Advances In Management Of Fractures Research Articles

Shortening Dome Osteotomy for Correction of Complex Multiplanar Elbow Deformities: A New Surgical Technique.

Despite surgical advances in fracture management, it is not uncommon to find pediatric or adolescent patients with elbow deformities. Correction of severe deformities, often leaves the ingenuity of the treating surgeon asking for more. Various osteotomy techniques have been described in the literature for the correction of elbow deformities. Although, the concept of dome osteotomy did address certain inadequacies of the existing osteotomy techniques for distal humerus, but correction of complex deformities associated with deformation of trochlea and olecranon fossa still remain a surgical challenge which has not been adequately addressed in the literature so far. Our experience with the existing osteotomies for distal humerus led to the development of a new surgical technique of shortening dome osteotomy for correction of such complex multiplanar elbow deformities. Surgical steps, indications, and expected outcome is described.

Simulation enabled search for explanatory mechanisms of the fracture healing process.

A significant portion of bone fractures fail to heal properly, increasing healthcare costs. Advances in fracture management have slowed because translation barriers have limited generation of mechanism-based explanations for the healing process. When uncertainties are numerous, analogical modeling can be an effective strategy for developing plausible explanations of complex phenomena. We demonstrate the feasibility of engineering analogical models in software to facilitate discovery of biomimetic explanations for how fracture healing may progress. Concrete analogical models—Callus Analogs—were created using the MASON simulation toolkit. We designated a Target Region initial state within a characteristic tissue section of mouse tibia fracture at day-7 and posited a corresponding day-10 Target Region final state. The goal was to discover a coarse-grain analog mechanism that would enable the discretized initial state to transform itself into the corresponding Target Region final state, thereby providing an alternative way to study the healing process. One of nine quasi-autonomous Tissue Unit types is assigned to each grid space, which maps to an 80×80 μm region of the tissue section. All Tissue Units have an opportunity each time step to act based on individualized logic, probabilities, and information about adjacent neighbors. Action causes transition from one Tissue Unit type to another, and simulation through several thousand time steps generates a coarse-grain analog—a theory—of the healing process. We prespecified a minimum measure of success: simulated and actual Target Region states achieve ≥ 70% Similarity. We used an iterative refinement protocol to explore many combinations of Tissue Unit logic and action constraints. Workflows progressed through four stages of analog mechanisms. Similarities of 73–90% were achieved for Mechanisms 2–4. The range of Upper-Level similarities increased to 83–94% when we allowed for uncertainty about two Tissue Unit designations. We have demonstrated how Callus Analog experiments provide domain experts with a fresh medium and tools for thinking about and understanding the fracture healing process.

Advances in management of fractures of extremities with locking plating

近年来,骨折内固定概念已经从机械固定转向生物学固定,同时强调利用非精确复位、间接复位的技术弹性同定长骨干骨折端来产生骨痂,促进骨生长[1-2].生物学同定包括使用锁定钢板固定、减少钢板与骨的接触、长距离的钢板桥接及较少螺钉固定,同时也允许骨折端之问存在一定的微动[1].锁定钢板作为生物学固定的一种实现方式,虽不同于传统钢板,但两者之间又存在千丝万缕的联系.本文就锁定钢板的发展、生物学特性、手术技术、国内外研究现状及使用锁定钢板出现的并发症进行回顾。

Total Hip Arthroplasty for Posttraumatic Arthritis after Acetabular Fracture

Total hip arthroplasty (THA) outcomes for posttraumatic arthritis after acetabular fracture have yielded inferior results compared to primary nontraumatic THA. Recently, improved results have been demonstrated using cementless acetabular reconstruction. Thirty-two patients underwent THA for posttraumatic arthritis after acetabular fracture; 24 were treated with open reduction internal fixation, and 8 were managed conservatively. Time from fracture to THA was 36 months (6-227 months). Average follow-up was 4.7 years (2.0-9.7 years). Harris Hip score increased from 28 (0-56) to 82 points (20-100). Six patients required revision. Five-year survival with revision, loosening, dislocation, or infection as an end point was 79%. Survival for aseptic acetabular loosening was 97%. Revision surgery correlated with nonanatomic restoration of the hip center and a history of infection ( P < .05). Despite obvious challenges, advances in fracture management and cementless acetabular fixation in THA demonstrate improved results for posttraumatic arthritis following acetabular fracture.

The Interaction of Projectiles with Tissues and the Management of Ballistic Fractures

Wounds to the limbs are the commonest injuries seen during armed conflict and injury results from the transfer of energy from the missile to the tissues. There are a number...

Advances in Fracture Management in the Hand and Distal Radius

Indications for internal and external fixation within the hand skeleton and distal radius have been presented and discussed. When used appropriately, these techniques will provide reliable fracture fixation and superior clinical results. Obviously, these techniques are not appropriate for all fractures. There remains a group of fractures well treated by more conservative methods. Additionally, some fractures exist which cannot be well treated by any method currently available. Nonetheless, these new techniques have added significantly to the clinical success available following the onset and treatment of complex fractures occurring within the hand skeleton and distal radius.