Diaphyseal Fractures Of Long Bones Research Articles

Early complications of elastic stable intramedullary nails in the treatment of pediatric diaphyseal fractures of long bones: an experience in Duhok center of Orthopedic Surgery

Early complications of elastic stable intramedullary nails in the treatment of pediatric diaphyseal fractures of long bones: an experience in Duhok center of Orthopedic Surgery

PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES

Due to the military conflict in Ukraine, the problem of treating gunshot fractures has become acute, which requires an urgent solution. Objective. On the basis of own experience, to determine the primary problems in the treatment of gunshot diaphyseal fractures of the long bones of the limbs and evaluate the preliminary results. Methods. The treatment process and its results were analyzed in 128 victims with gunshot fractures of long limb bones for the period 08.2022–08.2023. Classical methods of clinical, X-ray and laboratory investigations were used. The assessment was carried out according to the AO classification, that was supplemented with new options for tangent and perforated bone injuries, as well as the volume of destruction of adjacent soft tissues. Wounds of all the patinets were treated using vacuum aspiration, the fragments were fixed with external devices manufactured by Biomet, Stryker, ТОВ «Ейч Ві Орто», ОРТОПАК. Results. The analysis showed that 64 (50 %) of the wounded had a need to take additional measures to preserve or improve the position of the fragments: improvement of the geometry of the external apparatus, replacement of the apparatus with a more perfected one, with a plate or intramedular osteosynthesis; replacement of the apparatus with a plaster bandage or orthosis. Conclusions. Based on the study, it can be argued, that most gunshot diaphyseal fractures of long bones are multifragmental and accompanied with destruction of predominantly peripherally located soft tissues. At the same time, the periosteum with a layer of adjacent muscles for the most part retains integrity, viability and connection with the surface of the fragments. The basic and rational method of fixation of fragments for diaphysical gunshot fractures it is necessary to consider external osteosynthesis with schanz-screws devices. According to our preliminary data, the use of external fixator treatment led to fracture healing in 84% of patients with gunshot hip fracture, 56 % — tibia fracture, 59 % — humerus fracture, and 44 % — forearm fractures.

Predictive factors of malunion and nonunion at the Aristide le Dantec hospital

Background: Malunion and nonunion are late complications that can occur during the fracture healing process. The aim of this study was to determine the predictive factors for malunion and nonunion Methods: This was a retrospective study over a period of 43 months. Predictive factors were sought from patient, fracture and initial management data Results: We recorded 72 consolidation disorders in 69 patients. malunion accounted for 54.1% and nonunion for 45.9%. The study population was divided as follows: 53 men and 16 women. The average age was 37.8 years. The patients lived in urban areas in 81.2% of cases. Comorbidities were present in 14.5%. The circumstances of fracture occurrence were dominated by traffic accidents, especially for 39 patients. The initial fracture was closed in 91.3%. Long bones were involved in 97.2% of cases, with a diaphyseal location in 52.8%. The fracture was simple in 79.1%, with 84.7% of the fractures being transverse. The tibia was the bone most affected by malunion (53.8%). Nonunion occurred in the humerus, femur and tibia in 27.3% each. Initial treatment was undertaken in 91.3% of patients. Conclusions: Malunion and nonunion are a reality in our daily practice. These consolidation problems occur in young patients who are victims of road traffic accidents. Diaphyseal fractures of long bones with a transverse line have been the most frequently incriminated. conservative treatment and traditional practice have favoured the development of these complications.

Outcomes of diaphyseal femoral fractures treatment in relation to fracture union and full weight bearing among adults

BACKGROUND & OBJECTIVE: The femoral shaft fractures constitute 50% of all femoral fractures. The objective is to observe the outcome of diaphyseal femur fracture treatment of femur shaft with the union and full weight bearing by bridge plate osteosynthesis among adults.
 METHODOLOGY: A Prospective observational study was conducted in the department of Orthopaedic Surgery, Postgraduate Medical Institute/Lahore General Hospital. A sample of 30 patients was calculated using WHO calculator. Convenient sampling was used for patient selection. After reducing the fracture (indirectly), the other end of the plate was also fixed with screws. Data was collected at 6th months post-operatively to see radiological union and weight-bearing status. Data analysis was done using SPSS version 25. Fisher exact test was applied. p-value≤0.05 was considered significant.
 RESULTS: Mean age of the patients was 34.66±9.22 years. Gender distribution of patients shows that 17% of the patients were females, and 83% of the patients were male. At the 6th month follow-up, all 30 (100%) patients had achieved bony union. At the 5th month, 14(46.7%) of the operated cases were allowed to bear 36-45 Kg weight (p=0.024), and in the 6th month, there were 20(66.7%) operated cases were allowed to bear full weight after the radiological union (p=0.013).
 CONCLUSION: Bridge plating technique is a safe, easy, and effective method of fixation for comminuted diaphyseal fractures of long bones in terms of bony union and weight bearing. It has a high rate of union with fewer complications.

Role of Elastic Stable Intramedullary Nailing in Diaphyseal Fractures in Children

Background: All femoral or tibial fractures regardless of associated injuries, intramedullary nailing (IMN) has its more advantages in rapid rehabilitation, good effects on the child and his family and strong fixation. Objective: To assess the role of elastic stable IMN in union of diaphyseal fractures of long bones in children. Patients and Methods: A prospective and retrospective analytical study on ten children with isolated femoral or tibial fractures who were admitted to Orthopedic Department, Zagazig University Hospitals. They were divided equally into group I that included 5 patients with femoral shaft fracture managed with IMN and group II, which included 5 patients with tibial shaft fracture managed with IMN. Their mean age was 4.7 years old. Results: When the groups compared, the spica cast group was found to have a shorter duration of hospital stay compared to elastic nail group. The knee range of motion of the spica cast group was found to be better compared to the elastic nailing group. The elastic nailing group was found to have started walking earlier both with and without support. Patients with intramedullary nailing started to walk with aid after one month and independently after 2 weeks. Patients with spica cast started to walk with aid after 2 months and independently after 12 weeks. Conclusion: None of the available treatment tools to fix diaphyseal long bones fractures in preschool children is perfect because each method has its own set of complications. However, constitute the motive for developing new techniques or changing the design of currently available devices.

Biological and biomechanical basis of long-bone diaphyseal fractures: from fracture to non-union

Bone healing of diaphyseal fractures is a complex biological process that can often be adversely affected by patient-related and fracture-related factors and eventually end in delayed union and non-union. Surgical and non-surgical approaches have been widely applied, according to the fracture pattern and patient characteristics. For humeral diaphyseal fractures, plate fixation provided excellent results in terms of healing rate and time to union. For femoral and tibial shaft fractures, locked intramedullary nailing is considered the technique of choice. If impaired, the reparative process after intramedullary nailing can be enhanced through different surgical techniques, such as dynamization or exchange nailing. Moreover, the mechanical stability of the fracture site can be improved through augmentation plating, bone grafting or external fixation techniques, with satisfactory results. This article aims to review the biomechanical principles of reparative osteogenesis in long bone fractures after conservative and surgical treatment. Moreover, the evidence on the current options for bone healing enhancement, and treatment and prevention of delayed union and non-union will be discussed.

Primary union with external fix in open bothbone leg fracture as definative management

These days RTA and violence are on the rise and accounting for more cases of trauma in which bony injuries are common .Fracture of tibial shaft is due to its subcutaneous location is very often involved in these kind of injuries.this study was done to evaluate the effectiveness of external fixator as primary and definitive treatment for open tibia fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients [1]. Intramedullary nailing is considered the method of choice for treatment of closed diaphyseal fractures of long bones. However, there is controversy in the literature regarding the best way of managing open type II and type III fractures, tibial shaft fractures with severe soft tissue injuries or compartment syndrome, multiply injured patients. Material and Methods: A total of 16 patients who satisfied our inclusion and exclusion criteria were taken and were treated with AO external fixator as primary or secondary to failed Intramedullary nailing . patients were assessed radiologically and clinically. Results: as per clinical parameters of Karlstrom and Olerud 37% patients had excellent outcome 31% had good outcome 18% had fair outcome and 12% had poor outcome. Conclusion: Meticulously primary wound debridement at earliest is an absolute. Which augments prognosis and prevents complication. External fixator is now accepted, reliable and convenient method to manage open Long Bones fracture.

Post Plating Aseptic Non Union of Diaphyseal Fractures of Long Bones - A Treatment Protocol by Dual Plating

Post Plating Aseptic Non Union of Diaphyseal Fractures of Long Bones - A Treatment Protocol by Dual Plating

Treatment options in femoral radiation fractures following soft tissue sarcoma: Incidence, risk factors, failures and flowchart of treatment.

The femur is the most frequent involved site by post-attinic fractures. The appropriate treatment of pathological fractures after radiotherapy is still controversial as they are associated with a high risk of delayed consolidation and non-union. Authors review a single Center series of pathological fractures after radiation therapy in patients affected by soft tissue sarcomas analyzing incidence, risk factors, failure rate and proposing a flow chart of treatment of postattinic fractures of the femur. Authors selected 570 patients treated by limb salvage surgery associated to radiation therapy from 1992 to 2018. A pathological fracture during follow up was observed in 28 cases (5%). The mean time between the onset of the fracture after the prior surgery+radiotherapy was 70 months (range 3-182). The mean follow-up from the fracture was 86 months (range 9-222). The fracture treatment was performed with an intramedullary nail in 15 cases. Eight femoral fractures healed uneventfully (57%) and 6 required further surgical procedures. A total of eight patients underwent prosthetic replacement, 3 as a primary treatment and 5 as a salvage procedure after failure of internal fixation. Five patients developed a deep infection (62.5%).We observed 10 non-union (53%) in 19 patients treated with osteosynthesis. Overall amputation rate of the entire series was 18%. Authors propose a flowchart of treatment for femoral fractures. Intramedullary nailing is the treatment of choice in postradiation diaphyseal fractures of long bones, prosthetic replacement in meta-epiphyseal fracture site. Free vascularized grafts remain a valid salvage solution after failure of internal fixation.

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones

BackgroundExternal fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann® 3 system, as a reference.MethodsTransversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading—axial compression, medio-lateral (ML) bending, and torsion—in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2, and H3-SR (nine constructs each). Nine constructs were stabilized with UBEF1, UBEF2, and H3-DR (three constructs each).ResultsUUEF2 was significantly stiffer than H3-SR (p < 0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p = 0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p < 0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p = 0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p = 0.013).ConclusionsThe results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices.

Serum alkaline phosphatase: A prospective biomarker for assessment of progress of fracture healing in diaphyseal fractures of long bones in adult patients

Introduction: Serum biomarkers such as Alkaline Phosphatase can be used to assess bone-forming activity. Studies have shown that the measurement of bone formation markers such as Serum Alkaline phosphatase during the fracture healing process could enhance the accuracy of the bone healing stage assessment, allowing early detection in patients at risk of the development of delayed union or non-union. Aims: To evaluate the changes of serum alkaline phosphatase levels during healing of diaphyseal fractures of long bones in adults treated operatively. Materials and methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 91 adult patients ranging from 18 yrs to 50 yrs with diaphyseal fractures of the tibia or femur who met the inclusion criteria were recruited in our study. Patients with systemic diseases and drugs intake which could affect the bone turnover were excluded from our study. The fractures were treated with closed reduction or open reduction and internal fixation with intramedullary nailing. The biomarker serum Alkaliine Phosphatase was measured at definite intervals until bony union was achieved clinico-radiologically. Results: Out of the 91 patients, 36 patients (Group A=normal healing group) achieved bony union by the end of 6 months. 50 patients (Group B=delayed healing group) where bony union was not completed by the end of 6 months but completed by 9 months. 5 patients (Group C=non-union group) where bony union was not seen even by the end of 9 months. At the time of admission, mean serum ALP levels remained within normal limits in all the three groups. Mean serum ALP levels followed the same pattern in Group A and Group B reaching the maximum levels at 3rd week post trauma but the mean serum ALP at every selected interval was significantly higher in Group A than Group B. In Group A, the mean serum ALP returned to baseline level by the end of 6 months, whereas, in Group B patients, the mean serum ALP remained elevated even by the end of 6 months. In group C patients, the mean serum ALP level did not rise significantly throughout the period of study. Conclusion: Thus, the determination of serum ALP levels during the fracture healing could be an additional tool to help predict fractures at risk of delayed union or non-union of diaphyseal fractures therby allowing the clinician to step in early and take appropriate intervention.

Study of role of limited contact dynamic compression plates versus locking plates in long bone fracture management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Present study was conducted to assess the functional, radiological, clinical factors associated with long bone fractures stabilized with limited contact dynamic compression plating (LC-DCP) and locking plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective observational study conducted over 2 years, 60 osteoporotic patients undergoing surgery for diaphyseal fractures of long bones at the study centre were studied. Two groups were formed on the basis of usage of LC-DCP plate or the locking plate in fracture management. Participants were thoroughly evaluated clinically. Radiographic assessments included evaluation of callus formation and fracture fragments after the functional load. Functional outcome was assessed based on the range of movements and the ability to carry out daily activities. Disabilities of the arm, shoulder and hand (DASH) score was also calculated. Post-operative follow-ups were conducted at 6 weeks, 12 weeks and 1 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Radius or ulna were the commonest site of fracture with more than half (35, 58.33%) patients affected with 93.3% having middle 1/3&lt;sup&gt;rd&lt;/sup&gt; diaphysis fracture. There were no significant differences between the genders for site or location of fractures. DASH scores were comparable in both groups. The mean union time was significantly higher among females (9.76±2 weeks) than males (8.59±1.21 weeks). Most patients took 14-16 weeks to achieve the functional outcome, with LC-DCP observed to provide faster functional recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Radius or ulna fractures are the commonest amongst long bone fractures, with middle 1/3&lt;sup&gt;rd&lt;/sup&gt; diaphysis being the commonest site of affection. LC-DCP facilitates slighty faster fracture union and functional recovery than locking plates, with union time being significantly longer in females.&lt;/p&gt;

Use of flexible intramedullary nailing in treating diaphyseal fractures of long bone of lower limb in children

Background: Management of diaphyseal fractures of long bones of the lower limb in the age group of preschool to early teenage has multiple methods of treatment ranging from conservative management to internal fixation using open/closed reduction methods. Objective: The study was performed to know the potential of using principles of intramedullary nailing in treating diaphyseal fractures of long bones of the lower limb in preschool to early teenage population. Materials and Methods: Patients with diaphyseal long bones fractures of tibia and femur in between the age group ranging from 5 to 14 years were treated by closed reduction and internal fixation using titanium elastic nailing system (TENS) nail. The results were evaluated on the basis of radiological signs of union and Flynn's criteria. The average time after which surgery was done is 2 days. Results: Of 14 patients, eight patients had diaphyseal femur fracture and remaining six had diaphyseal tibia fracture treated by TENS nailing.Thirteen patients achieved union in a mean time of 8 weeks with full-weight-bearing in around 10 weeks. The average time duration of hospital stay was 6 days and follow-up period was up to 24 weeks. Conclusion: The use of flexible intramedullary nailing in properly selected patients in the preschool to early teenage population is an effective method of treating diaphyseal fractures of long bones of the lower limb.

Correlation of nutritional parameters in long bone diaphyseal fracture healing

Purpose: To study whether the nutritional status of the patient has any effect on the outcome of fracture healing. To correlate various clinical and biochemical parameters for assessment of nutritional status with union of fracture.Material and Methods: One hundred and two patients having diaphyseal fractures of various long bones were followed prospectively for two years. The patients were categorized into ‘malnourished/ undernourished’ and ‘nourished’ status according to the anthropometric markers like body mass index, triceps skin fold thickness and mid arm muscle circumference; and biochemical markers like Hemoglobin, serum albumin, serum transferrin, serum ferritin and creatinine-height index. These fracture was evaluated clinically and radiologically for healing.This union time or quality of union was correlated with the anthropometric and biochemical parameters.Results: Femoral diaphyseal fractures were the commonest fracture identified (n=35, 34. 31%) followed by radius and ulna (28%), tibia and fibula (25%) and humanus (12%). High velocity road traffic accident was the most common mechanism of injury seen in 49 fractures (48.04%) followed by fall from height (40%) and Domestic trauma (12%). None of the biochemical parameters showed any correlation for fracture healing. Only Serum Albumin, Creatinine-Height index, Serum transferrin could show significant correlation with malnutrition and poor fracture healing.Conclusion: Thus our study concluded that serum albumin, serum transferrin and creatinine-height index were good biochemical indicators to predict union time. Anthropometric markers, so commonly considered for assessing deficiency in nutrition, do not correlate with fracture healing significantly and are meant for screening only. Altering the nutritional status while fracture treatment can promote healing.

Managing intraoperative fatigue failure of proximal jig for interlocking nail – A case report and technical tip

Interlocking nails are widely used implants in the management of long-bone diaphyseal fractures. Interlocking nailing is an easy, predictable, and standard method owing to the presence of ancillary instruments and image intensifier. Proximal jigs help in guiding and inserting nail as well as its proximal locking. Intraoperative breakage of proximal jig may be an uncommon problem that is underreported in the literature. The creative use of variable unrelated instruments may prove instrumental to manage the complication and result in safe surgery. We describe one such uncommon intraoperative failure of proximal jig during femoral interlocking procedure and our experience in getting past the hurdle by an innovative solution.

Study of titanium elastic nailing system in long bone fractures in children at Pravara rural hospital, Loni

Globally, traumatic injuries of long bones shaft fractures in children are the most leading causes of fractures in children. Now a days the use of elastic stable intra-medullary nails has dramatically increased with the introduction of a variety of nails for paediatric fractures [1]. The Titanium Elastic Nail (TEN) is intended for fixation of diaphyseal fractures of long bones where the medullary canal is narrow or flexibility of the implant is paramount. The aim of this study of biological, minimally invasive fracture treatment is to achieve a level of reduction and stabilization that is appropriate to the age of the child. The biomechanical principal of the Titanium elastic nailing is based on the symmetrical bracing action of two elastic nails inserted into the metaphysis, each of which bears against the inner bone at three points. This was a prospective longitudinal study done over a period of one year in children between 5-14 yrs age groups. The complication rates associated with Titanium elastic nailing have been reported to be minimal.

Evolution and principles of intramedullary locked nailing

Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture. The indication spectrum for modern intramedullary locked nailing includes diaphyseal fractures of long bones, metaphyseal fractures and reconstructions, as well as treatment of nonunion, osteotomy and arthrodesis of the lower extremities. Continuous improvements in nail design and instrumentation as well as the introduction of anatomical reconstruction nails will optimize the spectrum and effectiveness of intramedullary osteosynthesis even further.

Evaluation of serum bone specific alkaline phosphatase levels in isolated closed diaphyseal fractures of long bones in relation to fracture healing

Introduction: In day-to-day practice, progression of bone healing is assessed mainly by clinico-radiological parameters. Furthermore, clinicians are unable to identify the delayed and non-unions early, and even advanced imaging techniques may not be helpful in these cases. To date, the methods used to monitor the bone healing process have been based on the patients’ assessment and the radiographic findings. In view of the fact that patient opinion is highly subjective, that the radiographic findings depend on the radiologist’s experience and that the monitoring of bone healing is a long-lasting process, measurements of biochemical parameters appear to be the only objective evidence of the changes occurring during bone regeneration. The aim of this study was to examine whether the assessment of Serum bone specific ALP (BsALP) as a biochemical parameter in the early posttraumatic phase may indicate the course of fracture healing. Methods: Changes in BsALP levels were observed at definitive intervals in 30 adult patients (enrolled as per inclusion/exclusion criterion) with closed fresh (within 1 week) traumatic diaphyseal fractures of long bone. All the patients had been surgically treated. Regular follow up of these patients was done till 6 months. The changes in serum BsALP levels were recorded and correlated with the clinico-radiological progression of fracture healing in these patients. Result: The mean BsALP increased significantly from baseline to 6 and 12 weeks and then decreased significantly at 16 to 24 weeks. Conclusion: BsALP levels were increased in all cases of closed isolated long bone diaphyseal fractures with maximum increase at 12 weeks and never reached to baseline levels till 24 weeks. The increase in BsAlp levels was more in surgical fixation done with nailing as compared to plating. No relationship was observed between BsALP levels and fracture healing outcome.

Management of Diaphyseal Fractures of Long Bones in Children with Titanium Elastic Nails – A Prospective Study of 30 Cases

Management of Diaphyseal Fractures of Long Bones in Children with Titanium Elastic Nails – A Prospective Study of 30 Cases

Role of flexible elastic nails in diaphyseal fractures of long bones of lower extremities in children of 5-14 years of age

Femoral and tibial fractures are common long-bone injuries in children. Above five years of age all such fractures, when treated conservatively could lead to loss of reduction, malunion, intolerance and complications associated with plaster. The goals are to stabilize the fracture, to control length and alignment. Flexible Elastic Nailing has become the choice of stabilization in paediatric long bone fractures. The aim of our study was to see the outcome of Flexible elastic nailing system in diaphyseal fractures of children of 5-14 years age. The study included total of 50 children treated with flexible elastic nailing system and they were followed up at 3, 6, 12 and 24 weeks. The average duration of callus formation was 3.8weeks (4.2weeks in Tibia & 3.4 weeks in femur). Radiological union was seen in a mean time of 9.65 weeks. Full weight bearing was possible in a mean time of 10 weeks. According to flynn’s scoring criteria, excellent and satisfactory results were in 90% and 10% respectively. There were 2 cases of post-operative superficial infection which resolved with regular dressing and no cases of physeal injury and implant failure. Flexible elastic nail is a safe and satisfactory mode of treatment and is relatively easy to perform in disphyseal fracture of femur and tibia in children. It avoids the chances of physeal injury, infection and offers early mobilisation and rapid healing.