who had suffered osteoporotic pelvic fractures: one group received daily 100 μg parathyroid hormone (1-84) injections, while the other group received no treatment. Patients who received the PTH (1-84) injections accelerated radiographic and clinical fracture healing (7.8 weeks) when compared to patients who received no treatment (12.6 weeks, pteriparatide use in patients recovering from fractures. In the following scenarios, teriparatide might be considered in patients with osteoporosis and a fracture: (1) patients with severe osteoporosis with use of bisphosphonates for a number of years with a fracture not expected to predictably unite, e.g. atypical femur fracture or open tibia fracture, (2) in cases where an osteoporotic patient has failed fracture healing and is considering surgical treatment e.g. non-union surgery. It seems prudent to reevaluate these patients frequently and reconsider which drug class of osteoporotic drug is best for

  3. Low-magnitude high-frequency vibration enhances gene expression related to callus formation, mineralization and remodeling during osteoporotic fracture healing in rats.

    Science.gov (United States)

    Chung, Shu-Lu; Leung, Kwok-Sui; Cheung, Wing-Hoi

    2014-12-01

    Low magnitude high frequency vibration (LMHFV) has been shown to improve anabolic and osteogenic responses in osteoporotic intact bones and during osteoporotic fracture healing; however, the molecular response of LMHFV during osteoporotic fracture healing has not been investigated. It was hypothesized that LMHFV could enhance osteoporotic fracture healing by regulating the expression of genes related to chondrogenesis (Col-2), osteogenesis (Col-1) and remodeling (receptor activator for nuclear factor- κ B ligand (RANKL) and osteoproteger (OPG)). In this study, the effects of LMHFV on both osteoporotic and normal bone fracture healing were assessed by endpoint gene expressions, weekly radiographs, and histomorphometry at weeks 2, 4 and 8 post-treatment. LMHFV enhanced osteoporotic fracture healing by up-regulating the expression of chondrogenesis-, osteogenesis- and remodeling-related genes (Col-2 at week 4 (p=0.008), Col-1 at week 2 and 8 (p<0.001 and p=0.008) and RANKL/OPG at week 8 (p=0.045)). Osteoporotic bone had a higher response to LMHFV than normal bone and showed significantly better results as reflected by increased expression of Col-2 and Col-1 at week 2 (p<0.001 for all), larger callus width at week 2 (p=0.001), callus area at week 1 and 5(p<0.05 for all) and greater relative area of osseous tissue (p=0.002) at week 8. This study helps to understand how LMHFV regulates gene expression of callus formation, mineralization and remodeling during osteoporotic fracture healing. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Potent anti-inflammatory agent escin does not affect the healing of tibia fracture and abdominal wound in an animal model

    OpenAIRE

    ZHANG, LEIMING; WANG, HONGSHENG; WANG, TIAN; JIANG, NA; YU, PENGFEI; LIU, FEIYAN; CHONG, YATING; FU, FENGHUA

    2012-01-01

    Escin, a potent anti-inflammatory and anti-edematous agent, has been widely used clinically in preventing inflammatory edema after trauma, such as fracture and surgery. The aim of this study was to investigate whether escin has an inhibitory effect on fracture healing, and whether escin has an inhibitory effect on wound healing after surgery. Male New Zealand white rabbits underwent tibial mid-diaphyseal osteotomy, and were administered escin once per day for 10 days. At weeks 2, 4 and 6, bon...

  5. [Ilizarov fixation of supramalleolar fractures].

    Science.gov (United States)

    Mseddi, M B E; Mseddi, M; Siala, A; Dahmene, J; Ben Hamida, R; Ben Ayeche, M

    2005-02-01

    Supramalleolar fractures are generally considered to be a difficult surgical challenge because they occur in a area where the tibia lies superficially with a precarious blood supply to the skin, exposing to the risk of infection and necrosis after internal fixation. These fractures are also situated close to the tibiotalar joint making centromedullary nailing difficult, even with distal locking. The Ilizarov external fixator could be an attractive alternative in this indication. We report a series of 17 supramalleolar fractures in 17 patients, 14 men and 3 women, treated with the Ilizarov external fixator between 1991 and 2001. Most were traffic accident victims and most had complex fractures resulting from high-energy trauma. There were many associated lesions. Fractures were open in ten patients. The Ilizarov fixator was used as the first intention treatment in seven patients and as a second line treatment in ten. The system allowed early weight bearing in all patients. Tolerance was generally good with a relatively low rate of superficial pin track infections (two cases). There was one case of osteitis which developed in a patient with an open fracture. There were no thromboembolic complications and no nerve involvement. Bone healing was achieved within three months in thirteen patients. There were three cases of late healing which were treated by the ascension technique using a cancellous graft and fibular osteotomy. The overall healing rate with this method was 94%. The one case of nonunion was successfully treated with an inter tibiofibular graft. The overall functional outcome was satisfactory in 76% of the patients, based on the Alho-Klemm criteria. Axial deformation predominated in the frontal plane: three patients had > 10 degrees varus in one case. These results could be improved by better operative technique. We advocate installing the patient in the supine position with transcalcaneal traction allowing good restitution of the leg axis. The assembly

  6. A biomechanical, micro-computertomographic and histological analysis of the influence of diclofenac and prednisolone on fracture healing in vivo.

    Science.gov (United States)

    Bissinger, Oliver; Kreutzer, Kilian; Götz, Carolin; Hapfelmeier, Alexander; Pautke, Christoph; Vogt, Stephan; Wexel, Gabriele; Wolff, Klaus-Dietrich; Tischer, Thomas; Prodinger, Peter Michael

    2016-09-05

    Non-steroidal anti-inflammatory drugs (NSAIDs) have long been suspected of negatively affecting fracture healing, although numerous disputes still exist and little data are available regarding diclofenac. Glucocorticoids interfere in this process over a similar and even broader mechanism of action. As many previously conducted studies evaluated either morphological changes or biomechanical properties of treated bones, the conjunction of both structural measures is completely missing. Therefore, it was our aim to evaluate the effects of diclofenac and prednisolone on the fracture callus biomechanically, morphologically and by 3-dimensional (3D) microstructural analysis. Femura of diclofenac-, prednisolone- or placebo-treated rats were pinned and a closed transverse fracture was generated. After 21 days, biomechanics, micro-CT (μCT) and histology were examined. The diclofenac group showed significantly impaired fracture healing compared with the control group by biomechanics and μCT (e.g. stiffness: 57.31 ± 31.11 N/mm vs. 122.44 ± 81.16 N/mm, p = 0.030; callus volume: 47.05 ± 15.67 mm3 vs. 67.19 ± 14.90 mm3, p = 0.037, trabecular thickness: 0.0937 mm ± 0.003 vs. 0.0983 mm ± 0.003, p = 0.023), as confirmed by histology. Biomechanics of the prednisolone group showed obviously lower absolute values than the control group. These alterations were confirmed in conjunction with μCT and histology. The inhibiting effects of both substances were not only mediated by absolute parameters (e.g. breaking load, BV), but we have shown, for the first time, that additional changes occurred in the microstructural bony network. Especially in patients at risk for delayed bone healing (arteriosclerosis, diabetes mellitus, smoking), the administration of these drugs should be weighed carefully.

  7. Identification of novel genes associated with fracture healing in osteoporosis induced by Krm2 overexpression or Lrp5 deficiency.

    Science.gov (United States)

    Gao, Feng; Xu, Feng; Wu, Dankai; Cheng, Jieping; Xia, Peng

    2017-06-01

    The aim of the present study was to screen potential key genes associated with osteoporotic fracture healing. The microarray data from the Gene Expression Omnibus database accession number GSE51686, were downloaded and used to identify differentially expressed genes (DEGs) in fracture callus tissue samples obtained from the femora of type I collagen (Col1a1)‑kringle containing transmembrane protein 2 (Krm2) mice and low density lipoprotein receptor‑related protein 5‑/‑ (Lrp5‑/‑) transgenic mice of osteoporosis compared with those in wild‑type (WT) mice. Enrichment analysis was performed to reveal the DEG function. In addition, protein‑protein interactions (PPIs) of DEGs were analyzed using the Search Tool for the Retrieval of Interacting Genes database. The coexpression associations between hub genes in the PPI network were investigated, and a coexpression network was constructed. A total of 841 DEGs (335 upregulated and 506 downregulated) were identified in the Col1a1‑Krm2 vs. the WT group, and 50 DEGs (16 upregulated and 34 downregulated) were identified in the Lrp5‑/‑ vs. the WT group. The DEGs in Col1a1‑Krm2 mice were primarily associated with immunity and cell adhesion (GO: 0007155) functions. By contrast, the DEGs in Lrp5‑/‑ mice were significantly associated with muscle system process (GO: 0003012) and regulation of transcription (GO: 0006355). In addition, a series of DEGs demonstrated a higher score in the PPI network, and were observed to be coexpressed in the coexpression network, and included thrombospondin 2 (Thbs2), syndecan 2 (Sdc2), FK506 binding protein 10 (Fkbp10), 2'‑5'-oligoadneylate synthase‑like protein 2 (Oasl2), interferon induced protein with tetratricopeptide repeats (Ifit) 1 and Ifit2. Thbs2 and Sdc2 were significantly correlated with extracellular matrix‑receptor interactions. The results suggest that Thbs2, Sdc2, Fkbp10, Oasl2, Ifit1 and Ifit2 may serve important roles during the fracture

  8. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion ? A Rare Case Report and Review of Literature

    OpenAIRE

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Introduction: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. Case Report: A 58 years old woman presented with 20 months ...

  9. Treatment of aseptic tibial shaft non-union without bone defect.

    Science.gov (United States)

    Tall, M

    2018-02-01

    Non-union is incomplete consolidation of a fracture, without effective formation of a uniting callus. Despite better understanding of the physiology of bone consolidation, management of tibial non-union remains a challenge for orthopedic surgeons. Several treatments have been developed in recent decades, and we now have a range of techniques, with indications based on type of non-union, prior treatments, available equipment, and the surgeon's experience. Firstly, there are surgical techniques such as osteo-periosteal decortication, cancellous iliac graft, or inter-tibiofibular graft. The decision to fix the non-union (or revise existing fixation) and choice of type of internal fixation depend on the stability of the fracture site. There are also non-operative biological and biochemical consolidation stimulation techniques: local injection of bone-marrow, platelet-rich plasma (PRP) or bone morphogenetic protein (BMP). Stimulation can also be physical, applying ultrasound or an electromagnetic field to the non-union site. Each technique may be used in isolation or association. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Vascularized pedicle bone grafting for nonunions of the tarsal navicular.

    Science.gov (United States)

    Fishman, Felicity G; Adams, Samuel B; Easley, Mark E; Nunley, James A

    2012-09-01

    Osteonecrosis and nonunions of the tarsal navicular remain a challenging clinical problem. This article presents a series of patients treated with local vascularized pedicle bone grafting to the navicular. The purpose of this study was to determine the early clinical and radiographic outcomes of this technique. Patients who underwent local vascularized pedicle bone grafting for osteonecrosis of the navicular from 2002 to 2007 were included in this study. The Ankle Osteoarthritis Scale (AOS), the Revised Foot Function Index (FFI-R), and the Short-Form 36 (SF-36) outcomes questionnaires were administered at most recent followup. Postoperative imaging was reviewed for evidence of healing. Eight patients with a mean age of 47.5 (range, 18 to 68) years were included in this study. The mean followup time was 61 (range, 32 to 72) months. Two patients underwent concomitant talonavicular arthrodesis. Two patients underwent additional procedures to address continued nonunion of the navicular. Neither patient elected to complete the outcomes questionnaires. The mean postoperative FFI score was 35.2 (range, 16.6 to 59). SF-36 subscales were as follows: bodily pain, 53; general health, 55; mental health, 75; physical function, 56; role emotional, 61; role physical, 37.5; social function, 71; and vitality, 56. The mean postoperative AOS pain score was 27.9 (range, 0 to 46.2) and the average disability score was 31.4 (range, 0 to 78.2). Postoperative imaging revealed consolidation and full healing in six of eight patients. Vascularized pedicle bone grafting is a treatment option for patients with chronic nonunion or osteonecrosis of the navicular. Additionally, it may serve as an adjunct procedure to provide increased vascularity to talonavicular arthrodesis in cases of navicular osteonecrosis and talonavicular arthritis.

  11. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study

    DEFF Research Database (Denmark)

    Doetsch, A M; Faber, J; Lynnerup, N

    2004-01-01

    density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements...... that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period...... demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other...

  12. Effects of " vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Eftekhari

    2014-01-01

    Full Text Available Background: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. Material and Methods: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1 one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus plus 250 mg magnesium oxide (VAC + Mg group (n = 10, 2 one Agnugol tablet plus placebo (VAC group (n = 15, 3 placebo plus 250 mg magnesium oxide (Mg group (n = 12, or 4 placebo plus placebo (placebo group (n = 14 per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF were measured together with radiological bone assessment. Results: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05, administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05. Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39. No relevant side effect was observed in patients in each group. Conclusion : Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

  13. Effects of "vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture.

    Science.gov (United States)

    Eftekhari, Mohammad Hassan; Rostami, Zahra Hassanzadeh; Emami, Mohammad Jafar; Tabatabaee, Hamid Reza

    2014-01-01

    The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

  14. [Our first experiences with autologous transplantation of bone marrow stem cells to treat pseudarthrosis, delayed fracture healing and long bone defects fracture].

    Science.gov (United States)

    Sír, M; Procházka, V; Gumulec, J; Pleva, L

    2009-03-01

    Traumatology and orthopaedics have undergone substantial progress in the use of new, sophisticated techniques, implants and navigation methods. Nevertheless, these new methods continue to fail in some instances. Regenerative medicine using the growth potential of stem cells that posses the ability to regenerate damaged tissues represent one of the possible ways forward. There is a potential for more comprehensive utilization of bone marrow stem cells that had for many years been used in transplant medicine. Traumatology and orthopaedics could utilise stem cells in the treatment of bone defects, i.e. in the treatment of pseudarthrosis, delayed fracture healing, defect fractures and aseptic bone necroses. Bone formation and growth is a complex, predominantly anabolic, process with a range of feedbacks. Nevertheless, it is the bone marrow where the necessary progenitors of bone growth are located. These are mesenchymal stem cells (MSCs), haematopoietic stem cells (HSCs) as well as thrombocytes containing a range of necessary growth factors. A number of studies showed positive results for stem cells treatment of pseudarthrosis, with only a fraction, however, being statistically significant in human medicine. This method was used in 11 patients of the Traumatology Centre of the Faculty Hospital in Ostrava, Czech Republic in 2008. The researched patients were treated for pseudarthrosis of long bones, delayed multifragmentary fracture haling and defect fractures of long bones. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect in a patient lightly anaesthetised with propofol. The results from this small sample of patients are not yet available. However, we are sharing our first experiences with this treatment option.

  15. TREATMENT OF UNSTABLE FRACTURES OF THE TIBIA

    Directory of Open Access Journals (Sweden)

    Dragan Petković

    2004-07-01

    Full Text Available Unstable fractures of cruris are all those fractures which cannot hold satisfactory position even after orthopedic reposition and imobilization.Bone fragments or fractures which redislocate and whithin 7 days after primary well done reposition and adeqate imobilization are also unstable fractures. These fractures can be treated by orthopedic repozition, by transosal traction through calcaneus or through supramalleolar area.These fractures can also be treated surgically by internal or by external fixation. The safest operative method today is external fixation. Using of Mitkovic external flxator this method minimally traumatizes bone and soft tisue of cruris,the operation is not time consuming and complications as infection and nonunion aresignificantly more rare in comparison to internal fixation. External fixation is minimaly invasive method, preserving both periostal and intramedular blood circulation. Mitkovic system also provides biological conditions, which are very similar to biomechanical features of natural tibia and probably it is one of important factor for qicker fracture healing with big periostal callus fortnation.This external flxation system has additional advantages in comparison to other existing devices, especialy in regard of simplicity of application and possibility of accurate closed intraoperative and postoperative fracture reduction.

  16. In Vivo Evaluation of Fracture Callus Development During Bone Healing in Mice Using an MRI-compatible Osteosynthesis Device for the Mouse Femur.

    Science.gov (United States)

    Haffner-Luntzer, Melanie; Müller-Graf, Fabian; Matthys, Romano; Abaei, Alireza; Jonas, René; Gebhard, Florian; Rasche, Volker; Ignatius, Anita

    2017-11-14

    Endochondral fracture healing is a complex process involving the development of fibrous, cartilaginous, and osseous tissue in the fracture callus. The amount of the different tissues in the callus provides important information on the fracture healing progress. Available in vivo techniques to longitudinally monitor the callus tissue development in preclinical fracture-healing studies using small animals include digital radiography and µCT imaging. However, both techniques are only able to distinguish between mineralized and non-mineralized tissue. Consequently, it is impossible to discriminate cartilage from fibrous tissue. In contrast, magnetic resonance imaging (MRI) visualizes anatomical structures based on their water content and might therefore be able to noninvasively identify soft tissue and cartilage in the fracture callus. Here, we report the use of an MRI-compatible external fixator for the mouse femur to allow MRI scans during bone regeneration in mice. The experiments demonstrated that the fixator and a custom-made mounting device allow repetitive MRI scans, thus enabling longitudinal analysis of fracture-callus tissue development.

  17. Minimally Invasive Plate Osteosynthesis In The Treatment Of Isolated Ulnar Bone Fractures

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    Suman K Shrestha

    2012-11-01

    Full Text Available BACKGROUND: Minimally invasive internal fixation is also called “biological internal fixation”. This concept is used widely in the treatment of various fractures but to date, there have been no report about such application in the repair of isolated ulnar bone fractures. METHODS: Eleven patients with fracture of isolated ulnar bone (four AO type 22A11 and seven AO type 22A12, mean age 43.16 (range, 24- 59y, were treated using closed reduction and locking compression plate with minimally invasive plate osteosynthesis (MIPO with the aim of minimising soft tissue damage. RESULTS: Fractures healed at an average of 7.8 weeks with good to excellent clinical outcomes. There were no complications such as nonunion, implant failure or neurovascular injuries. CONCLUSIONS: MIPO seems to be advantageous for soft tissue and bone biology. Good union was seen and fracture complications were also prevented by early mobilisation.

  18. Use of autologous human mesenchymal stromal cell/fibrin clot constructs in upper limb non-unions: long-term assessment.

    Directory of Open Access Journals (Sweden)

    Stefano Giannotti

    Full Text Available BACKGROUND: Tissue engineering appears to be an attractive alternative to the traditional approach in the treatment of fracture non-unions. Mesenchymal stromal cells (MSCs are considered an appealing cell source for clinical intervention. However, ex vivo cell expansion and differentiation towards the osteogenic lineage, together with the design of a suitable scaffold have yet to be optimized. Major concerns exist about the safety of MSC-based therapies, including possible abnormal overgrowth and potential cancer evolution. AIMS: We examined the long-term efficacy and safety of ex vivo expanded bone marrow MSCs, embedded in autologous fibrin clots, for the healing of atrophic pseudarthrosis of the upper limb. Our research work relied on three main issues: use of an entirely autologous context (cells, serum for ex vivo cell culture, scaffold components, reduced ex vivo cell expansion, and short-term MSC osteoinduction before implantation. METHODS AND FINDINGS: Bone marrow MSCs isolated from 8 patients were expanded ex vivo until passage 1 and short-term osteo-differentiated in autologous-based culture conditions. Tissue-engineered constructs designed to embed MSCs in autologous fibrin clots were locally implanted with bone grafts, calibrating their number on the extension of bone damage. Radiographic healing was evaluated with short- and long-term follow-ups (range averages: 6.7 and 76.0 months, respectively. All patients recovered limb function, with no evidence of tissue overgrowth or tumor formation. CONCLUSIONS: Our study indicates that highly autologous treatment can be effective and safe in the long-term healing of bone non-unions. This tissue engineering approach resulted in successful clinical and functional outcomes for all patients.

  19. Responses to Treatment With Teriparatide in Patients With Atypical Femur Fractures Previously Treated With Bisphosphonates.

    Science.gov (United States)

    Watts, Nelson B; Aggers, Deborah; McCarthy, Edward F; Savage, Tina; Martinez, Stephanie; Patterson, Rachel; Carrithers, Erin; Miller, Paul D

    2017-05-01

    If oversuppression of bone turnover explained the association between bisphosphonate use and atypical subtrochanteric femur fractures (AFF), this could be reversed with anabolic treatment such as teriparatide. We conducted a prospective, open-label study in patients previously treated with bisphosphonates who sustained AFF, examining the response to 24-month treatment with teriparatide on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers (BTM), and fracture healing as well as quantitative histomorphometry. We studied 14 patients. Baseline BMD, BTM, and TBS varied widely. On initial bone biopsies, 12 of 14 patients showed tetracycline labels, but mineralizing surface/bone surface was below published normal values in all but 2. Lumbar spine BMD increased significantly at month 24 (6.1% ± 4.3%, p teriparatide after prior bisphosphonate treatment. At month 24, fractures were healed in 6 patients, showed partial healing in 3, were unchanged in 2, and showed nonunion in 1. In a patient with two fractures, the fracture that occurred before teriparatide treatment was reported as healed, but the fracture that occurred while on treatment showed only partial healing. Bisphosphonate-treated patients who sustain AFF show heterogeneity of bone turnover. Treatment with teriparatide resulted in increases in BTM and lumbar spine BMD, as has been reported for patients without AFF. There was no significant effect of teriparatide on hip BMD, mineralizing surface to bone surface (MS/BS), or TBS and no consistent effect on fracture healing. In the context of a patient who has experienced an AFF after receiving bisphosphonate treatment, therapy with teriparatide for 24 months would be expected to increase BMD and BTM (and probably reduce the risk of fractures resulting from osteoporosis) but should not be relied on to aid in healing of the AFF. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  20. Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate.

    Science.gov (United States)

    Gaspar, Michael P; Kane, Patrick M; Zohn, Ralph C; Buckley, Taylor; Jacoby, Sidney M; Shin, Eon K

    2016-02-01

    To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system. We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of delayed or nonunion. Those variables associated with the development of delayed or nonunion were used in a multivariate logistic regression model. Complications, including the need for additional surgery, were also recorded. Seventy-two ulnar shortening osteotomy procedures were performed in 69 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8 of 72 cases (11%). Of 72 surgeries, 4 (6%) resulted in nonunions, all of which required additional surgery. Hardware removal was performed in 13 of 72 (18%) of the cases. Time to union was significantly increased in smokers (6 ± 3 months) versus nonsmokers (3 ± 1 months). On multivariable analysis, diabetics and active smokers demonstrated a significantly higher risk of developing delayed union or nonunion. Patient age, sex, body mass index, thyroid disease, worker's compensation status, alcohol use, and amount smoked daily did not have an effect on the time to union or the incidence of delayed or nonunion. Despite the use of an osteotomy-specific plating system, smokers and diabetics were at significantly higher risk for both delayed union and nonunion following elective ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing were not found to have a deleterious effect. Copyright © 2016 American Society for

  1. Percutaneous autologous bone marrow injections for delayed or non-union of bones.

    Science.gov (United States)

    Singh, Ashok K; Shetty, Sanat; Saraswathy, Jayadeep J; Sinha, Amit

    2013-04-01

    To evaluate 12 patients with delayed or nonunion of bones treated with bone marrow injections. 6 men and 6 women aged 15 to 70 (mean, 45) years underwent bone marrow injections for delayed union (n=2) or atrophic non-union (n=10) of the ulna (n=6), femur (n=3), humerus (n=2), or metacarpal (n=1). Bone marrow was aspirated from the anterior iliac crest and injected to the delayed and non-union sites. Two injections were given for children and adolescents, and 3 for adults. The interval between the injections was 6 to 8 weeks. The amount of bone marrow injected was 30 to 40 ml for long bones and 20 ml for metacarpals. Ten of the 12 delayed or non-union of bones healed after bone marrow injections. The mean time for callus formation was 5.8 (range, 3-10) weeks, for clinical union was 7 (range, 4-12) weeks, and for radiological union was 16 (range, 10-24) weeks. Multiple injections of low-volume bone marrow can be used for treatment of delayed or non-union of bones.

  2. Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats.

    Science.gov (United States)

    Thormann, Ulrich; El Khawassna, Thaqif; Ray, Seemun; Duerselen, Lutz; Kampschulte, Marian; Lips, Katrin; von Dewitz, Helena; Heinemann, Sascha; Heiss, Christian; Szalay, Gabor; Langheinrich, Alexander C; Ignatius, Anita; Schnettler, Reinhard; Alt, Volker

    2014-03-01

    Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n=14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n=14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p=0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3mm lever span biomechanical testing and histology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures.

    Science.gov (United States)

    von Rüden, Christian; Hungerer, Sven; Augat, Peter; Trapp, Oliver; Bühren, Volker; Hierholzer, Christian

    2015-02-01

    Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical

  4. Prognostic factors in the treatment of carpal scaphoid non-unions.

    Science.gov (United States)

    Schuind, F; Moungondo, F; El Kazzi, W

    2017-01-01

    In this literature review, the authors analyse the prognostic factors in the curative treatment of scaphoid non-unions. The main negative prognostic factors are smoking, the time elapsed since the fracture, and avascular necrosis of the proximal fragment. If the latter is present, the revascularization by a pedicle or microsurgical bone autograft is probably the treatment of choice. In non-unions without evidence of osteonecrosis, vascularized bone grafts are probably not superior to conventional bone grafts, which can presently be performed under arthroscopic control, with minimal morbidity.

  5. Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures.

    Science.gov (United States)

    Lian, Kejian; Wang, Lei; Lin, Dasheng; Chen, Zhiwen

    2013-08-01

    Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively; Pshaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures. Copyright 2013, SLACK Incorporated.

  6. Revision of a nonunited subtrochanteric femoral fracture around a failed intramedullary nail with the use of RIA products, BMP-7 and hydroxyapatite: a case report

    Directory of Open Access Journals (Sweden)

    Tsiridis Eleftherios

    2011-03-01

    Full Text Available Abstract Introduction Femoral subtrochanteric fractures are commonly treated using intramedullary devices. Failure of the implant and subsequent nonunion is still an issue, however, and limited evidence exists regarding the most appropriate treatment. Case presentation We report the case of an 80-year-old Caucasian woman with a subtrochanteric fracture originally treated using a trochanteric gamma nail which failed, resulting in a nonunion and fracture of its proximal end. The nonunion was revised with the removal of the broken trochanteric gamma nail, application of a condylar blade plate, ipsilateral Reamer/Irrigator/Aspirator autografting, recombinant human bone morphogenetic protein-7 and injectable hydroxyapatite cement. The fracture united fully at ten months following revision surgery, with no signs of femoral head avascular necrosis at 18-month follow-up. Conclusion The essential requirements for success when revising a nonunited fracture are to provide anatomical reduction, mechanical stability, bone defect augmentation and biological stimulation to achieve healing. Current advances in molecular biology, such as recombinant human bone morphogenetic protein-7, and biotechnology such as the Reamer/Irrigator/Aspirator system and hydroxyapatite injectable cement can improve patient outcomes over the use of our traditional revision techniques.

  7. Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study.

    Science.gov (United States)

    Bojan, Alicja J; Jönsson, Anders; Granhed, Hans; Ekholm, Carl; Kärrholm, Johan

    2018-03-01

    Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. External skeletal fixation of the tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2005-01-01

    Full Text Available Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitković’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3% and 33 females (28.7%, average age 43.92 years (16−84. Open tibial shaft fractures were present in 37 (31.36%. All the fractures were treated with Mitković’s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93% patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08% patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85% patient with closed fracture. Malunion was found in 2 (1.69% patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

  9. [External skeletal fixation of the tibial shaft fractures].

    Science.gov (United States)

    Milenković, Sasa; Mitković, Milorad; Radenković, Mile

    2005-01-01

    To present the possibility of a succesfful use of external skelatal fixation in treating the open and closed tibial shaft fractures with Mitković's external fixator. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16-84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitković's external fixator type M 20. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

  10. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities

    Directory of Open Access Journals (Sweden)

    Raaymakers Ernst

    2008-01-01

    Full Text Available Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip arthroplasties, especially in younger people and in the presence of osteopenia, are not always as expected; and a less radical approach is worth considering. The intertrochanteric valgization osteotomy, described by Pauwels, is an excellent alternative for healthy patients up to 65 years of age with a nonunion of the femoral neck. A union rate of 80-90% of the nonunion is described by most authors. Leg length inequallity, rotational and angular deformities can be corrected at the same time. During the period 1973-1995, we performed valgization osteotomy according to Pauwels in 66 patients of, 18-72 years old (mean 49.5 years. 24 (37% of our patients died 4 months to 24 years (mean: 9.5 years after the operation. Union of the femoral neck was achieved in 58 (88% of the 66 patients; union of the osteotomy in 65 patients (99%. A good or excellent result was achieved in 62% (23 uneventful and 13 with healed, necrosis/arthrosis without need for further treatment of our patients. However, the method has its limits. We feel if there is too little bone stock inside the femoral head, a valgization osteotomy does not give good result. The radiographic signs of avascular necrosis in patients over 30 years of age is considered a contraindication for an osteotomy. However our results show that it is worthwhile trying to save the joint of young patients even in case of a segmental collapse. In the race between revascularization and collapse, often revascularization is the winner. We deliberately give nature its chance and don′t rely on the result of bleeding from drill holes in the head, nuclear scans and other methods to estimate vascularity. A secondary total hip

  11. The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice

    Directory of Open Access Journals (Sweden)

    Esther Wehrle

    2015-01-01

    Full Text Available Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV. We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96 were either ovariectomised (OVX or sham operated (non-OVX at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day with 0.3 g peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine were evaluated using bending-testing, micro-computed tomography (μCT, histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (−81% and bone formation (−80% in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2 and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+1398% and bone formation (+637%, which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet. On a molecular level, we found an upregulation of ERα in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERα might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and

  12. Fluoroscopic-Assisted Olecranon Fracture Repair in Three Dogs

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    Stephen C. Jones

    2015-01-01

    Full Text Available Olecranon fractures in dogs are often both comminuted and intra-articular. Anatomic reduction and stable internal fixation are thus paramount to achieving primary bone healing and mitigating the development of posttraumatic osteoarthritis. Intraoperative fluoroscopy can be useful to confirm accurate fracture reduction and facilitate precise implant placement, potentially reducing the surgical exposure required and additional trauma. Despite widespread use in human surgery, reports of fluoroscopic-assisted fracture repair in dogs are limited. Presented here are three dogs in which intraoperative fluoroscopy was used to facilitate accurate olecranon fracture reduction and implant positioning. The olecranon fractures appeared to heal by primary bone union, although the anconeal process failed to obtain osseous union in one dog. Despite the development of mild-to-moderate osteoarthritis in all three dogs, and the nonunion of the anconeal process in one dog, the clinical outcome was considered successful with all dogs subjectively free of lameness at long-term follow-up evaluation. Intraoperative fluoroscopy was found to be a useful modality during fracture reduction and implant placement in dogs with olecranon fractures.

  13. ANTEROINFERIOR PLATING OF DISPLACED MIDDLE THIRD FRACTURE OF CLAVICLE

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    Shashi Kumar

    2016-05-01

    Full Text Available PURPOSE Even though clavicle fractures have a good union rate conservatively, there are several indications for surgical management. Among the surgical techniques open reduction and plate fixation have been used extensively. Although most surgeons prefer a superior plating technique, an anteroinferior plate location seems to be more advantageous considering the position and reduction of fragments. MATERIAL AND METHODS Fifteen consecutive patients with displaced middle-third fracture, delayed unions and non-unions of the clavicle underwent open reduction and internal fixation using an anteroinferior 3.5 mm reconstruction locking compression plate and screws. Patients were evaluated using patient symptoms, clinical signs and radiographic union, the Short Form-36 (SF-36, the American Shoulder and Elbow Surgeons Shoulder Assessment (ASES, and Constant Shoulder Score (CSS outcomes questionnaire. RESULTS The mean age of the patients was 34.6 years (range 19 to 53 years and all of them (n=15 were males. All patients were satisfied with their shoulder and upper extremity function as well as cosmesis from first week of surgery and were able to carry out their activities of daily living. Mean union time (absence of clinical tenderness and time for radiological union of fracture was 14.6 weeks, range being 12 to 21 weeks. ASES score was 89. Constant shoulder score was 84 at the latest follow-up. CONCLUSIONS Anteroinferior plating of acute displaced middle-third fractures of the clavicle and non-union using 3.5 mm reconstruction locking compression plate typically results in early healing, few complications and an excellent return of function. Advantages of this technique include stable bony fixation with screws directed away from potentially dangerous infraclavicular structures, minimal or no incidence of implant prominence problems and good patient compliance. Further, we would like to emphasise the fact that reduction of small inferior fragments in

  14. Novel Treatment of a Scapholunate Ligament Injury with Proximal Pole Scaphoid Nonunion

    Science.gov (United States)

    Gaspar, Michael P.; Kane, Patrick M.; Jacoby, Sidney M.; Culp, Randall W.

    2016-01-01

    Background  Nonunion of scaphoid proximal pole fractures presents a challenging management dilemma to hand surgeons. This problem is further complicated in the uncommon concurrence of scapholunate (SL) ligament disruption. Case Description  A 39-year-old male patient presented with new-onset wrist pain following a remote history of a proximal pole scaphoid fracture sustained as a teenager, which was treated nonoperatively. Six months before presentation, the patient sustained a fall while snowboarding. The patient was found to have a chronic nonunion of his scaphoid proximal pole with an associated SL ligament disruption. As the proximal fragment was too small to be amenable to fixation, the patient was treated with an arthroscopic partial scaphoid excision and SL ligament reconstruction using a scapholunateintercarpal screw placed percutaneously. At 26 months, the patient exhibited no pain, near-normal strength, and wrist motion, and expressed a high-level of satisfaction from his surgery. Literature Review  Although cases of SL ligament disruption with concomitant proximal scaphoid fractures have been reported, to our knowledge, this is the first report of SL ligament rupture occurring in the setting of a preexisting proximal pole scaphoid nonunion. Clinical Relevance  We report the use of SL ligament reconstruction augmented with intercarpal screw fixation, and excision of the proximal pole scaphoid nonunion. This minimallyinvasive approach may be a particularly useful option in young, active patients such as our own, where a motion-sacrificing salvage procedure would be less than ideal. PMID:27616829

  15. Comparison of the effects of dexketoprofen trometamol, meloxicam and diclofenac sodium on fibular fracture healing, kidney and liver: an experimental rat model.

    Science.gov (United States)

    Inal, Sermet; Kabay, Sahin; Cayci, M Kasim; Kuru, H Isa; Altikat, Sayit; Akkas, Gizem; Deger, Aysenur

    2014-03-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly used in patients with bone fractures, but there are limited studies on whether one NSAID is superior to another. In this study, we used histopathological and biochemical parameters to determine whether there are differences between the effects of the administration of clinical doses of dexketoprofen trometamol (DEXT), meloxicam (MEL) and diclofenac sodium (DIC) on the healing of closed fibular fractures and the toxicity of both the liver and kidney. Twenty-eight male Sprague-Dawley rats were randomly divided into four groups of seven each. Closed diaphyseal fractures were formed in the left fibulas of all of the rats. The NSAIDs dexketoprofen trometamol (DEXT) (Arveles(®)), meloxicam (MEL) (Melox(®)) and diclofenac sodium (DIC) (Voltaren(®)) were intramuscularly administered to Groups I, II, and III, respectively, for a period of 10 days after the fibular fractures were performed. No pharmacological agents were administered to Group IV (Control group). Blood samples were collected from all of the rats after the fractures were performed, and the rats were sacrificed on day 28. The histopathological findings were compared, and the blood samples were evaluated to determine any differences between the levels of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). Our results suggest that DEXT and MEL impair the healing of bone fractures and that DIC does not histopathologically affect the healing process of bone fractures. We also found that DEXT, MEL, and DIC impaired the renal histopathology compared with the control group. However, the liver histopathological analysis showed that DEXT and MEL caused a higher degree of parenchymal necrosis compared with DIC. Based on our results, DIC can be considered a relatively safe medication in patients with fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Delayed healing of a navicular stress fracture, following limited weight-bearing activity.

    Science.gov (United States)

    Robinson, Matthew; Fulcher, Mark

    2014-03-11

    This report describes a 21-year-old man, a semiprofessional football (soccer) player, with a navicular stress fracture. It highlights the difficulty in diagnosing the condition and the complications arising from inadequate management. The case discusses the optimal management of these stress fractures and the detrimental role of weight-bearing recovery. The diagnosis of navicular stress fractures is challenging, and a high index of suspicion is required. The available literature indicates that limited weightbearing is not an appropriate treatment for navicular stress injuries. Non-weight-bearing (NWB) cast immobilisation for 6-8 weeks appears to be the gold standard treatment; however, open reduction with internal fixation (ORIF) has similar success rates and an equal return-to-play time but should also be followed by a period of NWB. NWB cast immobilisation for 6 weeks remains a good second option at any time following failed limited weight-bearing activity.

  17. Mechanical stimulation enhanced estrogen receptor expression and callus formation in diaphyseal long bone fracture healing in ovariectomy-induced osteoporotic rats.

    Science.gov (United States)

    Chow, S K H; Leung, K S; Qin, J; Guo, A; Sun, M; Qin, L; Cheung, W H

    2016-10-01

    Estrogen receptor (ER) in ovariectomy-induced osteoporotic fracture was reported to exhibit delayed expression. Mechanical stimulation enhanced ER-α expression in osteoporotic fracture callus at the tissue level. ER was also found to be required for the effectiveness of vibrational mechanical stimulation treatment in osteoporotic fracture healing. Estrogen receptor(ER) is involved in mechanical signal transduction in bone metabolism. Its expression was reported to be delayed in osteoporotic fracture healing. The purpose of this study was to investigate the roles played by ER during osteoporotic fracture healing enhanced with mechanical stimulation. Ovariectomy-induced osteoporotic SD rats that received closed femoral fractures were divided into five groups, (i) SHAM, (ii) SHAM-VT, (iii) OVX, (iv) OVX-VT, and (v) OVX-VT-ICI, where VT stands for whole-body vibration treatment and ICI for ER antagonization by ICI 182,780. Callus formation and gene expression were assessed at 2, 4, and 8 weeks postfracture. In vitro osteoblastic differentiation, mineralization, and ER-α expression were assessed. The delayed ER expression was found to be enhanced by vibration treatment. Callus formation enhancement was shown by callus morphometry and micro-CT analysis. Enhancement effects by vibration were partially abolished when ER was modulated by ICI 182,780, in terms of callus formation capacity at 2-4 weeks and ER gene and protein expression at all time points. In vitro, ER expression in osteoblasts was not enhanced by VT treatment, but osteoblastic differentiation and mineralization were enhanced under estrogen-deprived condition. When osteoblastic cells were modulated by ICI 182,780, enhancement effects of VT were eliminated. Vibration was able to enhance ER expression in ovariectomy-induced osteoporotic fracture healing. ER was essential in mechanical signal transduction and enhancement in callus formation effects during osteoporotic fracture healing enhanced by vibration

  18. Development of a Novel Synthetic Drug for Osteoporosis and Fracture Healing

    Science.gov (United States)

    2014-09-01

    exclusively in electronic tonn (no paper notiJications will be sent). --------------~-~~::~-~~-~-~:::~-~-~---~-~-~~-~-~@-~_:;-~~!!~~~-~X::’.:!::~~2...expression. Thus, the result here is consistent with the previously reported role of salubrinal 30 that stimulates new bone fom1ation in the healing...17] Sudo H, KodamaHA, Amagai Y, Yamamoto S, Kasai S (1983) In vitro differentiation and calcification in a new donal osteogenic cell 1ine derived from

  19. Forces associated with launch into space do not impact bone fracture healing

    Science.gov (United States)

    Childress, Paul; Brinker, Alexander; Gong, Cynthia-May S.; Harris, Jonathan; Olivos, David J.; Rytlewski, Jeffrey D.; Scofield, David C.; Choi, Sungshin Y.; Shirazi-Fard, Yasaman; McKinley, Todd O.; Chu, Tien-Min G.; Conley, Carolynn L.; Chakraborty, Nabarun; Hammamieh, Rasha; Kacena, Melissa A.

    2018-02-01

    Segmental bone defects (SBDs) secondary to trauma invariably result in a prolonged recovery with an extended period of limited weight bearing on the affected limb. Soldiers sustaining blast injuries and civilians sustaining high energy trauma typify such a clinical scenario. These patients frequently sustain composite injuries with SBDs in concert with extensive soft tissue damage. For soft tissue injury resolution and skeletal reconstruction a patient may experience limited weight bearing for upwards of 6 months. Many small animal investigations have evaluated interventions for SBDs. While providing foundational information regarding the treatment of bone defects, these models do not simulate limited weight bearing conditions after injury. For example, mice ambulate immediately following anesthetic recovery, and in most cases are normally ambulating within 1-3 days post-surgery. Thus, investigations that combine disuse with bone healing may better test novel bone healing strategies. To remove weight bearing, we have designed a SBD rodent healing study in microgravity (μG) on the International Space Station (ISS) for the Rodent Research-4 (RR-4) Mission, which launched February 19, 2017 on SpaceX CRS-10 (Commercial Resupply Services). In preparation for this mission, we conducted an end-to-end mission simulation consisting of surgical infliction of SBD followed by launch simulation and hindlimb unloading (HLU) studies. In brief, a 2 mm defect was created in the femur of 10 week-old C57BL6/J male mice (n = 9-10/group). Three days after surgery, 6 groups of mice were treated as follows: 1) Vivarium Control (maintained continuously in standard cages); 2) Launch Negative Control (placed in the same spaceflight-like hardware as the Launch Positive Control group but were not subjected to launch simulation conditions); 3) Launch Positive Control (placed in spaceflight-like hardware and also subjected to vibration followed by centrifugation); 4) Launch Positive

  20. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion.

    Science.gov (United States)

    Oura, Keiichiro; Moritomo, Hisao; Kataoka, Toshiyuki; Oka, Kunihiro; Murase, Tsuyoshi; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2017-01-01

    The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns. Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients' with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n = 6); distal intra-articular (n = 5); and proximal (n = 6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined. The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type. The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion. Copyright

  1. Posterior trochanteric osteotomy in acetabular fractures for 32 cases.

    Science.gov (United States)

    Niu, Yunfei; An, Xiaofei; Xu, Shuogui; Wu, Dajiang; Zhang, Chuncai; Li, Ming

    2014-11-01

    The aim of this study is to explore the method and clinical outcome of posterior trochanteric osteotomy in acetabular fractures. From January 2000 to January 2008, 32 cases of acetabular fractures involving the dome of acetabulum underwent posterior trochanteric osteotomy for a better exposure and internal fixation with acetabular tridimensional memory fixation system. 28 cases (16 men and 12 women, mean age 39.9 years, range 16-73 years) were followed up with an average of 48.9 months (range of 19-95 months) and four were lost during follow up. Of 28 cases, 19 were fresh fractures and 9 were old fractures. The reduction was evaluated with Matta criteria. Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Motor strength of the abductors was evaluated according to the Medical Research Council grading system. Ectopic ossification was classified according to Brooker criteria. Anatomical reduction was achieved in 17 cases and satisfied reduction in 10 patients. Poor reduction happened in an old fracture. All acetabular fractures got a direct bone union and no displacement and deep infection occurred. All osteotomies healed within 3.5 months without any nonunion, proximal migration of the greater trochanter, loosing or broken of instrumentation, and deep infection. Two superficial infections were healed with a regular dressing. Two patients underwent removal of implants from greater trochanter because of irritation. The strength of the abductors was of Grade 3/5 in two patients, Grade 4/5 in five patients, and normal in the rest. Clinical scoring was excellent to good in 84 %. Ectopic ossification occurred in five patients, grade 1 in two patients, grade 2 in two, and grade 3 in one. But function of hip joint was not seriously affected. Posterior trochanteric osteotomy can provide an adequate exposure of the dome of acetabulum without the associated complications like nonunion, proximal replacement, and weak of the abductors which often occur

  2. Effects of intramedullary nails composed of a new β-type Ti-Nb-Sn alloy with low Young's modulus on fracture healing in mouse tibiae.

    Science.gov (United States)

    Fujisawa, Hirokazu; Mori, Yu; Kogure, Atsushi; Tanaka, Hidetatsu; Kamimura, Masayuki; Masahashi, Naoya; Hanada, Shuji; Itoi, Eiji

    2018-01-23

    The influence of Young's moduli of materials on the fracture healing process remains unclear. This study aimed to assess the effects of intramedullary nails composed of materials with low Young's moduli on fracture repair. We previously developed a β-type Ti-Nb-Sn alloy with low Young's modulus close to that of human cortical bone. Here, we prepared two Ti-Nb-Sn alloys with Young's moduli of 45 and 78 GPa by heat treatment, and compared their effects on fracture healing. Fracture and nailing were performed in the right tibiae of C57BL/6 mice. The bone healing process was evaluated by microcomputed tomography (micro-CT), histomorphometry, and RT-PCR. We found larger bone volumes of fracture callus in the mice treated with the 45-GPa Ti-Nb-Sn alloy as compared with the 78-GPa Ti-Nb-Sn alloy in micro-CT analyses. This was confirmed with histology at day 14, with accelerated new bone formation and cartilage absorption in the 45-GPa Ti-Nb-Sn group compared with the 78-GPa Ti-Nb-Sn group. Acp5 expression was lower in the 45-GPa Ti-Nb-Sn group than in the 78-GPa Ti-Nb-Sn group at day 10. These findings indicate that intramedullary fixation with nails with a lower Young's modulus offer a greater capacity for fracture repair. Our 45-GPa Ti-Nb-Sn alloy is a promising material for fracture treatment implants. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

  3. [Healing of spiral fractures in the sheep tibia comparing different methods--osteosynthesis with internal fixation, interlocking nailing and dynamic compression plate].

    Science.gov (United States)

    Seibold, R; Schlegel, U; Kessler, S B; Cordey, J; Perren, S M; Schweiberer, L

    1995-12-01

    The healing process of spiral fractures of the sheep tibia was investigated in an experiment with simulated clinical conditions. The effects of conventional internal fixation techniques with the DCP and the intramedullary nail are compared with those of internal fixation with the spine fixator. The internal fixation techniques are described in terms of their bending stiffness when mounted on the fractured bone. The in vivo investigation was documented clinically and radiographically and the post mortem specimens were evaluated histologically. The bending stiffness of the healed bone was assessed in relation to the contralateral side. After application of the DCP, primary healing took place and extensive transcortical necrosis occurred in the implant bed. Intramedullary nailing led to secondary healing and to necrosis of the inner cortex close to the endosteum. After internal fixation with the spine fixator, gap healing took place and no cortical necrosis was observed. The clinical course was generally good after all procedures. The histological evaluation shows that damage to the vascularity of the bone can only be avoided by using the spine fixator. This principle seems to be appropriate for the purposes of biological internal fixation.

  4. Rat tibial osteotomy model providing a range of normal to impaired healing.

    Science.gov (United States)

    Miles, Joan D; Weinhold, Paul; Brimmo, Olubusola; Dahners, Laurence

    2011-01-01

    The purpose of this study was to develop an inexpensive and easily implemented rat tibial osteotomy model capable of producing a range of healing outcomes. A saw blade was used to create a transverse osteotomy of the tibia in 89 Sprague-Dawley rats. A 0.89 mm diameter stainless steel wire was then inserted as an intramedullary nail to stabilize the fracture. To impair healing, 1, 2, or 3 mm cylindrical polyetheretherketone (PEEK) spacer beads were threaded onto the wires, between the bone ends. Fracture healing was evaluated radiographically, biomechanically, and histologically at 5 weeks. Means were compared for statistical differences by one-way ANOVA and Holm-Sidak multiple comparison testing. The mean number of "cortices bridged" for the no spacer group was 3.4 (SD ± 0.8), which was significantly greater than in the 1 mm (2.3 ± 1.4), 2 mm (0.8 ± 0.7), and 3 mm (0.3 ± 0.4) groups (p < 0.003). Biomechanical results correlated with radiographic findings, with an ultimate torque of 172 ± 53, 137 ± 41, 90 ± 38, and 24 ± 23 N/mm with a 0, 1, 2, or 3 mm defect, respectively. In conclusion, we have demonstrated that this inexpensive, technically straightforward model can be used to create a range of outcomes from normal healing to impaired healing, to nonunions. This model may be useful for testing new therapeutic strategies to promote fracture healing, materials thought to be able to heal critical-sized defects, or evaluating agents suspected of impairing healing. Copyright © 2010 Orthopaedic Research Society.

  5. Healing of shear strength and its time dependency in a single rock fracture

    International Nuclear Information System (INIS)

    Kawaguchi, Yuta; Nakashima, Shinichiro; Yasuhara, Hideaki; Kishida, Kiyoshi

    2011-01-01

    Evolution of the long-term mechanical, hydraulic, and transport characteristics of rock fractures should be, in advance, predicted in considering an issue on entombment of energy byproducts of high level radioactive wastes. Under stressed and temperature conditions, those behaviors of the rock fractures of interest may be evolved in time and space likely due to the change in topographical aperture distributions. This irreversible process may be induced by pure mechanical and/or chemo-mechanical creeps such as water-rock reactions like stress corrosion and pressure solution, and chemical effects including mineral dissolution and reprecipitation in the free-walls of fractures. Specifically, the chemo-mechanical processes active at the contacting asperities within rock fractures may exert a significant influence on the mechanical, hydraulic, and transport behaviors throughout a long period, and thus, should be vigorously examined theoretically and experimentally. This paper presents the slide-hold-slide shear test results for fully saturated, single-jointed mortar specimens so as to investigate the effects of load holding on mechanical properties of rock joints. From the test results, it was confirmed that shear strength increased for mortar specimens in both short and long time holding cases. However, the evolution of shear strength recovery in two cases is different. This is because a dominant factor of shear strength recovery during the short time holding may be attributed to a pure mechanical process like creep deformation at contacting asperities, while the one during long time holding is affected by both mechanical and chemical processes like pressure solution. Moreover, to reproduce the shear strength recovery during short time holding we develop a direct shear model by including temporal variation of dilation during holding. The model predictions are in relatively good agreement with the test measurements. (author)

  6. PEMF as treatment for delayed healing of foot and ankle arthrodesis.

    Science.gov (United States)

    Saltzman, Charles; Lightfoot, Andrew; Amendola, Annunziato

    2004-11-01

    Arthrodesis is the most common surgical treatment for foot and ankle arthritis. In adults, these procedures are associated with a 5% to 10% rate of nonunion. Pulsed electromagnetic field (PEMF) stimulation was approved by the Federal Drug Administration (FDA) for treatment of delayed unions after long-bone fractures and joint arthrodesis. The purpose of this study was to examine the results of PEMF treatment for delayed healing after foot and ankle arthrodesis. Three hundred and thirty-four foot and ankle arthrodeses were done. Nineteen resulted in delayed unions that were treated with a protocol of immobilization, limited weightbearing, and PEMF stimulation for a median of 7 (range 5 to 27) months. All patients were followed clinically and radiographically. The use of PEMF, immobilization, and limited weightbearing to treat delayed union after foot and ankle arthrodesis was successful in 5 of 19 (26%) patients. Of the other 14 patients with nonunions, nine had revision surgery with autogenous grafting, continued immobilization, and PEMF stimulation. Seven of these eventually healed at a median of 5.5 (range 2 to 26) months and two did not heal. One patient had a below-knee amputation, and four refused further treatment. The protocol of PEMF, immobilization, and limited weightbearing had a relatively low success rate in this group of patients. We no longer use this protocol alone to treat delayed union after foot and ankle arthrodesis.

  7. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting.

    Science.gov (United States)

    Lim, Tae Kang; Kim, Hyo Kon; Koh, Kyoung Hwan; Lee, Hyun Il; Woo, Sung Jong; Park, Min Jong

    2013-10-01

    To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments. We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated. Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery. Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Effects of Low-Dose Microwave on Healing of Fractures with Titanium Alloy Internal Fixation: An Experimental Study in a Rabbit Model

    Science.gov (United States)

    Zhang, Han; Fu, Tengfei; Jiang, Lan; Bai, Yuehong

    2013-01-01

    Background Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. Methods Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day) to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. Findings The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. Conclusion Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method. PMID:24086626

  9. Results of open tibial fracture treatment using external fixation

    Directory of Open Access Journals (Sweden)

    Golubović Ivan

    2016-01-01

    Full Text Available Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18% men and 23 (33.82% women. The majority of patients - 33 (48.53% of them - were injured in motor vehicle accidents, whereas 24 (35.29% patients sustained injuries due to falls from heights. In two (2.94% patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47% type I open fractures, 21 (30.88% type II open fractures, 19 (27.94% type IIIA open fractures, seven (10.29% type IIIB open fractures, and three (4.41% type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53% patients, whereas in 18 (26.47% patients we observed some complications. Nonunion was found in 10 (14.71% patients, osteitis in four (5.88, malunion in two (2.94% patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12% patients, infection of the open fracture wound soft tissue was observed in four (5.88% patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies. [Projekat Ministarstva nauke Republike Srbije, br. III 41017: Virtual Human Osteoarticular System and its Application in Preclinical and Clinical Practice

  10. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root frac