Clinical Healing Time Research Articles

The modified open reduction and internal fixation for treatment of middle phalangeal fractures

Objective To stuay and analyze the outcome ofmedified open reduction and internal fixation using mini titanium plate for treatment of middle phalangeal fracture. Methods Ten cases(ten fractures)of middle phatangeal fractures were treated by open reduction and intemal fixation.After exposure of the fracture site and protection ofthe extensor apparatus via a lateral approach,the fracture WBS fixed with mini titanium plate and screws.Early postoperative rehabilitation started 2 days after the operation. Results Pestoperafive fonow up ranged from 3 months to 8 months,with an average of 5 months.The clinical healing time ranged from 4 t0 8 weeks and averaged 6 weeks.Eight of the cases were rated as excellent and 2 good according to the TAM scores.Conclusion The modified lateral internal fixation using mini titanium plate for treatment of middle phalangeal fractures can avoid disturbing the extensor apparatus,reduce tendon adhesion and abrasion,and achieve excellent functional recovery of the injured finger. Key words: Fractures,bone; Finger phalanges; Fracture fixation,internal

Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions: A prospective randomised clinical study on 120 patients

The purpose of this prospective randomised clinical study was to compare the efficacy of recombinant bone morphogenetic protein 7 (rhBMP-7) and platelet-rich plasma (PRP) as bone-stimulating agents in the treatment of persistent fracture non-unions. One hundred and twenty patients were randomised into two treatment groups (group rhBMP-7 vs. group PRP). Sixty patients with sixty fracture non-unions were assigned to each group (median age: 44 years, range 19-65, for the rhBMP-7 group and 41 years, range 21-62, for the PRP group, respectively). In the rhBMP-7 group, there were 15 tibial non-unions, 10 femoral, 15 humeral, 12 ulnar, and 8 radial non-unions. In the PRP group, there were 19 tibial non-unions, 8 femoral, 16 humeral, 8 ulnar, and 9 radial non-unions. The median number of operations performed prior to our intervention was 2 (range 1-5) and 2 (range 1-5) with autologous bone graft being used in 23 and 21 cases for the rhBMP-7 and PRP groups, respectively. Both clinical and radiological union occurred in 52 (86.7%) cases of the rhBMP-7 group compared to 41 (68.3%) cases of the PRP group, with a lower median clinical and radiographic healing time observed in the rhBMP-7 group (3.5 months vs. 4 months and 8 months vs. 9 months, respectively). This study supports the view that in the treatment of persistent long bone non-unions, the application of rhBMP-7 as a bone-stimulating agent is superior compared to that of PRP with regard to their clinical and radiological efficacy.

Treatment of Barton's fracture with LCP internal fixation combined with bone graft

Objective To evaluate the clinical outcome of treating Barton' s fractures using locking compression plate (LCP) combined with bone graft. Methods Thirty cases of Barton's fracture treated from June 2002 to January 2008 were involved in the study. They were treated with open reduction and internal fixation with LCP combined with bone graft. Early rehabilitation was carried out postoperatively. There were 18 males and 12 females. The mean age of them was 39 years. Results All of the 30 patients were followed up for 3 to 24 months and the average time was 12 months. Bone union was seen in all cases and the average clinical healing time was 8 weeks. The volar tilting angle was 6° to 16°(average 10.4°), and the ulnar inclining angle was 17° to 25°( average 20.1°). There was no shortening of the radius. Clinical outcome was evaluated by X-rays and wrist function assessment. The result of 20 cases was graded as excellent, 8 cases as good, and 2 cases as poor. The overall satisfaction rate was 93.3%. Conclusion Surgical treatment using LCP internal fixation combined with bone graft for Barton's fractures can maintain the length of the radius and ulna, restore volar tilting angle and ulnar inclining angle, and achieve good reduction of the articular surface. Early rehabilitation is equally important for the best recovery of wrist function. Key words: Radius fractures; Fracture fixation, internal; LCP; Bone graft

Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: A multi-centre double blind randomised controlled trial

Several randomised trials have been published on the effect of low-intensity pulsed ultrasound (LIPUS) on fracture healing in both distal radius and tibia fractures. Most studies showed a positive effect on time to clinical and radiological healing. We hypothesised that LIPUS has a beneficial effect on the healing of fresh clavicle fractures as well and studied its effect in non-operatively treated shaft fractures. We conducted a randomised double blind, placebo-controlled multi-centre trial in 101 adult patients with a non-operatively treated fresh clavicle shaft fracture. Of these patients, 49 used a placebo transducer and 52 patients had an active transducer with ultrasound stimulation (Exogen 2000). Data were analysed on intention to treat basis. Baseline parameters of both groups were not significantly different. There were no differences in time to subjective clinical fracture healing, resumption of daily activities, sports or professional work, Visual Analogue pain Scores (VAS) and use of pain medication. Our findings did not confirm that LIPUS accelerates clinical healing time of fresh clavicle shaft fractures. Level 1 evidence that low-intensity pulsed ultrasound does not accelerate clinical fracture healing in non-operatively treated fresh midshaft clavicle fractures.

Realization of the operative treatment for 35 cases of femoral shaft fractures with ipsilateral femoral neck or intertrochanteric fractures

目的 观察动力髁螺钉(DCS)、近端股骨髓内钉(PFN)治疗股骨干骨折合并同侧股骨颈及转子间骨折的临床疗效.方法采用内固定方式治疗35例股骨干骨折合并同侧股骨颈或转子间骨折,其中股骨干合并同侧股骨颈骨折10例,合并转子间骨折25例,使用DCS固定9例,使用PFN固定26例.结果随访时间6～30个月,平均18个月,33例骨折愈合、患肢关节功能优良,2例出现股骨头坏死,愈合率为94%,不愈合率为6%.结论对于股骨干骨折合并同侧股骨颈或转子间的复杂骨折,选择采用DCS或PFN治疗,DCS适用于较稳定的骨折,PFN有手术时间短,组织损伤小的优点.两者均具有在骨折愈合、功能恢复和早期活动方面均较满意的效果。

Exploratory Analysis of the Bacteriological Status of Post-irradiation Wounds and Its Relationship to Healing

Aims To investigate the bacteriological status of post-irradiation wounds and its relationship to wound healing in patients with nasopharyngeal cancer. Materials and methods One hundred and forty-six nasopharyngeal cancer patients with post-irradiation wounds on one or both sides of the neck were studied prospectively. Swabs were taken from the wounds at the initial study visit for bacteriological examination. A further swab for culture was taken when possible signs of infection developed. Wound healing was assessed on alternate days with respect to wound condition, the presence of clinical infection and healing time. Results The results showed that most of the post-irradiation wounds were colonised with bacteria. This was not associated with clinical signs of infection in any instance. There was no association between wound healing time and the presence of organisms, the identity of organisms, the number of species of organisms, or the use of antibiotics. Conclusions The presence of bacteria in post-irradiation wounds, in the absence of clinical signs of wound infection, is not a barrier to wound healing. Oncology practitioners should recognise the unique features of radiation-induced wounds and skin reactions with confidence and provide appropriate treatment as needed.

The Effects of Erythrosine on Alveolar Bone and Gingival Connective Tissue in Dogs

This study was conducted to determine if erythrosine had any effect when placed in contact with alveolar bone and gingival connective tissue in dogs in conjunction with a periodontal surgical procedure. Periodontal surgery was performed on 15 dogs, with a mucoperiosteal flap affording access for introduction of erythrosine (test) or saline (control) solutions, and subsequent flap replacement. The dogs were sacrificed at 2, 7, 10, 14, 21, and 28 days. Autopsy specimens were prepared, stained, sectioned, and examined by light microscopy. The general amount, degree, and type of inflammatory infiltrate was evaluated and recorded. Erythrosine had no apparent effect on the clinical healing time, alveolar bone, or gingival connective tissue in regard to the general degree, type, and location of the inflammation infiltrate based on postsurgical observations.