Fracture Healing Complications Research Articles

Multidisciplinary approach of hip fractures based on Hungarian data

Hip fractures are described by increased mortality, loss of quality of life, functional decline and burden of diseases. They show a growing number worldwide. The aim of the present study is to summarise the existing data on the incidence, mortality, complications and rehabilitation of hip fractures, which relevance is reported only by few studies. To reduce mortality and complications of hip fractures the authors emphasize the importance of primary treatment within 12 hours, appropriate selection of surgical methods corresponding to the fracture type after the assessment of femoral head viability, vitamin D supplementation, same conditions for primary treatment during everyday of the week, and an adequate acute treatment and rehabilitation for patient's general health status. In the future integrated processing of multidisciplinary results of hip fractures based on Hungarian data can support the development of efficient treatment and prevention strategies, which can be advantageous for the patient, families, health care system, and the society, too, by the reduction of costly complications of hip fracture healing and mortality. Orv. Hetil., 2016, 157(37), 1469-1475.

Plate fixation versus intramedullary nailing for midshaft clavicular fractures: a prospective rndomized controlled trial

Objective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures. Methods A prospective, randomized, controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture. They were 136 males and 58 females, from 16 to 65 years of age. They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing(n= 98)or open reduction and plate fixation(n= 96). We recorded operation time, intraoperative blood loss, hospitalization expenses, fracture healing time and complication rate. Functional assessments were conducted at 3, 6 and 12 months using the Disabilities of the Arm, Shoulder and Hand(DASH)and Constant-Murley scores. The preoperative general data showed no statistical significance between the 2 groups(P> 0. 05). Results All the 194 patients were followed up for 12 to 27 months(average, 15. 6 ±3. 1 months). The operation time(27. 7 ±16. 3 min), intraoperative blood loss(18. 6 ±14. 4 mL), hospitalization expenses(12, 462. 0 ±3, 263. 4 yuan), and fracture healing time(12. 1 ±3. 0 weeks)in the intramedullary nailing group were significantly better than those(62. 3 ±19. 4 min, 40. 3 ±17. 4 mL, 24, 760. 0 ±3, 320. 4 yuan, and 16. 9 ±2. 8 weeks)in the plate fixation group(P 0. 05). The complication rate in the intramedullary nailing group(25.5%, 25/98)was significantly higher than in the plate fixation group(9.4%, 9/96)(P<0. 05). Conclusions In the treatment of displaced midshaft clavicular fractures, compared with open reduction and plate fixation, closed reduction and intramedullary nailing has advantages of less invasion, lower cost and faster fracture healing, but a disadvantage of higher complication rate. The 2 treatments may lead to similar functional recovery of the shoulder. Key words: Clavicle; Fracture fixation, internal; Bone plates; Bone nails

Inhibition of Midkine Augments Osteoporotic Fracture Healing.

The heparin-binding growth and differentiation factor midkine (Mdk) is proposed to negatively regulate osteoblast activity and bone formation in the adult skeleton. As Mdk-deficient mice were protected from ovariectomy (OVX)-induced bone loss, this factor may also play a role in the pathogenesis of postmenopausal osteoporosis. We have previously demonstrated that Mdk negatively influences bone regeneration during fracture healing. Here, we investigated whether the inhibition of Mdk using an Mdk-antibody (Mdk-Ab) improves compromised bone healing in osteoporotic OVX-mice. Using a standardized femur osteotomy model, we demonstrated that Mdk serum levels were significantly enhanced after fracture in both non-OVX and OVX-mice, however, the increase was considerably greater in osteoporotic mice. Systemic treatment with the Mdk-Ab significantly improved bone healing in osteoporotic mice by increasing bone formation in the fracture callus. On the molecular level, we demonstrated that the OVX-induced reduction of the osteoanabolic beta-catenin signaling in the bony callus was abolished by Mdk-Ab treatment. Furthermore, the injection of the Mdk-Ab increased trabecular bone mass in the skeleton of the osteoporotic mice. These results implicate that antagonizing Mdk may be useful for the therapy of osteoporosis and osteoporotic fracture-healing complications.

Locked META intramedullary nailing fixation for tibial fractures via a suprapatellar approach.

Background:Intramedullary nailing is an effective approach for treatment of diaphyseal tibial fractures. However, infrapatellar intramedullary nailing can easily cause angulation and rotation displacement at the fracture ends and increase risk of postoperative infection. Intramedullary nailing via the suprapatellar approach was proved with good reduction and fixation. We used locked intramedullary nailing for the treatment of tibial fractures via a suprapatellar approach in this study.Materials and Methods:23 patients undergoing tibial fractures fixation by locked META intramedullary nailing via a suprapatellar approach were enrolled between June 2012 and October 2013. There were 18 males and 5 females. The average age was 35.5 years (range 18-60 years). The intraoperative data including operative time and blood loss and postoperative data consisting of hospital stays, fluoroscopy time, fracture healing time and complications were all recorded.Results:The average operative time, blood loss, fluoroscopy time and hospital stay were 78.2 ± 9.1 min, 90.4 ± 23.4 mL, 38.5 ± 6.5 s and 11 ± 3.4 days respectively. The mean followup period in all the patients was 15.5 months. Callus appeared in the patients at average 8 weeks after surgery. The mean knee and ankle range of motion were significantly improved at the last followup (P < 0.05). The average Hospital for Special Surgery and Olerud–Molander scores was 92 ± 4.3 points and 93.6 ± 3.9 points, respectively. No complications were observed.Conclusion:Locked META intramedullary nail fixation via a suprapatellar approach is safe and effective for patients suffering from tibial fractures and earlier functional recovery.

Mini-plate fixation of ulnar coronoid process fracture via anteromedial approach

Objective To investigate the clinical efficacy of mini-plate fixation for ulnar coronoid process fracture via anteromedial approach. Methods A retrospective review was made on 28 cases of ulnar coronoid process fracture treated with open reduction and mini-plate fixation from April 2010 to December 2014. There were 18 males and 10 females, with age range of 21-60 years(mean, 34.3 years). Causes of injury were falls in 21 cases and traffic accidents in 7 cases. According to the O’Driscoll classification, there were 14 cases of type Ⅰ, 11 cases of type Ⅱ and 3 cases of type Ⅲ. Time from injury to operation was 2-10 d(mean, 3.7 d). Reduction loss, fracture healing time and complications were documented.Elbow function was evaluated at the last follow-up by Mayo elbow performance score(MEPS)and Broberg & Morrey score. Results All cases were followed up for 12-25 months(mean, 15.1 months). Restricted elbow activity was initiated one week after operation. Bone united in mean 10.6 weeks(range, 8-14 weeks). No nerve injury or fracture redisplacement occurred. At the final follow-up, mean flexion was(124±15)°(range, 90°-140°), mean extension loss was(18±20)°(range, 0°- 50°), mean pronation was(65±18)°(range, 40°- 85°), and mean supination was(63±16)°(range, 35°- 85°), showing significant difference in comparison with the preoperative measure(P<0. 05). According to the MEPS, the results were excellent in 17 cases, good in 8, fair in 2 and poor in 1. According to the Broberg & Morrey score, the results were excellent in 16 cases, good in 8, fair in 3 and poor in 1. Conclusion Through anteromedial approach, mini-plate fixation of the ulnar coronoid process fracture provides rigid fixation, which benefits joint stability and bone union, and allows early functional exercise. Key words: Unlar fractures; Fracture fixation, internal; Mini-plate

Effect of near-infrared light on in vitro cellular ATP production of osteoblasts and fibroblasts and on fracture healing with intramedullary fixation.

Evaluate the effect of near-infrared light (NIR) on immediate production of ATP by osteoblasts and fibroblasts in vitro, and the healing process of rat femur fractures with intramedullary fixation. NIR is one potential treatment option for complications of fracture healing, which has shown to stimulate cellular proliferation and to enhance the healing process. Cell culture - MC3T3-E1 and 3T3-A31 cells were subjected to NIR at 660nm, 830nm, or both combined. ATP was assayed at 5, 10, 20, and 45min after exposure. Animal study - 18 rats had surgery with retrograde intramedullary pins inserted into their femurs, which then underwent closed, transverse femur fracture. Rats were randomly divided into 3 study groups of 6 each: nonirradiated controls, 660nm, and 830nm NIR. Healing process was assessed by a blinded radiologist, assigning a healing score of 1-6 for radiographs taken on days 0, 7, 14, and 21. Cell culture - All groups gave significant increase in ATP within 5-10min, with decay to baseline by 45min. 660nm NIR was significantly more effective than 830nm with fibroblasts or either wavelength with osteoblasts. Animal study - A significant increase in the fracture healing grade in the 660nm group at day 14, but with no differences at day 21. The study demonstrated an immediate increase in ATP production in vitro and an initial acceleration of callus formation in the fracture healing process, in the presence of NIR.

Short Term Results with Z Plasty for Checkrein Deformity Following Tibia Fractures

Introduction: Checkrein deformity is rarely seen following fracture in the leg bones. The surgical treatments is the method of choice but the site of release at the fracture site or at the midfoot are debatable. Since the deformity is rare the literature is scarce. We evaluated six cases of such deformity after releasing the tendon behind the medial malleolus. Methods: Six patients were followed after releasing the tendon and performing Z plasty lengthening midway between the previously described procedures. Results: We achieved full correction of the deformity with satisfaction in all the six cases and had no recurrence with minimum 2 years following surgery. Conclusion: The method described is simple, effective with less learning curve however larger series is required to compare it in a randomised control manner. Key Words: Checkrein deformity, Complications of fracture healing

An important factor often ignored in operative treatment of fracture of acetabular posterior wall -- analysis of plate placement

Objective To analyze the optimal position of reconstructive plate in the operative treatment of acetabular posterior wall fractures by comparing 2 plate placements. Methods From May 2004 to January 2014, 58 patients with acetabular posterior wall fracture according to Letournel-Judet classification were treated at our department. They were 46 men and 12 women, aged from 20 to 67 years. The fracture affected the left side in 27 cases and the right side in 31 ones. The time from injury to surgery ranged from 1 to 19 days. Their reduction and fixation were conducted with a 3.5 mm reconstructive plate and lag screws via the Kocher-Langenbeck approach. They were divided into 2 groups according to the positions of the plate and the screws. In group A of 25 cases, screws were placed behind the plate, far from the acetabular rim. In group B of 33 cases, screws were placed ahead of the plate, close to the acetabular rim. The 2 groups were compared in terms of reduction, fracture healing time, complications, and functional recovery. Results The 58 patients were followed up for an average of 2.3 years (range, from 1 to 5 years). According to the modified Matta criteria, anatomic reduction was achieved in all the patients. Fracture healing time averaged 14.8±3.5 weeks in group A and 14.6±3.4 weeks in group B, showing no statistically significant difference(t =0.073, P=0.788). According to the modified Merle d'Aubigne & Postel criteria, the hip function was excellent in 8 cases, good in 11, fair in 4, and poor in 2 in group A, giving an excellent to good rate of 76.0% ; the hip function was excellent in 11 cases, good in 17, fair in 4, and poor in one in group B, giving an excellent to good rate of 84.8%. There was a significant difference between the 2 groups (χ2 = 4.581, P=0.032). The incidence of complications in group A (32.0%, 8/25) was significantly higher than in group B (9.1%, 3/33) (χ2 = 5.926, P= 0.015). Conclusion In treatment of acetabular posterior wall fractures, the pelvic reconstructive plate should be placed as close as possible to the acetabular rim because the plate at this position can provide stronger and more stable fixation. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Treatment outcome

Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats.

Impaired bone healing can have devastating consequences for the patient. Clinically relevant animal models are necessary to understand the pathology of impaired bone healing. In this study, two impaired healing models, a hypertrophic and an atrophic non-union, were compared to physiological bone healing in rats. The aim was to provide detailed information about differences in gene expression, vascularization and histology during the healing process. The change from a closed fracture (healing control group) to an open osteotomy (hypertrophy group) led to prolonged healing with reduced mineralized bridging after 42 days. RT-PCR data revealed higher gene expression of most tested osteogenic and angiogenic factors in the hypertrophy group at day 14. After 42 days a significant reduction of gene expression was seen for Bmp4 and Bambi in this group. The inhibition of angiogenesis by Fumagillin (atrophy group) decreased the formation of new blood vessels and led to a non-healing situation with diminished chondrogenesis. RT-PCR results showed an attempt towards overcoming the early perturbance by significant up regulation of the angiogenic regulators Vegfa, Angiopoietin 2 and Fgf1 at day 7 and a further continuous increase of Fgf1, -2 and Angiopoietin 2 over time. However µCT angiograms showed incomplete recovery after 42 days. Furthermore, lower expression values were detected for the Bmps at day 14 and 21. The Bmp antagonists Dan and Twsg1 tended to be higher expressed in the atrophy group at day 42. In conclusion, the investigated animal models are suitable models to mimic human fracture healing complications and can be used for longitudinal studies. Analyzing osteogenic and angiogenic signaling patterns, clear changes in expression were identified between these three healing models, revealing the importance of a coordinated interplay of different factors to allow successful bone healing.

Loop plating for ulnar coronoid fractures of Regan-Morry type I

Objective To explore the clinical efficacy of loop plating for treatment of ulnar coronoid fractures of Regan-Morry type I. Methods From January 2011 to March 2014, 42 patients with ulnar coronoid fracture of Regan-Morry type I were treated in our department. They were 31 males and 11 females, 23 to 58 years of age (mean, 39.3 years). There were 5 cases of coronoid fracture combined with elbow dislocation, 33 cases of terrible triad injury, 30 cases of comminuted coronoid process, and 12 cases of simple fractures. All the patients were treated through the Kocher approach aided by a small posterior incision. The 12 simple fractures were fixated with a loop plate after anatomic reduction. The anterior joint capsule and the brachialis muscle insertion were reconstructed with a loop plate in the 30 cases of comminuted fractures. Replacement of the radial head was performed in the 38 cases of combined radial head fracture. Anchor repair was conducted for cases combined with disruption of lateral collateral ligament. Reduction, reduction loss after loop plating, fracture healing time and complications were documented. The elbow function was evaluated at the last follow-up by Mayo elbow performance score (MEPS). Results Thirty-eight patients were followed up for 8 to 34 months (average, 25 months), and 4 patients were lost. All the 38 patients obtained bony union after 6 to 18 weeks (average, 11.8 weeks). At the last follow-up, elbow flexion ranged from 110° to 135° (average, 115°), elbow extension from 0 to 15° (average, 5°), forearm pronation from 45° to 75° (average, 70°), and supination from 68° to 94° (average, 82°). According to MEPS, 22 patients were excellent, 10 good, 2 fair, and 4 poor. The excellent to good rate was 84.2%. None of the patients had deep wound infection. Plate breakage at the radial head occurred in one case and stiff elbow in 4. One case had superficial wound infection which responded to dressing changes. Conclusions In treatment of ulnar coronoid fractures of Regan-Morry type I, loop plating can result in good efficacy because it allows reduction under direct vision, leads to rigid fixation which facilitates articular stability, and is simple as well. Key words: Elbow joint; Fracture fixation, internal; Fractures, comminuted; Ulna coronoid

Young femoral neck fractures: Are we measuring outcomes that matter?

IntroductionFemoral neck fractures in younger aged patients are particularly devastating injuries with profound impairments of quality of life and function. As there are multiple differences in patient and injury characteristics between young and elderly femoral neck fracture patients, the geriatric hip fracture literature is unlikely to be generalisable to patients under age 60. We conducted a systematic review to determine if clinically relevant outcome measures have been used in previously published clinical studies of internal fixation in young adults with femoral neck fractures. MethodsWe conducted a comprehensive literature search using multiple electronic databases and conference proceedings to identify studies which used internal fixation for the management of femoral neck fractures in patients between the ages of 15 to 60. Eligibility screening and data abstraction were performed in duplicate. We classified the reported outcomes into the following categories: operative and hospital outcomes, radiographic outcomes, clinical outcomes, and functional outcomes and health-related quality of life. We calculated the frequencies of reported outcomes. ResultsFort-two studies met our inclusion criteria. Operative and hospital outcomes were poorly reported with less than one-quarter of studies reporting relevant data. Important radiographic outcomes were also inadequately reported with only one-third of studies reporting the quality of the fracture reduction, and methods for assessment were highly variable. The assessment of avascular necrosis was reported in almost all the included studies (95.2%); however, the assessment of nonunion was only reported in three-quarters of the studies. Re-operations were reported in 73.8% of the included studies and the assessment of fracture healing was only reported in two-thirds of the studies. Less than half of the studies reported functional outcomes or health-related quality of life (overall patient evaluation scales and systems (45.2%), patient functional outcomes (30.9%), and health-related quality of life (4.8%). DiscussionOur systematic review found that the assessment of clinically relevant outcomes in the young femoral neck fracture literature is lacking, which makes utilising the literature to guide clinical practice challenging. Future studies should aim to include important radiographic measures, fracture-healing complications, functional outcomes, and health-related quality of life during any assessment of young femoral neck fracture treatment.

Management of young femoral neck fractures: Is there a consensus?

BackgroundFemoral neck fractures in young adults (ages <60) are high-energy injuries that are associated with major fracture healing complications such as avascular necrosis, nonunion, and significant shortening. Historically, evidence from small trials has suggested multiple cannulated screws were the optimal implant; however, newer studies and implant designs warrant reevaluation of screws as the gold standard among surgeons. In addition, controversies surrounding reduction technique and urgency of surgical fixation have been previously identified. We aimed to survey surgeon treatment preferences for these challenging fractures. MethodsA 17-item survey was developed and tested for validity and reliability prior to administration. The questionnaire characterised surgeon demographics, treatment preferences for displaced and undisplaced fractures, and controversies for future clinical trials. The target population consisted of surgeons from the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and attendees at an international fracture course. Results540 surgeons completed the survey, exceeding our sample size requirement. There was a similar proportion of respondents from academic and community hospitals. Most surgeons (61%) treat 1–5 young adult femoral neck fractures per year. For undisplaced fractures, 78% of respondents prefer to use multiple cannulated screws. For displaced fractures, equal preference for multiple screws (46%) and the sliding hip screw (SHS, 49%) was reported. The majority of surgeons perform an open reduction in less than 25% of cases, and the time to fixation was typically between 8 and 24h. ConclusionsMultiple cannulated screws remain the preferred treatment for most surgeons treating undisplaced fractures; however, there is an equal divide in preference between multiple screws and the SHS for displaced fractures. This increased preference for the SHS contradicts previous survey and small trial data recommending multiple screws for all fracture patterns. The lack of surgeon consensus and the high rates of fracture complications associated with fixation of young femoral neck fractures supports the need for definitive clinical trials to optimise patient important outcomes.

Pediatric Femoral Shaft Fractures Treated With Titanium Elastic Nailing

The objective of this study was to prospectively compare intraoperative fluoroscopy time and clinical and radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN) using a small-incision, blind-hand reduction vs closed reduction. From February 2008 to December 2009, sixty-eight children were enrolled in the study. Patients were divided into 2 groups: group A comprised 34 patients treated with a small-incision, blind-hand reduction technique and group B comprised 34 patients treated with a closed reduction technique. Operative time, intraoperative fluoroscopy time, fracture union time, and complications were recorded in both groups. Clinical and radiological results were assessed using the TEN scoring system. Mean operative time was 30.5±8.5 in group A and 53.0±15.0 minutes in group B, and mean fluoroscopy time was 28.4±18.5 seconds in group A and 65.0±28.5 seconds in group B. Operative time and fluoroscopy time were significantly longer in group B (P<.001). According to the TEN scoring system, the results were excellent in 31 patients and good in 3 patients in group A and excellent in 29 patients and good in 5 patients in group B. There was no significant difference between the 2 groups in terms of clinical and radiological results. There was also no significant difference in terms of fracture healing time, weight-bearing time, and complications. The small-incision, blind-hand reduction technique provided similar clinical results as closed reduction. This technique could be an alternative to closed reduction because it significantly reduced intraoperative radiation exposure and operative time.

Tooth in the line of angle fractures: The impact in the healing process. A retrospective study of 112 patients

BackgroundThere is no consensus regarding the prophylactic removal of mandibular third molars (TM) in fracture lines to facilitate healing. Recent evidence suggests that poor healing is attributed to the limited use of antimicrobials, delayed care and semi-rigid fixation as a treatment method, favoring retention of TM. Study designA retrospective cohort study of all patients presenting with mandibular angle fractures at the Hippokration General Hospital of Athens (2006–2011) was designed to examine the association between the presence versus absence of TMs in the line of mandibular fractures and the fracture healing process. Development of complications during the healing process was the outcome of interest. Additional factors considered were patient age, sex, and fracture etiology. Materials and methodsData were extracted from a retrospective chart review, including information from clinical and radiological examinations. The analytical sample included 112 patients with 121 angle fractures. Bivariate methods including Fisher's exact and chi-square tests were used to test the association between TM presence in the fracture line and healing complications. ConclusionThis study found no association between the presence of mandibular TM in the fracture line and postoperative complications and the healing process when combined with light intermaxillary fixation for 15 days.

Persistence at 12months with denosumab in postmenopausal women with osteoporosis: interim results from a prospective observational study.

SummaryTo determine persistence with subcutaneous denosumab every 6 months in women being treated for osteoporosis, we conducted a single-arm prospective, observational study in the United States and Canada. Among 935 patients enrolled, 12-month persistence was 82 %, with 66 patients (7 %) reporting serious adverse events and 19 patients (2 %) reporting fractures.IntroductionIncreased persistence with osteoporosis therapy is associated with reduced fracture risk. Denosumab reduced fracture risk in clinical trials; persistence in community settings is undetermined. This study evaluates persistence with denosumab in community practice in the United States (US) and Canada.MethodsIn a 24-month multicenter, prospective, single-arm, observational study, women being treated for osteoporosis were enrolled ≤4 weeks after the first subcutaneous injection of denosumab. For this 12-month prespecified interim analysis, endpoints include persistence (one injection at study entry and another within 6 months + 8 weeks), attributes associated with persistence (univariate analysis), and serious adverse events (SAEs).ResultsAmong 935 patients (mean age 71 years), mean baseline T-scores were −2.18 (femoral neck) and −2.00 (lumbar spine); 50 % of patients had experienced osteoporotic fracture(s). At 12 months, 82 % of patients were persistent with denosumab. Baseline factors significantly (p < 0.05) associated with higher persistence included use of osteoporosis medications >5 years previously, lumbar spine T-score > −2.5, and treatment by female physicians (US). Lower persistence was associated (p < 0.05) with psychiatric diagnoses including depression, southern US residence, being divorced, separated, or widowed (US), and prior hip fracture (Canada). SAEs were reported in 66 patients (7 %); no SAEs of osteonecrosis of the jaw, atypical femoral fracture, fracture healing complications, hypocalcemia, eczema, or hypersensitivity were reported. Nineteen patients (2 %) reported osteoporotic fractures.ConclusionsThe 12-month persistence observed in this single-arm open-label study of US and Canadian community practice extends the evidence regarding denosumab’s potential role in reducing fracture risk in postmenopausal women with osteoporosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-014-2871-6) contains supplementary material, which is available to authorized users.

The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures.

Objectives: Modern implants for proximal femur fracture treatment have clearly improved clinical results. However, complications, including cut-out and loss of reduction, requiring revision surgery still occur. A major challenge in these cases is a loss of bone stock due to the existing implant, which is usually exacerbated by osteoporosis. A potential solution is the augmentation of implants, for example, of the femoral neck blade using bone cement.Materials and Methods: Ten patients (five loosening of femoral neck implant, two pseudarthrosis, two implant failures and one acute fracture) were included. The initial hardware was removed and a PFNA augmented was implanted. The perforated femoral neck blade was augmented using polymethyl methacrylate cement. Clinical and radiological follow-up was performed at a mean of 5.4 months (SD ±4.34). The main outcome parameters were fracture healing and implant-related complications.Results: Technical handling was uneventful in all cases. No cement leakage into the joint occurred in any of the cases. The mean amount of cement injected was 5.3 ml. The fracture healed during follow-up in all cases except two patients who died from causes unrelated to the procedure and prior to complete consolidation. Problem-free elective hardware removal of the PFNA augmented was performed in two cases.Discussion: The PFNA augmented is a potential implant for joint-preserving revision surgery in proximal femur fractures. The augmentation improves implant anchorage in the impaired bone stock. In this preliminary series, no negative biological side effects of the cement (i.e. osteonecrosis) were observed.

SAT0090 Analysis of Potential Risk Factors for Delayed Fracture-Healing

BackgroundRheumatoid arthritis patients exhibit a high prevalence of osteoporosis and bone fractures. Furthermore, these patients are reported to be more often affected by delayed or impaired fracture healing. The inflammatory...

Extramedullary fixation of trochanteric hip fracture.

Extramedullary fixation with a sliding hip screw remains the treatment of choice for the majority of trochanteric hip fractures. Attention to surgical detail is far more important that the actual choice of implant. The fracture must be reduced to an anatomical or slight valgus position using the fracture table. Surgical exposure need not be excessive as most fractures can be reduced by closed means. The position of the lag screw is critical to achieve a central to inferior position on the anterior-posterior radiograph and a central position on the lateral view. A four-hole plate should suffice for most fractures. After surgery, weight bearing as able should be allowed. For fractures fixed correctly, wound or fracture healing complication should be rare, occurring in <5% of cases.

Mixing Implants of Differing Metallic Composition in the Treatment of Upper-extremity Fractures

Mixing implants with differing metallic compositions has been avoided for fear of galvanic corrosion and subsequent failure of the implants and of bone healing. The purpose of this study was to evaluate upper-extremity fractures treated with open reduction and internal fixation with metallic implants that differed in metallic composition placed on the same bone. The authors studied the effects of using both stainless steel and titanium implants on fracture healing, implant failure, and other complications associated with this method of fixation. Their hypothesis was that combining these metals on the same bone would not cause clinically significant nonunions or undo clinical effects from galvanic corrosion. A retrospective review was performed of 17 patients with upper-extremity fractures fixed with metal implants of differing metallic compositions. The primary endpoint was fracture union. Eight clavicles, 2 proximal humeri, 3 distal humeri, 3 olecranons, and 1 glenoid fracture with an average follow-up 10 months were reviewed. All fractures healed. One patient experienced screw backout, which did not affect healing. This study implies that mixing implants with differing metallic compositions on the same bone for the treatment of fractures does not adversely affect bone healing. No evidence existed of corrosion or an increase in complications with this method of treatment. Contrary to prior belief, small modular hand stainless steel plates can be used to assist in reduction of smaller fracture fragments in combination with anatomic titanium plates to obtain anatomic reduction of the fracture without adversely affecting healing.

Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta

Background:Children with osteogenesis imperfecta (OI) can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation.Materials and Methods:We prospectively followed nine children (five boys, four girls) with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias) between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects.Results:At the time of surgery the average age in our study was 7.7 years (range 5-12 years). The average length of followup was 69 months (range 60-84 months). All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks) and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches.Conclusions:These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities.