Early Union Research Articles

Functional evaluation of unstable intertrochanteric fractures treated with proximal femoral nailing

In this study the functional outcome of proximal femoral nailing (PFN) in patients with unstable intertrochanteric fractures is studied and outcome is assessed with Modified Harris Hip Score. A post-operative analysis of unstable intertrochanteric fractures treated with PFN is done for its functional assessment. Various national & international studies are taken into consideration and our institutional study is compared with them. Between September 2020 to March 2022, 20 patients with unstable intertrochanteric fractures of the hip joint who were operated with PFN were functionally and clinically evaluated as per the Modified Harris Hip Score. Patients who satisfied the inclusion criteria were included in the study and follow-up was done up to 9 months. Fracture pattern, operative details and post-operative complications were documented. This study of 20 patients of unstable intertrochanteric fractures fixed with PFN showed excellent results in 9 patients (45 %), good functional outcome in 6 patients (30 %) and fair functional outcome in 3 patients (15 %). 2 patients showed a poor outcome accounting for 10%. The study showed that PFN is a reliable and effective device for the treatment of unstable intertrochanteric fractures. It provides a satisfactory fixation, but success is dependent mainly on fracture type, bony architecture, operative technique, postoperative care and rehabilitation. In view of the fewer post-operative complications, early union of fracture, early weight bearing and early return to work, we concluded the PFN to be a versatile, stable and acceptable implant in fixation of unstable intertrochanteric fractures which leads to a better functional outcome.

Long-term functional outcomes of BIFOLD osteosynthesis in distal femoral fractures with metaphyseal comminution: A retrospective analysis

BackgroundThis retrospective study aimed to evaluate the long-term functional outcomes of BIFOLD osteosynthesis, employing retrograde nailing and distal femoral locked plating, in patients with distal femoral fractures and metaphyseal comminution. MethodsA retrospective analysis was conducted on patients treated for distal femur fractures with metaphyseal comminution between 2012 and 2022, with a minimum follow-up of 2 years. Inclusion criteria encompassed distal femur fractures with metaphyseal comminution, excluding specific conditions. BIFOLD osteosynthesis was employed in all 33 cases, utilizing retrograde SIGN (Surgical Implant Generation Network Nail) and distal femoral locking plates. Primary outcome measures included radiographic and functional outcomes assessed through the Sanders functional evaluation score, with secondary outcomes focusing on perioperative or postoperative complications. ResultsA total of 33 patients (21 male, 12 female) were included, with an average age of 51.4 years. BIFOLD osteosynthesis exhibited an average radiographic fracture healing time of 6.2 ± 2.5 months. The procedure's average operative time was 100 ± 15 min, and blood loss averaged 420 ± 50 ml. According to Sanders criteria, 28 patients (84.84 %) demonstrated well-to-excellent functional outcomes, while 3 patients (9.09 %) reported fair outcomes, and 2 patients (6.06 %) reported poor outcomes. No significant shortening or implant failure occurred, and all patients achieved over 90 degrees of knee range of motion within 8 weeks. One patient experienced superficial infection, and two patients exhibited insignificant coronal plane deformity. ConclusionBIFOLD osteosynthesis, combining intra and extra medullary fixation principles, offers a stable construct for distal femoral fractures with metaphyseal comminution. This approach facilitates faster ambulation, pain relief, early knee joint mobilization, and significant early union, resulting in improved functional outcomes. Additionally, BIFOLD osteosynthesis helps prevent collapse, translational and rotational deformities, as well as shortening.

Empowering Women Leadership Through Community Mobilization to Prevent Early Marriage

This qualitative research study explored the impact of early marriages on women in Malang Regency and examined strategies for preventing such marriages by empowering women. Utilizing data collected through Focus Group Discussions (FGD), the research investigated the complex web of social, economic, and generational consequences resulting from child marriages in rural areas. The study highlights the significant role played by Women’s Leadership Houses (RKP) in the Singosari and Karangploso regions, where community mobilization is employed to foster gender equality and empower women. RKP’s community engagement approach allows members to dissect the underlying factors driving early marriages and adolescent interactions within their communities. The research uncovered a diverse range of issues associated with early unions, each uniquely shaped by the local environment. RKP’s methodology places a strong emphasis on problem identification and potential recognition, encompassing human and natural resources while challenging prevailing social norms that perpetuate early marriages. In conclusion, this study underscores the importance of empowering women and promoting gender equality as key strategies in preventing early marriages. Through qualitative research methods and community engagement via FGDs, we can aspire to create a future where early marriages become a historical relic and women attain the agency and opportunities they rightfully deserve. Keywords: Early Marriage; Women Empowerment; Community Mobi-lization; Gender Equality

Open Reduction and Internal Fixation versus Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Extra-Articular Fracture (Mini Thesis)

Abstract Background Extra-articular distal tibia fracture is one of the difficult fractures to treat and the optimal treatment remains controversial, however plates seem to be the obvious choice for treating this type of fractures. The mechanism on how to achieve the balance between anatomic reduction and indirect reduction as well as direct and indirect healing remains unclear. Thus, the key point is whether to use ORIF or MIPO in treating fractures. Aim of the Work to provide a complete overview of the optimal plating technique for distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive plate osteosynthesis (MIPO) vs Open reduction and internal fixation (ORIF) for treating extra- articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (AOFAS score). Patients and Methods From August 2020 to August 2021, a prospective randomized study was conducted at the department of orthopedic surgery of Ain-shams University Hospital including 36 patients to compare MIPO vs. ORIF in fixation of extra-articular distal tibial fractures. The patients were allotted to the MIPO or ORIF group with the flip of a coin. Results Regarding complications rate, no cases developed infection in MIPO technique. On the other hand, the ORIF technique had an infection incidence of 16.6% overall, with two cases (11.11 %) developing superficial infection and one case (5.56 %) developing deep infection. There was no significant difference in the incidence of mal-union between both techniques with no cases of non-union in both groups. The MIPO group had only one case of sagittal plane malunion (5.56%), compared with no cases in the ORIF group. There was no significant difference between both groups in secondary operations rate, with one case in each group. Conclusion Both MIPO and ORIF have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although MIPO is advantageous over ORIF with earlier weight-bearing, earlier union, and clinical lower incidence of infection, it has delayed operation time.

How Effective is Fibula Pro Tibia Plating in Treatment of Distal Tibial Fractures: A Pilot Study.

Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Uniones tempranas en adolescentes afrocolombianas en el municipio de Zaragoza, Antioquia

This article arises from an educational research whose purpose is to understand the incidence of cultural and social aspects that influence early unions of Afro-Colombian adolescents between the ages of fourteen and sixteen. For the purposes of this study, early union was defined as the union of two individuals where one of the two is under eighteen years of age. The study was carried out in the Luis Fernando Restrepo Restrepo Educational Institution, located in the municipality of Zaragoza, Antioquia, during the period 2021-2023. This research process adopted a qualitative approach, inspired by Latorre's (2005) action research. The results of the research revealed relevant factors that influence this phenomenon. Among them, the normalization of early unions and their contribution to the prolongation of poverty was highlighted, as well as the perpetuation of gender patterns, the circle of violence, roles and stereotypes. In this context, education plays a crucial role, as it empowers girls and adolescents to make informed decisions and avoid being constrained by harmful practices that may hinder their future.

The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health

Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout,...

Effect of Denosumab Injection in Early Union and Consolidation o f Callus in Aseptic Tibial Shaft Non-union

Fractures of the tibial shaft is one of the most common fractures than any other long bone fractures in the human body. Surgical treatment offers better functional outcome than a conservative management. Reamed intramedullary interlocking (IMIL) nailing is the treatment of choice for most of the closed tibial shaft fractures. Despite after a good surgical fixation non-union still persists after reamed IMIL nailing. Plate augmentation and bone grafting with nail in situ was found to have superior results and union rates than any other methods, but the average union time was almost 3 to 5 months. To enhance faster union and recovery here we have used Injection Denosumab 60 mg Sc post operatively during follow up. So, the aim of the study is to find the efficacy of injection Denosumab in enhancing early union and consolidation of callus. It is a comparative prospective study involving 43 patients treated for aseptic non-union of tibial shaft fractures following reamed intramedullary interlocking nailing between 2020 and 2023. All the patients treated by reamed intramedullary interlocking nailing who met the inclusion and exclusion criteria were included in the study. Group A was managed with plate augmentation and bone grafting following non-union IMIL nailing and Group B was managed with Plate augmentation bone grafting with Injection Denosumab Sc post operatively. Both the groups were followed up post operatively for period of one year. Total of 43 patients were included in the study. The average duration of union in GROUP A -14.82 weeks and in GROUP B- 9.45 weeks. Excellent results were obtained in both the groups. There was no complication such as malunion, non-union, implant loosening, nerve palsy, infection and plate/IMIL nail breakage. Augmentation plating, decortication and autogenous iliac crest bone grating is a better treatment option compared to exchange nailing in case of tibial shaft aseptic non-union following IMIL nailing. Using injection denosumab 60mg Sc postoperatively after plate augmentation and bone grafting offers early union and early consolidation of callus. Keywords Tibial Shaft Fractures, Intramedullary Interlocking Nailing, Plate Augmentation, Bone Grafting

Immediate versus early soft tissue coverage for severe open grade III B tibia fractures: a comparative clinical study

Controversy remains regarding timing in the management of grade III-B open tibia fractures. Many authors recommend an immediate definitive soft tissue coverage within a critical period of 12 hours, yet in many patients, this may be impossible due to concomitant injuries or delayed referral. The present case series aims to compare the role of immediate versus early soft tissue coverage for severe open grade III-B tibial fractures. 20 cases of tibial fractures of were divided into two groups; 10 cases each. Immediate group (within 12 hours) and early group (3-7 days), according to the soft tissue coverage time. Strict criteria for inclusion in the first group included debridement within 12 hours of injury, no sewage or organic contamination, the presence of bleeding skin margins, and the absence of systemic illness. All 20 cases had been treated by a debridement and soft-tissue cover with a muscle pedicle or fasio-cutanous flap. Functional outcome measures included deep infection rate, stable soft tissue coverage, number of inpatient’s stays, number of surgical procedures, and union time. The mean follow-up period was 24 months. Mean inpatient time was 30 and 41 days respectively. Mean surgical procedures were 2.2 and 3.4 respectively and union time was 26 versus 34 weeks. Mean inpatient time, mean surgical procedures per time and union time were pointedly less in the immediate flap coverage group which significantly improves results concerning early union, healing time, and cost of hospitalization and rehabilitation.

From 'Pen Sao' to 'Tue Pa': Understanding diverse pathways to adolescent pregnancy in Lao People's Democratic Republic through qualitative investigation with girls in Vientiane Capital, Vientiane Province, and Luang Namtha.

Adolescent birth rates in Lao People's Democratic Republic (PDR) remain the highest in Southeast Asia. There is growing recognition that adolescent pregnancy in Lao PDR is occurring within and outside marriage, but there is a lack of robust qualitative evidence to understand girls' pathways to adolescent pregnancy and contributing factors, especially outside of union (cohabitation or marriage). This study aimed to improve understanding of pathways to adolescent pregnancy in Lao PDR among girls who experienced pregnancy at age 18 or below. We conducted participatory timeline interviews with 57 girls from urban, peri-urban, and rural communities in Vientiane Capital, Vientiane Province, and Luang Namtha, and follow-up interviews with a subset of 20 girls. We identified six pathways to pregnancy, including pathways outside (n = 23) and within union (n = 34). Outside-union pathways diverged according to the nature of sex preceding pregnancy (consensual/pressured, or forced), and pregnancy intention (unplanned, partner-led, or planned). Within-union pathways diverged according to the nature of the relationship before union (romantic or no romantic relationship/arranged union), who initiated the union (couple/girl, parent/partner, or pressured), and pregnancy intention. Factors contributing to girls' pregnancy included barriers to sexual and reproductive health (SRH) information and services; partner's control over reproductive decision-making; male sexual entitlement and alcohol use driving pressured/forced sex; cultural acceptance of child marriage and early union; and attitudes and norms regarding sex and pregnancy outside of union. Our findings support strengthening comprehensive sexuality education, including a focus on addressing myths about contraception, building girls' and boys' communication skills, engaging in respectful relationships, and addressing harmful gender norms. Our findings also highlight the need to improve girls' access to adolescent-responsive SRH services, address harmful substance use, challenge sociocultural barriers to young people accessing SRH information and services, and respond to sociocultural and financial drivers of child marriage/early union that contribute to adolescent pregnancy.

Prospective study of surgical management of femoral shaft fractures in children using tens nail

Background: Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods: This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria. Results: Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion. Conclusions: TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.

Minimally Invasive Percutaneous Plate Osteosynthesis versus Interlocking Intramedullary Nail Fixation in Treating Extra-Articular Distal Tibial Fractures in Adults. A Systematic Review

Background IM nailing and MIPPO fixation remain viable options for management of distal tibia fractures. IM nailing provides superior operation time, union time, and time to full weight-bearing as well as a lower incidence of superficial and deep infection, but may provide inferior alignment and is associated with residual knee pain. MIPPO fixation provides superior alignment and avoids knee pain, but it has a higher rate of soft-tissue complications and hardware irritation. This review revealed that MIPPO has a higher risk of both superficial and deep infection among patients treated with MIPPO compared to IMN. In the MIPPO technique, 15% developed a superficial infection, compared to 7% after IMN, and 14% developed a deep infection, compared to 6.3% after IMN. Aim of the Work to provide a complete overview of the optimal surgical treatment of distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs Interlocking intramedullary nail (IMN) for treating extra-articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (quality of life scores and ankle scores). Patients and Methods In terms of union complication, IMN has a higher incidence of malunion which occurred in 14.7% of the patients after IMN compared to 8.8% after MIPPO fixation. The incidence of non-union was similar in both treatment methods, it occurred in 3.5% of patients. In addition to union rate, the union time was significantly shorter after IMN fixation compared to the MIPPO technique especially in AO 43A fracture type and the closed fractures. The mean time for union was 18 weeks in IMN compared to 20 weeks in MIPPO. Results Nine studies including 813 patients reported on operation time with an overall weighted mean operation time of 74.1 minutes (range 56.4 – 124 minutes) in IMN and 85.4 minutes (range 51.4 – 124 minutes) in MIPPO. The operation time in the IMN was significantly shorter compared to MIPPO (WMD -11.24 minutes, 95% CI -15.44 to -7.05, P < 0.05) with significant moderate heterogeneity (I2 = 68%). Conclusion Based on this study, both MIPPO and IMN have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although IMN is advantageous over MIPPO with a lower incidence of infection and implant irritation symptoms, shorter operation time, earlier weight-bearing, and earlier union, it leads to a higher rate of mal-union and anterior knee pain. Overall, choosing an implant based on the findings of this meta-analysis is difficult and should be done on a caseby-case basis. Patients who have a high risk for infection (due to high age, comorbidities, smoking, or severe soft tissue injury) should preferably be treated with a nail. MIPPO fixation may be more beneficial to young, active, and healthy patients who are less prone to infection because it reduces the risk of knee pain and mal-union.

A gender story of institutional disengagement of young adults in Latin America

AbstractLatin America is home to many young adults who are neither engaged in formal education nor work, controversially dubbed as “nini” (“ni” trabajan “ni” estudian, denoting neither working nor studying). At the same time, early union formation and parenthood are pervasive in the region. Theories pertaining to the linkage between parenthood and female labor force participation are heavily based on evidence found in the Global North, with limited research on the topic in settings with less stable family structures, such as Latin American countries. This study tests the role household structure and family formation play on institutional disengagement of young adults in 12 Latin American countries. We explore the gender dynamic of human capital stagnation by focusing on early parenthood and conjugal partnership for women and men aged 20–25. We use censuses from the Integrated Public‐Use Microdata Series and country‐specific linear regression models. Our results reveal that the intersection of class and gender is a major determinant of institutional disengagement in the region. Women from lower social origins who leave parental home to enter conjugal union and parenthood at younger ages are particularly at risk. This study highlights the urgency of contextualizing the interplay between work and family within the framework of regional family norms, prompting further dialogues concerning the social implications of perceived inactivity.

Surgical and Functional Outcomes of the Results of Conventional Two-Screw Proximal Femoral Nail (PFN) Versus Helical-Blade Anti-rotation Proximal Femoral Nail (PFNA2).

Introduction An intertrochanteric (IT) femur fracture is an extra-capsular fracture between greater and lesser trochanters. Unstable IT fractures are those where there is poor contact between fracture fragments (especially medial and posterior cortices), comminution, and fracture pattern, such that the weight-bearing forces tend to displace the fracture further or a reverse oblique type. Proximal femoral nailing (PFN) is one of the modalities for proximal femoral fractures. A newer modality for proximal femoral fracture is PFNA2, i.e., PFN anti-rotation, which makes use of a helical blade for a better compaction of bone. Both nail designs (PFN and PFNA2) are available in short and long sizes (so a total of four variants). Only a few studies have compared the treatment of IT femur fracture concerning fracture geometry, design, and length using either of the two nail types. In our study, we assessed the surgical and functional outcomes of PFN and PFNA2. Materials and methods This prospective observational study was carried out on 30 patients who had sustained ITfractures of the femur. All cases of IT femur fractures more than 18 years of age, closed injuries, and the patients who consented to participate in this program were included in the study. All open injuries, the patients who refused to participate in this program, patients who have associated injuries, patients with a subtrochanteric femur fracture, and patients with less than six months of follow-up were excluded. The patients were randomized into two types of implant groups. All patients were operated with a standard protocol. The study was conducted for18 months from February 2021 to August 2022. The results were analyzed (of all four variants) by comparing patient demographics, implant size, implant type, locking methods, union time, and other parameters. Results Most of the patients were operated on with a 10 mm nail diameter (17/30 patients), 380 mm length (long-nail group) (five/11 patients), and 250 mm length (short-nail group). With the use of PFNA2, the overall duration of hospital stay was less. The overall operative time (incision to wound closure) with the use of the short PFNA2 was lesser than that with the use of other designs due to the use of the zig for distal screws. The use of a distal dynamic locking screw in a majority of the patients can get better compression at the fracture site once the patient starts weight bearingand decreasethe chances of the Z-effect, reverse Z-effect, screw back-out, and screw cut-out. The union time was nearly the same in the majority of the patients, with an early union seen with the use of PFNA2 nails. The overall modified Harris hip score (HHS) at the final follow-up was nearly the same with slightly better results with the use of PFNA2. Conclusions PFNA2 is the implant of choice in elderly patients with osteoporotic bone. It has less operative time, which is required in such patients with medical comorbidities; hence, it has marginal superiority over PFN. Short-nail design results in less operative time and less blood loss.

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

Osteochondral Autograft Transplantation for Proximal Pole Scaphoid Nonunions

Osteochondral autograft transplantation (OAT) is a technique to reconstruct the proximal pole scaphoid nonunion associated with an intact dorsal and volar scapholunate ligament. This study aimed to report the clinical and radiographic outcomes in patients who underwent OAT for this indication. A retrospective review of patients who underwent proximal pole scaphoid nonunion reconstruction with a femoral trochlea OAT was undertaken between 2018 and 2022. Patient demographics, scaphoid nonunion characteristics, surgery details, and clinical and radiographic outcomes were obtained. Eight patients underwent the procedure at an average of 18.2 months from injury. Four patients failed prior attempts at scaphoid union surgery, one of whom failed two prior surgeries. Four had no prior surgery. The average follow-up was 11.8 months. The postoperative wrist flexion-extension arc of motion was 125° or 87% of the contralateral wrist. Grip strength averaged 30.0 kg or 86% of the contralateral side. Adjusted grip strength for hand dominance was 81% of the contralateral side. All OATs healed. Computed tomography scan confirmed the union in 6 patients between 6 and 10 weeks. Two patients whose radiographs demonstrated OAT incorporation at the time of follow-up did not undergo advanced imaging. Osteochondral autograft transplantation is an attractive surgical reconstructive procedure for patients with proximal pole scaphoid nonunions associated with an intact scapholunate ligament. Osteochondral autograft transplantation mitigates the need for vascularized bone grafting, has a rapid time to osseous incorporation, and has a simple postoperative course in which patients can expect early union, near-full range of motion, and grip strength. Therapeutic V.

The changing social gradient of marriage and cohabitation in seven Latin American countries

While research shows that cohabitation has increased significantly among highly educated individuals in Latin America, much less is known about how the relationship between educational attainment and first union formation has changed over time and across the region's countries. Accordingly, this paper describes the changes across cohorts in the type of first union (marriage or cohabitation) entered by women from seven Latin American countries. It also analyzes trends in the relationship between women's education and the type of first union within and between these countries. Using Demographic and Health Survey (DHS) data, life tables, discrete-time event history models, and predicted probabilities were estimated to analyze the changing determinants of first-union formation. The results pointed to an overall increase in first-union cohabitation over time, with some important differences across countries. The multivariate analysis suggested that women's education influences the type and sequencing of the first union, with socioeconomically disadvantaged women increasingly likely to transition to early unions and enter cohabitation rather than marriage.

Reduced angiogenesis and delayed endochondral ossification in CD163-/- mice highlights a role of M2 macrophages during bone fracture repair.

While recent studies showed that macrophages are critical for bone fracture healing, and lack of M2 macrophages have been implicated in models of delayed union, functional roles for specific M2 receptors have yet to be defined. Moreover, the M2 scavenger receptor CD163 has been identified as a target to inhibit sepsis following implant-associated osteomyelitis, but potential adverse effects on bone healing during blockage therapy have yet to be explored. Thus, we investigated fracture healing in C57BL/6 versus CD163-/- mice using a well-established closed, stabilized, mid-diaphyseal femur fracture model. While gross fracture healing in CD163-/- mice was similar to that of C57BL/6, plain radiographs revealed persistent fracture gaps in the mutant mice on Day 14, which resolved by Day 21. Consistently, 3D vascular micro-CT demonstrated delayed union on Day 21, with reduced bone volume (74%, 61%, and 49%) and vasculature (40%, 40%, and 18%) compared to C57BL/6 on Days 10, 14, and 21 postfracture, respectively (p < 0.01). Histology confirmed large amounts of persistent cartilage in CD163-/- versus C57BL/6 fracture callus on Days 7 and 10 that resolves over time, and immunohistochemistry demonstrated deficiencies in CD206+ M2 macrophages. Torsion testing of the fractures confirmed the delayed early union in CD163-/- femurs, which display decreased yield torque on Day 21, and a decreased rigidity with a commensurate increase in rotation at yield on Day 28 (p < 0.01). Collectively, these results demonstrate that CD163 is required for normal angiogenesis, callus formation, and bone remodeling during fracture healing, and raise potential concerns about CD163 blockade therapy.

A PROSPECTIVE RANDOMISED CLINICAL TRIAL TO EVALUATE THE EFFECT OF FIBULAR PLATING IN TWO STAGED TREATMENT OF TIBIAL PLAFOND FRACTURES

Introduction: A single blinded randomized clinical trial of distal plafond fractures , who were treated with primary external xation with and without bular plating followed by distal tibial plating .Sincere efforts were made to analyze and compare the results of bular xation and staged protocol in tibial plafond fractures. A prospective study was Materials and Methods: conducted for 40 cases of tibial plafond fractures who were aged between 18yrs - 65yrs and presented within 2 weeks of injury. Randomization was done to allocate 20 patients each into two treatment models – a)External xation with bular plating , b)External xation without bular plating. Second stage distal tibial lock plating was done in all cases and follow up was carried out. Results: Statistically signicant differences were found in case of operating time, duration of hospital stay in favour of external xation without bula plating group, but these may not be clinically signicant. Delay in second stage tibial plating was more in bular plating group. Fibula plating reduces rotational malalignment more signicantly than coronal and saggital plane malalignment. There is no signicant early union , malunion or nonunion on comparing both groups. Both the procedures gave equally good functional results. We recommend two stage protoc Conclusion: ol for management of plafond fracture to decrease complication rate and bular xation is not always necessary in those cases with undisplaced lateral column. Displaced bular fractures which destabilize the ankle mortise should always be picked up for bular plating.

THE CLINICO-RADIOLOGICAL AND FUNCTIONAL OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS IN PROXIMAL TIBIAL FRACTURES.

The proximal tibia helps in transmission of body weight and plays an important role in the stability and functioning of the knee joint. The goal of proximal tibial fractures treatment is to obtain early union of fracture in the most acceptable anatomical position with early and maximum functional return of activity. This study aims to determine the clinico-radiological and functional outcome of Minimally Invasive Plate Osteosynthesis in proximal tibia fractures. A total of 30 patients with proximal tibial fractures and fullling the inclusion criteria were included in the study. The fractures were classied according to the Schatzker classication. Patients were evaluated functionally using the Knee Society score and radiologically according to the Modied Rasmussen criteria. According to the Knee Society Score, 23 (76.67%) of the patients had excellent results, 4 (13.33%) patients had good results, 2 (6.67%) patient had fair results and 1 (3.33%) patient performed poorly. According to the Modied Rassmussen criteria, 24 (80.00%) of the patients had excellent results, 5 (16.67%) patients had good results, 1 (3.33%) patient had fair result and none of the patient performed poorly. Supercial surgical site infection was observed in 2 (6.67%) of the patients. 1 (3.33%) patient had delayed union and 1 (3.33%) patient had aseptic exposure of implant. In 26 of the patients there were no complications. There were no cases of deep infection. The present study shows and demonstrates that closed reduction and internal xation using the principles of minimally invasive plate osteosynthesis is a reliable method for the management of proximal tibial fractures.