Fracture Consolidation Research Articles

Humerus osteosynthesis in Green Iguana (Iguana iguana)

Background: The Green iguana (Iguana iguana) is a reptile belonging to the Iguanidae family. It is an ectothermic animal with arboreal habits and a daytime activity pattern. Leaves, fruits, and eggs are part of their diet. These animals can be found in the South, North and Central America. Free-living Green iguanas may suffer stress during environmental changes, which can lead to a homeostatic imbalance. There is a correlation between stress and anorexia which results in an increase in the occurrence of fractures. Reptile fractures are generally treated by providing rigid stabilization and alignment maintenance. The present study reports the use of locking-plate osteosynthesis in one iguana.Case: One female green iguana, weighing 1.690 kg, was assisted at the Hospital Veterinário Federal da Universidade Federal de Mato Grosso. During anamnesis, it was observed that this iguana was a non-captive animal, which had fallen from a tree. The animal was unable to perform physical movements with the forearm displaying bone crepitation. It was also observed apathy and dehydration. The iguana was subjected to a range of supplementary examinations and on the x-ray image, it was detected that there was a complete right humerus fracture. Following examination, the animal underwent surgery for fracture stabilization. Humerus osteosynthesis was performed with compression in a 1.5 mm 6-hole locking-plate. During the osteosynthesis procedure a morphogenetic graft was inserted. Immediate post-surgery radiographic evaluation was performed, and that confirmed fracture reduction and bone alignment. The animal displayed clinical improvement after the second post-operative day once it returned to regular ingestion of diet. On the 30th post-operative day, the radiographic evaluation showed evidence of bone consolidation. On the 40th post-operative day, the animal displayed satisfactory gait and voluntary ingestion of food, thus enabling its return to the wild.Discussion: In this case study, the iguana displayed a satisfactory body condition score and good bone quality, which suggested a fall from a tree as the cause of the fracture, rather than a metabolic bone disorder. The osteosynthesis procedure followed the principles of orthopaedic surgery. The literature shows that there are reports of osteosynthesis being performed with the aid of intramedullary rod insertion. The intramedullary rods do not neutralize rotational forces, and thus are not recommended for the treatment of transverse fractures, like the one in the present study. A 6-hole 1.5mm locking-plate was inserted during osteosynthesis on this iguana. The protocol used was the one letting just the two middle-locking-plate holes free. This technique provided the advantage of fixation as a means of functional support once the power of the vascular system has not been damaged. In this case study, a bone morphogenetic protein was used in order to induce the differentiation of mesenchymal cells into chondroblasts and osteoblasts. However, whether such a procedure influenced the consolidation of the bone fracture remains unsolved since it was not possible to assess owing to a lack of previous studies to determine the base parameters of the bone healing process in this species. It was observed that osteosynthesis with a locking-plate, effectively consolidated the humerus bone fracture of the Iguana iguana, and enabled its early return to the wild notwithstanding.

Treatment of Avulsion Fractures of the Base of the Fifth Metatarsal with Walking Boot and Hard-Soled Shoes: A Comparative Study

Category:Midfoot/Forefoot, TraumaIntroduction/Purpose:Acute avulsion fractures of the base of the fifth metatarsal are common and usually treated non- surgically with satisfactory outcomes. Forms of conservative treatments are described such as elasticated bandaging, immobilization in a cast, walking boot and hard-soled-shoes.The aim of this study was to compare the clinical and functional outcomes, time to return to the previous activities, time and rate of fracture healing of the patients with avulsion fracture of the base of the fifth metatarsal treated in a hard-soled-shoes (HSS) or in a walking boot (WB). Our null hypothesis is that a less rigid immobilization without restriction of the ankle yields the same final results.Methods:A retrospective and comparative study of 72 patients with acute avulsion fractures of the base of the fifth metatarsal treated with the WB or the HSS, from March 2014 to November 2018. The average age of the patients was 41,25 (range, 11-88) and there were 56 female and 16, male. 39 were treated with the WB and 33, with the HSS. Patients with comorbities that could interfere in the rate and time of bony healing (diabetes and inflammatory joint disease), associated ankle ligament lesions and loss of follow-up were excluded.Patients were followed regularly until they were clinically asymptomatic and able to return to their previous activities (work, daily activities, sports). We retrospectively reviewed medical records containing the visual analogue scale (VAS) for pain and the american orthopaedic foot and ankle society (AOFAS) score of each visit as well as radiographic exams to evaluate time and rate of fracture healing.Results:Patients of both groups had similar VAS and AOFAS scores in 8 (p=0,34 and p=0,83) and 12 (p=0,25 and p=0,79) weeks. Age and gender distribution in the two groups were equal (p=0,23 and p=0,34, respectively). Time taken to return to the previous activities were not significant different between both groups, with the HSS group taking 8,33 weeks and the WB taking 9,73 weeks (p=0,10). The mean time for bone consolidation was significant higher in the HSS group, taking 8,64 weeks while in the WB took 7,18 weeks (p<0,001). Only 1 case of non-union was observed in the WB group and none in the HSS group.Conclusion:Our study concluded that avulsion fractures of the base of the fifth metatarsal can be treated equally with the HSS or the WB. Both types of immobilization showed to be equivalent in terms of clinical and function evaluation, return to the previous activities without difference in the rate of the fracture consolidation.

The effect of A-PRP-therapy on reparative regeneration of bone tissue with acute bone fractures of the limbs

Material and methodsThe study consisted of two parts – in the first part we studied the effect of A-PRP-therapy on the model of a comminuted fracture created in the operating room, an experimental study conducted on 40 Mature rabbits of the Flander breed, all animals were divided according to the principle of analogues into 2 groups (20 animals): in the study group – on the 5th day after osteotomy, platelet-rich plasma was injected into the fracture area, in the comparison group – the fusion occurred without the influence of any drugs. The second part presents the results of clinical testing of A-PRP-therapy, analyzed the results of treatment of 16 women with low-energy fractures of the distal radius metaepiphysis. The study group consisted of 6 patients whose surgical treatment was supplemented by A-PRP-therapy on 7, 14 days after surgery. The control group consisted of 10 patients who underwent surgical treatment without A-PRPtherapy.Results:The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.ConclusionPlatelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective procedure. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the Use of a-PRP-therapy to stimulate the maturation of bone calluses. Results The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.ConclusionPlatelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective alternative to the methods considered. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the use of PRPtherapy to stimulate the maturation of bone calluses.

Stress fracture of the posterior talar process in a female long-distance runner treated by osteosynthesis with screw fixation via two-portal hindfoot endoscopy: a case report

BackgroundStress fracture of the lateral tubercle of the posterior talar process in runners is extremely rare. Here, we describe a case of a female long-distance runner who sustained a stress fracture of the lateral tubercle of the posterior talar process. Osteosynthesis with screw fixation via two-portal hindfoot endoscopy achieved a good surgical outcome with a less invasive procedure.Case presentationAn 18-year-old female long-distance runner who belonged to her university’s road running club presented to our institution with a half-year history of persistent left hindfoot pain when running. Radiographs revealed a stress fracture of the lateral tubercle of the posterior talar process. Because the fracture showed no signs of healing 3 months after starting conservative therapy, osteosynthesis with screw fixation was performed via two-portal hindfoot endoscopy. Non-contrast computed tomography at 10 weeks postoperatively revealed consolidation of the stress fracture. At 15 weeks postoperatively, the patient was permitted to jog and return to athletic activity while wearing an orthosis. As of this writing 2 years postoperatively, she remains an active competitive runner.ConclusionsOsteosynthesis with screw fixation via two-portal hindfoot endoscopy was a less invasive procedure that successfully treated stress fracture of the lateral tubercle of the posterior talar process in this female long-distance runner.

Dental evaluation specificity in orofacial damage assessment: A serial case study

IntroductionThe evaluation of medico-legal post-traumatic events has been increasing over the last decades. This study analysed the input of dental evaluation in orofacial damage assessment, highlighting the individual's biopsychosocial model, by a serial case study. It is aimed to analyse the physical as well as the psychological repercussions of traumatic events. It also aimed to relate the type of trauma impact with the individual's sequelae. Material and methodAn observational and retrospective study was carried out of Portuguese medico-legal database. A serial case study was distinguished by the direction of the impact: frontal striking, lateral striking and clashing with a bidirectional (frontal-lateral). Results and discussion7 cases fulfilled the inclusion criteria, as a pilot study. They have in common the involvement of the 2 lower thirds of the face, including the temporomandibular joint. The consolidation of the maxillary bone fractures does not always correspond to restituto ad integrum. ConclusionThe impact direction may guide clinical examination in detecting permanent impairment, emphasizing temporomandibular joint disorders, as well as their association with psychosocial repercussions. The medical-dental examination is differentiating and relevant to the accomplishment of the general objective of damage assessment.

Platelet-rich plasma, bone marrow and chitosan in minimally invasive plate osteosynthesis of canine tibia fractures - a randomized study

The goal of this study was to analyse the effects of percutaneous application of platelet rich plasma (PRP), autologous bone marrow concentrate (BM) and chitosan gel (CHI) on bone consolidation following minimally invasive plate osteosynthesis (MIPO) of the fractures of the tibia in dogs. Client-owned dogs (n = 30) with tibial fracture were divided into four treatment groups – Group 1 (control), Group 2 (BM), Group 3 (PRP) and Group 4 (CHI). The biomaterial specific to each group was injected at the fracture site immediately after the MIPO procedure. Serial radiographs were used to determine the fracture line and the development of periosteal callus immediately after surgery and at 15, 30, 60, 90 and 120 days post-surgery. There was no significant difference (P &amp;gt; 0.05) in the degree of oedema or grade of lameness between the groups. Grade 4 (minimum) or 5 lameness (absent) was observed in 70% of animals from all groups at 15 days post-surgery. The biomaterials PRP, BM and CHI combined with MIPO contribute to bone consolidation of tibial fractures in dogs and do not cause adverse reactions or fracture complications. Bone marrow concentrate results in shorter bone consolidation time.

Changes in Indicators of Microcirculation in the Early Postoperative Period in the Treatment of Diaphyseal Fractures of the Shin Bones Using a Plate with Limited Contact

Background. Unsatisfactory results of treatment, such as delayed consolidation and non-fusion of fractures, the formation of false joints and limb bone defects, have no tendency to decrease. We can assume that one of the leading factors of complications in traumatology is a violation of microcirculation in the affected segment of the limb.Aims. To identify patterns of changes in the parameters of the microcirculatory bed of the damaged segment of the lower limb when fixing bone fragments with a plate with limited contact in the early period after surgery.Materials and methods. In 25 patients, we studied four parameters of microcirculation of the lower limb segment with application of laser Doppler flowmetry. The control group consisted of 25 healthy volunteers, comparable in age and sex with the study group.Results. We found that in the early postoperative period (from the first to the 10th day after the surgery) in patients with diaphyseal fractures of the tibia operated with metal plate with limited contact there was an increase in microcirculation by 75.69 %, an increase in the proportion of the nutritive component of microcirculation compared to the shunt fraction by 24.64 %, as well as an increase in more than one ratio of the amplitude of the heart and respiratory range. All of that indicates a local circulatory disorder in the nutritive arterial hyperemia. We note that the increase in the amplitude of the respiratory component by 17.22 % and the equality of the amplitude of the cardiac range compared with the control group indicate violations of local blood circulation by the type of venous stagnation.Conclusion. On the basis of the results obtained, we note that patients with diaphyseal fractures of the shin bones treated with metal osteosynthesis with a plate with limited contact in the early postoperative period develop a violation of local blood circulation in the stagnant-hyperemic type.

Minimally invasive intramedullary fixation with flexible nails in the treatment of metatarsal neck fractures

Objective: This study was designed to retrospectively assess patients with deviated central metatarsal neck fractures subjected to reduction and fixation with flexible intramedullary nails. Methods: Thirty-six patients (36 feet) diagnosed with acute fractures of one or more metatarsals and whose therapeutic indication was exclusively surgical were evaluated between June 2010 and August 2011. Considering the metatarsophalangeal joint, such injuries should be located up to two centimeters in the proximal direction of this segment, with plantar deviation greater than 10 degrees and translation greater than three millimeters in any plane. Minimally invasive intramedullary fixation with two flexible titanium nails was used when adequate stability was not obtained with the use of one nail. The visual analog scale (VAS), American Orthopedic Foot &amp; Ankle Society (AOFAS) forefoot score and specific statistical tests were used. Results: There was a significant (p&lt;0.001) improvement in the results until 6 months of follow-up. There was no significant difference (p&gt;0.05) in the results between 6 and 12 months of follow-up. The average time of consolidation was 8 weeks, and there were no complications during the period evaluated. Conclusion: This technique provided a significant (p&lt;0.001) improvement in the VAS and AOFAS forefoot scores at 6 months of follow-up. Between 6 and 12 months of postoperative follow-up, we did not observe a significant (p&lt;0.05) difference in the results of the analysis due to stabilization of the condition and fracture consolidation. Although the results were considered excellent, the level of evidence of studies should be increased to effectively demonstrate the efficacy of this technique. Level of Evidence IV; Therapeutic Studies; Case Series.

Stability of femoral neck fracture fixation: A finite element analysis

Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. Clinical outcome in these patients can be improved by optimizing surgical procedures and selecting appropriate fixation methods. The aim of this study was to develop a numerical fracture model to investigate the influence of critical mechanical factors on the stability of fixation methods for femoral neck fractures. The mechanical stability of fracture fixation was assessed through employing finite element models and simulating progressive consolidation of the fracture for a vertical femoral neck fracture (i.e. Pauwels type III in which the angle between the fracture line and the horizontal plane is greater than 70°). Mechanical performance was compared among three different fixation methods (cannulated screws, dynamic hip screw with de-rotational screw, and proximal femoral locking plate). Axial femoral head displacement varied from 2.3 mm for cannulated screws to 1.12 mm for proximal femoral locking plate, although dynamic hip screw with de-rotational screw indicated a value of 0.94 mm. Considering a consolidated fracture and full weight-bearing load case, average displacements of fracture fragments were obtained of about 1.5, 3 and 70 µm for dynamic hip screw with de-rotational screw, proximal femoral locking plate and cannulated screws methods, respectively. In terms of interfragmentary movements at the fracture site, outcomes of this study demonstrated that, in agreement with our previous experimental research, the dynamic hip screw with de-rotational screw implant is a more effective choice than cannulated screws and proximal femoral locking plate techniques for vertical femoral neck fractures in young patients. Thus, one may conclude that the use of dynamic hip screw with de-rotational screw, particularly during the early stages of bone healing, could provide suitable mechanical environments that facilitate direct bone formation and shorter healing times.

Physical treatment options with impact on bone healing

The impact of physical stimulation of afracture remains unsolved because of the complexity of this process. Differences in the localization and the morphology of the fracture, soft tissue injury, pretreatment and risk factors have an influence on study results, leading to problems in evaluation of physical modulation concerning fractures and nonunions. Extracorporeal shock wave therapy (ESWT) is technically demanding and often associated with local complications including bone and soft tissue stress; however, it is still applied in some centers for the treatment of nonunions. The study situation assessing the effectiveness of this treatment consists of asingle randomized controlled trial (RCT) with amedium risk of bias. Apositive effect for bony healing could be seen in 70-71% of ESWT patients but also in 73% of the surgically treated group. A systematic review and meta-analysis demonstrated an insufficient and inconsistent study quality but acknowledged that ESWT can be an effective treatment for delayed union and nonunion. For low-intensity pulsed ultrasound (LIPUS) studies with areduced bias are available, representing abetter level of evidence. Concerning advantages in the consolidation of acute fractures, only one RCT showed areduction of healing time in fractures with an expected prolonged bony bridging. For the treatment of delayed unions, ahighly rated RCT showed asignificantly improved consolidation of midshaft tibial fractures using LIPUS. A systematic review and meta-analysis of nonunions showed positive effects in biologically active lesions, e.g. in hypertrophic pseudarthrosis, leading to afusion rate of 80%. The consolidation process was better in patients without surgical revision 3-6months prior to LIPUS.

Extracorporeal Shockwave Therapy for the treatment of scaphoid delayed union and nonunion: a retrospective analysis examining the rate of consolidation and further outcome variables

Operative procedures are considered gold standard in the treatment of scaphoid nonunion, albeit their considerable complexity and the risk of intraoperative complications. High energy extracorporeal shockwave therapy (ESWT) offers a non-invasive treatment option for scaphoid nonunion. The aim of this study was to explore the rate of bony consolidation and further outcome variables in patients with delayed union of scaphoid fractures and scaphoid nonunion treated with ESWT. Due to delayed union (21) or nonunion (21) of a scaphoid fracture 42 patients (37 men, and 5 women) with an average age of 48,3 (15-66) years underwent ESWT followed by immobilization in a forearm cast including the proximal phalanx of the thumb for 6 to 8 weeks. In 13 patients the fracture was initially treated, 8 with immobilization, 5 with screw fixation. In 5 of the 29 patients without an initially treatment, the fracture resp. nonunion was secondarily treated with screw fixation (2) or a medial femur condyle (3) but failed to heal. 10 to 12 weeks after the ESWT bony healing was controlled with computed scanning in the long axis of the scaphoid. If 50 % of diameter of the scaphoid showed trabecula bony healing was considered. Factors with potential influence on bony healing (site of the fracture/nonunion, scapholunate angle, patient´s age, Body Mass Index, smoking and alcohol consume) were analyzed. In addition, 34 patients underwent a clinical follow-up examination including DASH and Mayo Wrist Score, pain analyzes (VAS). Seventy-one per cent of patients showed scaphoid fracture consolidation using ESWT. In 7 out of 8 patients with conservative treatment and in 4 out of 5 patients with screw fixation of the initial fracture bony healing was achieved. From the 5 patients with secondary surgical treatment of the scaphoid only 1 patient, treated with a medial femur condyle, failed to heal the scaphoid. 15 out of the 24 initially non-treated scaphoid fractures healed. The time between ESWT and the documented bony healing averaged 8.4 months (256 days). Neither fracture site, nor the scapholunate angle, alcohol and tobacco use, as well as biometric factors, such as age and BMI had influence on the success rate of the ESWT. Side effects of the ESWT were limited to local skin irritations and petechial bleedings. ESWT has a positive effect regarding bony healing of scaphoid fracture with delayed fracture healing and nonunion with a success rate of 71 %. The complication rate is low, and the clinical results regarding wrist motion and pain are satisfying. Further investigations are necessary to evaluate the input of fracture/nonunion characteristics like the morphological appearance on bony healing.

Mid-term follow-up after surgical treatment of fifth metatarsal base fractures in professional soccer players

Objective: Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1,000 people a year. The objective of this study was to evaluate the functional outcome of professional soccer players subjected to surgical treatment of fifth metatarsal base fractures. Methods: A total of 34 soccer players who underwent surgery from July 2001 to June 2016 were evaluated. All participants were evaluated by the American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue scale (VAS) score before and after surgery, with a mean follow-up of 23 months. The need for grafting relative to time to surgery, time to fracture consolidation and Torg classification and graft use relative to return to sport were valuated. Results: There were 10 forwards, 7 offensive midfielders, 6 fullbacks, 5 center midfielders, 3 defenders, 2 goalkeepers and 1 defensive midfielder, with a mean age of 19 years. The mean pre- and postoperative AOFAS was 42 and 99 points whereas the mean VAS score was 6 and 0, respectively. The longer the time to surgery, the greater was the need for grafting (p=0.011). The time to return to sport was not influenced by the time to surgery, time to consolidation, Torg classification or graft use. Conclusion: The surgical treatment of fifth metatarsal base fractures in professional soccer players showed good clinical results. The return to activities after surgery is not influenced by the time to surgery, time to consolidation, Torg classification or grafting. Level of Evidence IV; Therapeutic Studies; Case Series.

Combination treatment for giant cell tumors of the bone.

e22504 Background: Positive effect of the monoclonal antibody denosumab in cancer treatment has been reported in recent years. Since surgical treatment is considered the main method of treatment for giant-cell tumors of the bone (GCTB), the purpose of our study was to improve treatment outcomes using denosumab. Methods: The study included 10 patients with verified GCTB (5 men, 5 women, mean age 36±3.14 years). Tumors were located in the upper third of the tibia (3 patients), the lower third of the tibia (3), iliac bone (1), heel bone - 1, the lower third of the femur - 1, the lower third of the humerus - 1.Patients received 2 cycles of neoadjuvant denosumab treatment (120 mg subcutaneously once every 4 weeks) with further tumor resection. The bone defect was reconstructed with bone grafting in marginal resections and endoprosthetics in segmental resections. The effect of neoadjuvant therapy was assessed morphologically by optical light microscopy; histological and histochemical methods were used. Results: Neoadjuvant treatment reduced pain syndrome and restored the support ability. X-ray and spiral X-ray CT showed sclerotic sites in the lytic foci. Consolidation of pathological fractures in the tumor area was registered, as well as fibrosis of the tumor focus. The tissue on the sections of removed material appeared dryish and whitish, it replaced the medullary canal. Microscopic examination of tumors revealed areas of extensive sclerosis foci, and a slight lymphohistiocytic infiltration in some cases. Osteoclasts and osteoblasts were absent in the histological preparations. Conclusions: Neoadjuvant denosumab in GCTB with the following surgery has a pronounced positive effect. This was confirmed by the morphological picture of the operative material demonstrating the development of extensive foci of loose and dense fibrous connective tissue with a small amount of lymphohistiocytic elements.

Enhanced Healing and Bone re-Modelling by Low-Level Laser Therapy for Rapid Pain Control in Pediatric Fractures

Objective The current clinical case series assess the clinical outcome of the use of low-level laser in the treatment of painful pediatric fractures not solidly consolidated and re-modelled after casting for a standard of 4-6 weeks Materials and Methods The patient cohort consisted of 17 consecutive unselected patients in pediatric age group with delayed fracture consolidation and/or undesirable angulation despite casting for a standard period of 4-6 weeks in whom the parents refused any surgical intervention and/or bone grafting options. All subjects were referred from other medical centers after inadequate healing of the fracture ends upon repeating the x ray after the cast was off at the 4-6 weeks mark. Low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases were administered with a view of enhancing bone healing and/or re-modelling since both previous clinical and basic science studies on LLLT showed a stimulatory effect on fracture healing. Results All patients had solid union, mean time for union for upper and lower limb fractures were 6 and 10 weeks respectively. The calculated p value is statistically significant at p &lt; 0.05. No patient defaulted follow up. All parents were satisfied with the clinical and radiological result of the LLLT treatment. Conclusion LLLT was found not only to enhance bone healing potential but in fact improved bone re-modelling when used in the proper wavelength and energy density in pediatric upper and lower limbs fractures, thereby also rapidly resolve the intolerable pain in paediatric fracture population

Малоинвазивные методы комбинированного остеосинтеза спицами Киршнера при лечении оскольчатых переломов плечевой и бедренной кости у кошек

The article describes clinical cases of surgical treatment of comminuted diaphyseal fractures of three humerus and four femur bones in cats. Three animals (two tomcats, one cat) have the open complex comminuted, not reconstructed fractures of the humerus ― 12-C3, according to AO classification. Two animals (cat and tomcat) were diagnosed with comminuted, non ― reconstructed femoral fractures-32-C3, according to AO classification. One animal (cat) was diagnosed with wedge-shaped fractures of both femur bones-32-v3, according to AO classification. The diagnosis was made on the basis of clinical examination and radiography of bones in the lateral and direct projection. From the moment of injury to the examination and the treatment from 3 to 5 days passed in all patients, the age of patients ranged from 6 months to 4 years. For the treatment of patients, a minimally invasive combined method of osteosynthesis with a monolateral external fixator in combination with an intramedullary spoke (Tie-in method) and a hybrid of I...II type of external fixators in combination with intramedullary fixation were used. Minimally invasive osteosynthesis with Kirschner spokes provided adequate fixation of fractures with maximum preservation of biological factors of bone healing. Consolidation of fractures occurred with the formation of corn, limb function restored in a short time in the absence of contractures of adjacent joints.

Midterm surgical treatment outcomes of unstable distal radius fractures

Background. Fracture of the distal radius is the most common injures bones of the forearm. Multifragmentary articular injures have occupied a special place among all fractures of the distal radius This factor due to the severity of the injury wrist joint, young patients and difficult rehabilitation.&#x0D; Purpose of study: Improvement results surgical treatment unstable fractures of the distal radius.&#x0D; Patients and methods. All patients were depended into two groups: The first group consisted of 34 patients. The first stage of treatment include close reduction and external fixations. If after external fixation we have persisting fractures dislocation, we take conversion external fixation, open reduction and plate fixation. The second group were included 30 person. In this group we take open reduction and plate fixation.&#x0D; Results. 6 or 12 month after surgery in 1 group we have receiver 87% excellent results. In the the second group we have received 77% excellent results. In the first group 2 cases have slow fractures consolidation, infection complication not found. In the second group we have 2 complication: CRPS and infection.&#x0D; Conclusion. Results in two groups of patients are assessed as good and excellent. The results of the study showed that external fixation in first stage of treatment allows to achieved better restoration radiocarpal joint anatomy (except for type В fractures), and without secondaly displacement tendency. The last fact is very important for patient with delayed the second stage of treatment. This patients with multiple injuries, open fractures and presence of an infected wound and etc. The second stage of treatment consisted of open reduction and plate fixation. Achieved full anatomy restoration radiocarpal joint with possible early rehabilitation.

Design and examination of the new biosoluble casting alloy of the system Mg–Zr–Nd for osteosynthesis

We have performed a comparative analysis of existing materials for the fabrication of implants and report their physical-mechanical properties; their advantages and disadvantages have been defined. It is shown that magnesium alloys are among the most promising biosoluble materials. They are bioinert and biocompatible, but their use in osteosynthesis is limited mainly by their inadequate mechanical properties due to the high rate of biodegradation, which requires improving them by changing the chemical composition of the alloy. In order to develop a new magnesium-based biosoluble alloy, we have selected the most suitable doping systems in accordance with the established criteria. Employing the methods of experiment design, we studied the separate and joint influence of zirconium, neodymium and zinc on structure formation and mechanical properties of magnesium alloy. Mathematical models have been constructed that describe the influence of the examined alloying elements on the mechanical properties of the metal. Using the regression equations derived, we have carried out the optimization of the chemical composition of magnesium alloy. The industrial and pre-clinical tests of implants made from the designed biosoluble alloy have been performed. Experiments on animals confirmed the absence of toxic effect from the products of degradation of the devised magnesium alloy on a living organism. Studying the influence of the designed alloy on reparative osteogenesis during experiment on rabbits has shown the positive dynamics of bone tissue regeneration without noticeable changes in its structure, which ensures reliable merging of elements in bones at osteosynthesis. It was established that the implants made from the designed alloy possess the necessary level of mechanical properties that match the mechanical properties of bone tissue. At the same time, they are non-toxic and provides a secure bone tissue healing until the complete fracture consolidation. Positive results of the experiments conducted allow us to suggest a favorable prognosis on the possibility of using implants made from the devised biosoluble alloy of the system Mg–Zr–Nd in humans

A Comparison of the Long-Term Results of Posterior Transarticular Stand-Alone Screw Instrumentation and Magerl Technique in Patients with Traumatic Atlantoaxial Instability: Mean 5-Year Follow-Up Study with Radiological and Patient-Rated Outcomes Assessments

To perform a radiological analysis of the degeneration of C1-C2 joints after C1-C2 transarticular fixation (TAF) and compare the long-term results of a routine Magerl technique (RMT) to a posterior transarticular C1-C2 stand-alone screw instrumentation (SAS) application. A total of 40 patients (26 men and 14 women) were included in the present retrospective observational cohort study. The mean follow-up period was 61.7 months (range, 11-118). The mean patient age at the baseline examination was 48.4 years (range, 22-82). Of the 40 patients, 11 were included in the RMT group and 29 in the SAS group. The structure of 80 atlantoaxial joints was analyzed, with grade 4 degenerative changes observed in 57 joints (71.3%). Of the 40 analyzed atlanto-odontoid joints, grade 4 degenerative changes were revealed in 18 joints (45%). C1-C2 bone fusion was observed in 38 patients (95%) and stable fibrous fusion in 2 patients (5%). No cases of C1-C2 nonunion were revealed. No statistically significant differences in the frequency of C1-C2 fracture consolidation or C1-C2 fusion were revealed between the RMT and SAS groups. The application of cortical lag screws in TAF might result in stable atlantoaxial joint fusion formation without joint curettage. Atlanto-odontoid joint fusion was also observed after C1-C2 TAF. The application of cortical lag screws for bilateral fixation using the SAS technique resulted in C1-C2 fusion in 93.1% of cases, comparable to the results with the Magerl technique.

Galeazzi fracture associated with an ipsilateral fracture of ulna diaphysis and olecrane. A rare lesional association. About a case and review of literature

Introduction: Tripolar lesions of the thoracic limb are rare. We report a rare a Galéazzi fracture associated with an ipsilateral fracture of ulna and olecranon in a 45-year-old patient. Surgical management has been delayed due to limited resources of the patient. Case presentation: It was a 45-year-old man admitted in our emergency after a fallen on bicycle. He presented a fracture of olecranon, shaft bone fracture of radius and ulnar, and distal radio-ulnar disjunction. The assessment at 18 months has found a consolidation of fractures. The elbow and wrist regained joint range, but we noted a limitation of prono-supination related to radioulnar synostosis. This limitation had no impact on the professional and sporting activities of the patient. Conclusion: Apart the difficulties to describe mechanism responsible of this complex lesion, the functional prognosis of the limb depends on a correct diagnosis and adequate management. At the last follow-up, the patient was satisfied with the result obtained. Longer term follow-up will allow us to determine the issue of this complex lesion in this patient. For the moment patient is not complained so wejust wait and see. Keywords: Galeazzi fracture, distal radioulnar disjunction, fractures, forearm, olecranon.

Periostin in Bone Regeneration.

Bone regeneration is an efficient regenerative process depending on the recruitment and activation of skeletal stem cells that allowcartilage and bone formation leading to fracture consolidation. Periosteum, the tissue located at the outer surface of bone is now recognized as an essential player in the bone repair process and contains skeletal stem cells with high regenerative potential. The matrix composition of the periosteum defines its roles in bone growth, in cortical bone modeling and remodeling in response to mechanical strain, and in bone repair. Periostinis a key extracellular matrix component of the periosteum involved in periosteum functions. In this chapter, we summarize the current knowledge on the bone regeneration process, the role of the periosteum and skeletal stem cells, and Periostin functions in this context. The matricellular protein Periostinhas several roles through all stages of bone repair: in the early days of repair during the initial activation of stem cells within periosteum, in the active phase of cartilage and bone deposition in the facture callus, and in the final phase of bone bridging and reconstitution of the stem cell pool within periosteum.