Average Fracture Healing Time Research Articles

Minimally Invasive Percutaneous Plating of Distal Femoral Fractures Using the Dynamic Condylar Screw

In distal femoral fractures, conventional open reduction and internal fixation causes complications because of excessive soft-tissue stripping. To prevent this, minimally invasive percutaneous plating was performed in distal femoral fractures. Sixteen supracondylar or intercondylar femoral fractures were treated by minimally invasive percutaneous plating with the dynamic condylar screw without bone graft. Five (31%) were open fractures. All fractures healed except one. The average time for fracture healing was 17 weeks (range, 14-22 weeks). Complications included one nonunion related to early full weight bearing. No patient showed malunion or deep infection. Results were evaluated by modified Neer rating, and all patients had excellent or good results. Intra-articular fractures showed less favorable range of motion and clinical scores than extra-articular fractures. Minimally invasive percutaneous plating with the dynamic condylar screw can provide favorable results in the treatment of distal femoral fractures.

Indirect reduction and bridge plating of supracondylar fractures of the femur

Between October 1995 and December 1998, 16 patients with A–O type A3, C2 or C3 supracondylar femoral fractures were treated by open reduction and internal fixation using indirect reduction and bridge plating. Seven (44%) patients had open fractures. The patients were followed for a mean of 46 months (range 24–71). All fractures healed. The average time for fracture healing was 18.5 weeks (range 12–28). Four primary bone grafts and three secondary bone grafts were performed. By using the modified Schatzker rating scale, the result of 13 patients (81%) were rated as excellent or good. Complications included two implant failures that were due to full weight bearing before bone healing, and one superficial delayed wound healing. No deep infections were found in this series. The open fracture group needed longer time to heal and had a higher rate of receiving bone grafts. We conclude that indirect reduction and bridge plating with a 95° dynamic condylar screw (DCS) or condylar blade plate can produce favourable results for complex distal femoral fractures. We suggest primary bone grafts or early secondary bone grafts for comminuted open fractures using an indirect reduction technique.

Treatment of multifragmentary fractures of the femur by indirect reduction (biological) and plate fixation

We present a retrospective review of the results of 43 multifragmentary femur fractures treated under the principle of indirect reduction (biological) and plate fixation. Fractures were caused by high-energy trauma in all patients. Sixteen were subtrochanteric, 14 diaphyseal and 13 supracondylar. There were 13 open fractures. In six of the patients with diaphyseal fractures, a plate was inserted through isolated proximal and distal incisions only, deep to the vastus lateralis. None of the fractures was treated with bone graft. The mean follow-up time was 28.3 months. Union was achieved in 41 patients within a mean period of 4.25 months. There was delayed union in one patient (subtrochanteric), non-union in two, infection in three, malunion in three, leg shortening in six and mild knee stiffness in seven. In eight patients with diaphyseal fractures in whom a single incision was performed, the average time for fracture healing was 4.14 months in seven and non-union developed in one. In six patients with diaphyseal fractures, in whom proximal and distal incisions were performed, the average time for fracture healing was 4 months. There was no difference ( P>0.05) between single and double incision with reference to infection and time to union, but the indirect reduction methods must be meticulously implemented. The implants we used are cheaper and more easily supplied than many others. The success rate is high when the technique is correctly implemented. We believe that this is a treatment of choice in countries with low socioeconomic status, no efficient health insurance system and no intraoperative image intensification.

First experiences with unreamed AO intramedullary nail in treatment of femoral shaft fractures

The unreamed femoral nail (UFN) system, with its numerous proximal interlocking options, allows a minimal invasive surgical procedure for the treatment of nearly all femoral fracture patterns. Sixty-six fractures, 5 cases of osteolysis or pathologic fractures, 2 limb shortenings and 1 lengthening (monorail technique) and 3 cases of pseudarthrosis were stabilised with the UFN from July 1994 to December 1996. The fractures were analysed according to the AO classification. We found 31 polytrauma patients with an mean ISS of 21.8 and a mean PTS of 25.4. Most of the multiply injured patients (n = 26) were stabilised with the UFN primarily. Follow-up of 44 patients ranged from 4 to 18 months postoperatively. According to our clinical and radiological score the results were excellent in 34% of cases, good in 36.3%, poor in 20.4% and bad in 9%. Average fracture healing time was about 9.8 weeks.

The results of open reduction and Internal fixation of distal femur fractures using a biologic (indirect) reduction technique.

The results of 57 A-O type A or C supracondylar femur fractures treated by open reduction and internal fixation using indirect reduction techniques are reported. No bone grafting or dual plating was used. All patients were placed in a continuous passive motion (CPM) machine postoperatively. Patients were followed at 4-week intervals until fracture healing had occurred. All patients were followed for at least 1 year after injury. All fractures were treated by a single surgeon. The average time for fracture healing was 10.7 weeks (range 8-16). Hardware failure did not occur in this series. Outcomes were assessed using a modified Schatzker scoring method. Using the scale, there were 84% good to excellent results, 11% fair results, and 5% poor outcomes. Fair and poor results tended to occur in more severe fractures and were primarily due to limited knee motion. Complications included two broken screws, one deep infection, and one malunion. No fractures failed to unite. In conclusion, holding the surgical skill factor constant, it appeared that biologic reduction techniques, although they provided excellent bone healing capability, did not guarantee universally satisfactory outcomes.

Direct Anterior Fixation of Dens Fractures with a Cannulated Screw System

Anterior screw fixation of dens fractures appears to be an optimal method of treatment for these injuries. Anatomic dens fracture reduction with stable internal screw fixation satisfies the established principles of the AO/ASIF. Iatrogenic trauma is minimized by the use of an anterior surgical approach, and no supplemental bone grafting is required. This procedure is quite prone to complications when performed improperly or in contraindicated situations. The use of meticulous surgical technique along with a newly designed cannulated screw system has evolved this procedure into an established form of treatment at our department. Since 1982, 23 patients were treated with direct screw fixation of dens fractures. The overall rate of fracture union was 92.3%, and fracture resolution averaged 5.5 months. The major complication rate of 17% (4/23) resulted from inappropriate use of this technique. The 11 most recent cases, all of which involved stabilization with cannulated screws, resulted in only a single complication (9%) and an average fracture healing time of 3.5 months. A recommended operative technique for anterior screw fixation of dens fractures will be presented along with a discussion of potential sources of difficulty or failures.

Treatment of fractures of the femoral shaft with early cast bracing

This study describes experience in the treatment of fractures of the femoral shaft by early weight bearing in a cast brace, at Glasgow Royal Infirmary. During 1977–1979, 117 fractures of the femoral shaft were treated. The average time for fracture healing was 15 weeks and 96 per cent of the fractures had overall satisfactory results.

Orthoplast brace for the treatment of tibial shaft fractures

This is a preliminary report of a prospective study in treating 82 tibial shaft fractures using Orthoplast brace during 1979–1980 at Glasgow Royal Infirmary. The brace was applied at 3–4 1 2 weeks to tibial shaft fractures managed conservatively. This method is found to be extremely satisfactory and free of major complications e.g. non-union and infection. The average time for fracture healing was 13.50 weeks for closed and 16.75 weeks for open fractures.

Managing Difficult Fractures due to Ballistic Trauma with Ilizarov Ring Fixation

20 fractures (7 femoral and 13 tibial) were treated with the illizarov apparatus between 2003 to 2006. Allwere old injuries, previously managed by internal fixation (intramedullary rods), external fixation (Hoffman'sexternal fixators), or conservatively with traction and plaster of paris slabs. Ilizarov fixators were appliedto manage infected non-union with or without bone loss and malunion. Corticotomy and bone transportwas carried out in cases with significant bone loss. In others without any limb shortening and minimalbony defect, bone grafting and compression was carried out. In one case valgus deformity along withnon-union was corrected. Early weight bearing with range of motion exercises for ankle and knee jointswere encouraged. Average fracture healing time was 12 months (8 to 18 months). All fractures healed with<5° of malalignment. Complications included pin site inflammation/ infection, muscle transfixation, kneeand ankle joint stiffness and a wire fracture. The ilizarov device provided definitive fixation with acceptableresults in all cases.Key words: Ilizarov ring fixator; distraction osteogenesis; bone transport; infective non-union;corticotomyDOI: 10.3126/mjsbh.v9i1.3482Medical Journal of Shree Birendra Hospital Vol.9(1) 2010 1-8