Long Bone Fractures Research Articles

Healing of Comminuted Fractures of Long Bones in Dogs

Fracture healing in dogs is a complex process influenced by factors such as age, weight, fracture type, and underlying conditions. Among fractures, complex diaphyseal comminuted fractures stand out due to their susceptibility to complications like delayed union or nonunion. Despite the recognized complexities, veterinary-specific data on their incidence, complications, and effective treatment strategies remain surprisingly scarce. This retrospective study analyzed 99 comminuted fractures among 542 long bone fractures treated at the Small Animal Clinic of the Freie Universität Berlin (2007–2014). The femur (n = 42) was most affected, followed by the tibia/fibula (n = 29), radius/ulna (n = 24), and humerus (n = 4). Plates (n = 81) and intramedullary pins or external fixators (n = 16) were used for osteosynthesis. Healing occurred without complications in 72%, while 28% experienced issues such as implant failure or delayed union. Open fractures, high-energy trauma, and >3 fragments were associated with higher complication rates (p < 0.05). Fractures treated with plates healed slower (p = 0.016), and implants were removed later compared to other methods (p = 0.049). This study highlights the challenges of managing complex fractures and emphasizes the need for tailored surgical approaches. It provides new insights into their treatment and outcomes, paving the way for future research to establish standardized veterinary protocols.

Single-stage intramedullary nailing for patients with multiple concurrent long-bone fractures in a low-resource setting: what factors contribute to prolonged operative duration?

To investigate the factors that prolonged the operative duration (OD) in patients who underwent single-stage locked intramedullary nailing of their multiple concurrent long-bone fractures (LBFs) using Surgical Implant Generation Network (SIGN) nails. Forty-nine patients who fulfilled the inclusion criteria were enrolled prospectively over 8½ years. Data collected included age, sex, injury mechanism and severity, fracture characteristics, nail types and diameter, OD, fracture-to-fixation time, length of hospital stay (LOS), functional outcomes and complications. Factors associated with prolonged OD were identified using Pearson's chi-square test. The mean age was 40.6 years. There were 101 fractures of the humerus (8), femur (41) and tibia (52). The median ISS was 14. The mean OD per fracture was 55.8min. The average LOS was 11 days. A prolonged OD was significantly associated with fracture-to-fixation time > 5 days, fractures with end-segment involvement, fixation with SIGN standard and thinner nails, open reduction, supplemental plating, and antegrade femoral nailing. Radiographic and functional outcomes were satisfactory. Ten patients developed post-operative breathing difficulty warranting oxygen administration. Four fractures were infected. No mortality within the first post-operative year. The study identified fracture fixation beyond five days, end-segment involvement, open reduction, use of standard and thinner nails, supplemental plating, and antegrade femoral nailing as factors that can prolong the OD during single-stage fixation of multiple concurrent LBFs in settings without modern fracture-care equipment. While some of these factors are unmodifiable on certain occasions, bearing them in mind can improve pre-operative planning and intra-operative efficiency to reduce OD.

Delayed Surgery Increases the Rate of Infection in Closed Diaphyseal Tibial and Femoral Fractures.

Although delays in musculoskeletal care in low- and middle-income countries (LMICs) are well documented in the open fracture literature, the impact of surgical delays on closed fractures is not well understood. This study aimed to assess the impact of surgical delay on the risk of infection in closed long-bone fractures treated with intramedullary nailing in LMICs. Using the SIGN (Surgical Implant Generation Network) Surgical Database, patients ≥16 years of age who were treated with intramedullary nailing for closed diaphyseal femoral and tibial fractures from January 2018 to December 2021 were identified. Infection was diagnosed based on the assessment by the treating surgeon. A logistic regression model, adjusting for potential confounders, was used to analyze the association between delays to surgery (in weeks) and infection. Of the 9,477 closed fractures that were included in this study, 58% were femoral fractures and 42% were tibial fractures. The mean age was 35 years, and 76.2% of the patients were men. The mean delay to surgery was 10.5 days, and the median delay to surgery was 6 days. The overall infection rate was 3.1%. The odds of developing an infection increased by 9.2% with each week of delayed surgical treatment (odds ratio,1.092; 95% confidence interval, 1.042 to 1.145). Increasing delays were also associated with longer surgery duration and higher rates of open reduction. Surgical delays in LMICs were associated with an increased risk of infection in closed long-bone fractures. This study quantified the increased risk of infection due to delays in receiving care, highlighting the importance of timely surgery for closed fractures in LMICs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis

PurposeIn polytrauma patients, injuries involving the extremities are frequently seen. Treatment concepts vary from early definitive care to temporary fixation and delayed definite stabilization. This analysis therefor aims to illuminate the impact of timing for operative stabilization of extremity fractures on outcome factors in adult polytrauma patients.MethodsWe searched PubMed and Cochrane CENTRAL to identify studies from inception of each database to 14 September 2022. We included systematic reviews and RCTs comparing immediate versus delayed operative fracture stabilization and early definite care versus primary external fixation in adult polytrauma patients.ResultsFive randomized controlled trials were included, with a total of 335 patients. The analysis found no statistically significant difference in overall mortality or improvement in ICU admission between early (< 24 h) and late fracture stabilization. Comparing femoral nailing and external fixation, findings showed that femoral nailing reduce ICU length of stay and duration of invasive mechanical ventilation.ConclusionThe results indicate that immediate surgical treatment by nailing is superior to delayed treatment or a staged surgical approach in stable polytrauma patients with long-bone fractures. As there is a lack of clear evidence regarding the optimal timing for definitive operative stabilization of extremity fractures in polytrauma patients, further high-quality studies are essential to enhance the certainty of evidence and provide more conclusive treatment algorithms.

Association of Surgical Debridement Timings With Infection and Non-union Rates in Open Fractures of Lower Limb Long Bones

Association of Surgical Debridement Timings With Infection and Non-union Rates in Open Fractures of Lower Limb Long Bones

Pediatric osteoporosis: An update

The diagnosis of childhood osteoporosis is relatively straightforward in primary bone diseases. However, in chronic diseases that can cause osteoporosis, the focus is often on primary treatment, and the risk of osteoporosis is frequently overlooked. Primary bone disease typically presents in infancy or early childhood with multiple fractures of long bones, abnormalities of the sclera or teeth, and an associated family history. On the other hand, secondary osteoporosis is associated with underlying chronic disease and long-term use of medications for these conditions. It may present with vertebral fractures as the only sign. Clinicians must be vigilant in diagnosing it due to its more insidious course. Once diagnosed, diet and lifestyle changes should be made. Also, any vitamin and mineral deficiencies should be replaced. The next step will be the identification of patients who are suitable for medical treatment. In some cases, patients with multiple bone deformities may require corrective surgery. Children diagnosed with osteoporosis should be monitored by a pediatric bone specialist, and their treatment should be coordinated by a multidisciplinary team.

DETERMINING THE DISTANCE OF DIAPHYSAL FRACTURES OF LONG TUBULAR BONES BASED ON THE RADIOGRAPHY METHOD

Backgraund: the study of skeletal trauma is one of the main ones in the work of a forensic expert when conducting an examination of living persons. In the conditions of the non-obviousness of the crime committed against the health of the individual, the deliberate concealment by those involved in the case of the circumstances and date of injury, and the delayed request for medical help, determining the age of fractures presents certain difficulties. In such cases, an important source of information is the results of x-rays of the damaged bone. Aims: identification of radiological features of diaphyseal fractures of long tubular bones, characteristic of a certain stage of consolidation. Materials and methods: a retrospective study was conducted of 192 radiographs (primary and control, during follow-up) of 56 people (men and women) aged 20 to 80 years with fractures of long tubular bones in conditions of metal osteosynthesis and without it. The dynamics of changes in the X-ray picture of fractures at different stages of consolidation were consistently studied, the main morphological signs were described, their systemic analysis, comparison in groups and structuring were carried out. Results: clear time periods of consolidation have been determined, basic reference signs have been established that allow tracking the dynamics of healing; a consistent change in the morphology of the fracture during healing was established; there is no significant difference in the dynamics of consolidation by gender; the MOS operation did not play a significant role in the speed of consolidation. Conclusions: the X-ray picture of a diaphyseal fracture of a long tubular bone has its own morphological features depending on the duration of the injury. Keywords: duration of fractures of tubular bones, timing of consolidation of diaphyseal fractures, radiological morphological features of fractures.

Difficulty in financing fracture care in south-western Nigeria: a prospective cohort study of predictors and recommendations for improvement

BackgroundBone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria.MethodsThe study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts – easy fracture-care financing (EF) and difficult fracture-care financing (DF) – based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF.ResultsThe mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036).ConclusionsThe findings suggest that improving people’s socioeconomic status through job creation, women’s empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings.

Cerebral Fat Embolism After Traumatic Long-Bone Fracture: A Case Report.

We here describe a rare case of a 26-year-old male patient, presenting to our hospital after a motorcycle-car accident for the surgical management of long-bone fractures to the tibia and femur and shoulder dislocation and undergoing orthopedic surgery, who postoperatively developed seizure, coma, and respiratory failure due to a cerebral fat embolism. After some hours after the surgery, a loss of consciousness was described by caregivers, and the ICU team was alerted, and the patient was admitted to ICU. Intracranial hemorrhage and stroke were subsequently excluded and, finally, a whole-body computed tomography angiography scan and head magnetic resonance imaging showed lesions consistent with cerebral fat embolism. Patent foramen ovale was then suspected by contrasted echocardiography. An early diagnosis helped to choose the correct management, with early tracheostomy, and to correctly interpret and manage hemodynamic dysregulations. Overall, the care provided lead to positive long-term outcomes, as the patient was discharged alive and successfully completed neurological rehabilitation, regaining many functional abilities. The initial management, diagnostic pathway, and ICU management are here described.

Clinical Observations of the Effectiveness of the Masquelet Induced Membrane Technique in the Treatment of Critical Long-Bone Defects of the Lower and Upper Extremities.

Background and Objectives: Successful treatment of severe trauma and fractures of the long bones with successful healing and bone union is still a significant challenge for surgeons. Unfortunately, up to 10% of long-bone fractures develop bone healing disorders. The aim of this study was to evaluate the results of treating bone defects with different etiologies in the upper and lower extremities using the induced membrane technique. Materials and Methods: We prospectively evaluated the radiological and clinical outcomes of 45 patients with severe bone defects treated with the induced membrane technique during the period from May 2021 to October 2023. The time to bone defect regeneration, size of the bone defect, and the cost of treatment were evaluated. Functional outcomes were assessed using the Disabilities of the Arm Shoulder and Hand (DASH) scale, SF-36, and the Lower Limb Functional Index (LLFI). Results: The mean follow-up time was 31 months (12-35). There were 20 patients with upper extremity bone defects and 25 with lower extremity bone defects. The mean defect length was 7.9 cm for the upper extremity (3.5-18) and 5.3 cm for the lower extremity (3-11). The mean times to achieve bone union and remodeling were 6.0 months (3-12) and 9 months (3-13) for the upper and lower limbs, respectively. Clinical evaluation at the end of treatment (achieving bone union) showed statistically significant improvements in the DASH, SF-36, and LLFI scales for pre- and postoperative outcomes. There was no statistical significance in the SF-36 clinical scale scores after surgical treatment compared to reconstructive treatment of upper and lower extremity bone defects. Results: The presented reconstructive approach to the treatment of bone defects and healing disorders and extensive analysis demonstrate the effectiveness of the induced membrane technique in a short follow-up period, with a relatively high level of patient comfort and good clinical results in the treatment of severe bone defects with particularly infectious etiologies.

Multidisciplinary standardized protocol decreases time to antibiotic administration for open fractures.

Wound complications after open fracture are common, including superficial and deep infections. Many factors may contribute to outcomes after open fracture, including comorbidities, injury location and characteristics, timing and quality of surgical debridement, and soft tissue coverage. Early prophylactic antibiotic administration is one of the few modifiable factors demonstrated to reduce infection rates. Retrospective comparative study at a single Level 1 Trauma Center evaluated patients age > 18 who presented directly to and were admitted with open long-bone fracture. Primary outcome measure was time from arrival to antibiotic administration pre- and post-implementation of a standardized open fracture protocol. Secondary analysis evaluated percentage of patients receiving antibiotics within one hour for open long-bone fracture, injury characteristics and patient demographics influence on time to antibiotics. Median time to antibiotic administration improved post-protocol (69min vs. 39min, p < 0.001). Patients receiving antibiotics within one hour improved after protocol implementation (42.9% vs. 79.0%, p < 0.001). Antibiotic administration was more often delayed for patients with penetrating injuries compared to blunt injuries (80min vs. 54min, p = 0.003). Patients with penetrating injuries were less likely to receive antibiotics within one hour (46% vs 56%, p < 0.001). The implementation of a standardized protocol reduced the time to antibiotic administration and increased the percentage of patients with open fractures receiving antibiotics within one hour. Penetrating injuries were often not appreciated as open fractures during the initial evaluation, which led to a delay in antibiotic administration. Level III, Therapeutic/Care Management.

Modeling of Healing of Intra-Articular Fractures of Long Tubular Bones in Rats

Background: We present a new original method of modeling an intra-articular fracture of the long tubular bone in laboratory animals.Objective: To create a new experimental model of an intra-articular fracture of the long tubular bone and to approve it for comprehensive evaluation of morphofunctional parameters of cartilage and bone healing.Materials and methods: The experiment was performed on 30 white sexually mature Wistar rats. Modeling involved layer-by-layer dissection of tissues along the anteromedial surface and formation of an incomplete fracture of the femoral medial condyle using a sharp L-shaped working end of an 0.2 × 0.2 сm instrument perpendicular to the medial condyle with a slight single muscle force. The rats were euthanized in groups of 10 animals on days 7, 14, and 30. We performed knee radiography and determined blood osteocalcin and BMP-7 levels. The Mankin score was used in the histological evaluation of the articular cartilage changes. The groups were compared using the Kruskal-Wallis test. P &lt; .05 was considered statistically significant.Results: We noted statistically significant differences (P &lt; .0001) when comparing the groups using the Mankin score. The post hoc test revealed statistically significant differences in the Mankin scores between days 7 and 14 (P = .014) and between days 7 and 30 (P &lt; .0001). Group comparisons showed no statistically significant differences in blood osteocalcin levels (P = .518). However, there were statistically significant differences (P = .0028) between the groups in blood BMP-7 levels. The post hoc test revealed statistically significant differences in blood BMP-7 levels between days 7 and 14 (P = .048) and between days 14 and 30 (P = .0195).Conclusions: The developed experimental model of intra-articular fractures of long tubular bones allows for a comprehensive assessment of reparative processes of cartilage and bone tissue. The model is close to the real mechanism of pathology development.

Effect of Ketorolac Administration on the Rate of Nonunion of Operatively Treated Pediatric Long-Bone Fractures: A Matched Cohort Analysis.

Nonunion is a rare yet serious complication in pediatric fracture healing that can lead to patient morbidity and economic burden. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of fracture nonunion in adults, but data are lacking in the pediatric population. This study examines the relationship between postoperative ketorolac administration and nonunion in operatively managed pediatric long-bone fractures. A retrospective cohort study was conducted with use of TriNetX, a research network that encompasses data from the United States, Canada, and Western Europe. A total of 462,260 patients from 52 health-care organizations met the inclusion criteria. Patients <18 years old with operatively managed upper or lower-extremity long-bone fractures were included. The exposure of interest was ketorolac administration within 30 days postoperatively between 2003 and 2023. Nonunion was identified and verified with use of the pertinent medical codes. Absolute risks and hazard ratios (HRs) were calculated for both study groups. Significance was set at p < 0.05. After propensity score matching, 48,778 patients were identified per group. The incidence of nonunion was 2.19% in the ketorolac group and 0.93% in the non-ketorolac group (HR, 2.71; 95% confidence interval [CI]: 2.46, 3.21; p < 0.0001). Subgroup analyses demonstrated a higher risk of nonunion in patients with lower-extremity fractures (HR, 3.45; 95% CI: 3.14, 3.75; p < 0.0001) than in those with upper-extremity fractures (HR, 2.11; 95% CI: 1.84, 2.32; p < 0.0001). Among the fracture location subgroups, the greatest HR for nonunion was observed in patients with femoral fractures, followed sequentially by those with tibial and/or fibular fractures, humeral fractures, and radial and/or ulnar fractures. To our knowledge, this is the largest study to date to explore postoperative ketorolac use and nonunion in the setting of operatively managed pediatric long-bone fractures. Nonunion in children was rare, occurring in <1% of all included patients. Ketorolac administration was associated with a 2 to 3-fold increase in nonunion risks, with pronounced implications for patients with lower-extremity fractures, particularly those with femoral fractures. Clinicians should weigh the therapeutic advantages of non-opiate analgesia with ketorolac against the risk of nonunion in order to optimize postoperative pain management and recovery. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The outcome of titanium elastic nail fixation of pediatric long bone fractures – a retrospective analysis

Background and Objectives Titanium Elastic Nails (TENs) in the surgical management of pediatric long bone fractures (LBF) have emerged as a pivotal technique. This study aimed to report experience with this technique for managing pediatric LBF at the Orthopaedic Department of Samtah General Hospital. Material and Methods A retrospective analysis was conducted using the pediatric LBF patients treated with TENs at the hospital from January 2021 to December 2023. Data regarding demographics, mechanism of injury, fracture patterns, time to achieve union, and functional outcome was extracted from their medical charts. Functional outcome was evaluated using the Flynn et al. criteria. Results A total of 26 patients, four females and 22 males, were included in the study, and the mean age was 9.6 years (6-16 years). Fractures analyzed were radius and ulna (n=12), femur (n=8), tibia (n=5), and isolated ulna (n=1). The most frequent cause was self-fall (n=17). The average time to achieve fracture consolidation (grade 3 callus) was 11.5±2.9 (6-16 weeks) for all fractures. The outcomes were excellent in 19 patients (73.1%) and satisfactory in 7 (26.9%). There were no poor results; only minor complications, such as skin irritation, were recorded in the study. Conclusion TENs fixation for Pediatrics LBF is an efficient and safe method with satisfactory outcomes.

Autologous Growth Factor-Rich Concentrate (GFC) Injection in Non-union of Fractures: A Quasi-experimental Study.

Non-union fractures represent a significant challenge in orthopedic practice, contributing to considerable morbidity and socioeconomic burden. Traditional treatments, such as autologous bone grafting, are effective but have limitations, including donor-site morbidity and limited tissue availability. Autologous peripheral blood-derived orthobiologics, including growth factor-rich concentrate (GFC), have emerged as a minimally invasive alternative, leveraging the body's natural healing mechanisms by concentrating and applying growth factors directly to the fracture site. This study evaluates the safety and efficacy of GFC injections in the treatment of non-union fractures. This quasi-experimental study included 17 patients with non-union fractures of various long bones, treated under fluoroscopic guidance with three doses of 5mL GFC injections, administered 2weeks apart at the non-union site. Demographic data, injury characteristics, and comorbid conditions were recorded. Growth factor levels were quantified via enzyme-linked immunosorbent assay (ELISA), and statistical analyses were conducted to explore associations between the amount of growth factors and treatment outcomes. Radiographic assessments and bony callus appearance were evaluated at the baseline and at 1-, 3-, and 6-month follow-up post-last injection. No adverse effects were reported throughout the duration of the study. The majority of patients (82.4%) showed significant improvement, evidenced by enhanced bony callus formation and reduced non-union signs. No significant correlation was found between the specific growth factor levels and the clinical outcomes of non-union of fractures. However, the presence of comorbid conditions significantly influenced treatment efficacy, underscoring the importance of patient selection in clinical practice. Administration of GFC injection is safe and potentially efficacious for the treatment of non-union fractures, offering an alternative to traditional surgical interventions. These results laid the foundation for prospective, adequately powered, randomized and non-randomized clinical studies with longer follow-up to further establish the efficacy of GFC in patients with non-union fractures. Moreover, formulation protocols need to be optimized while considering patient-specific variables, to ensure reproducibility and repeatability of outcomes from these studies. The online version contains supplementary material available at 10.1007/s43465-024-01278-1.

Study of clinical and radiological outcome of augmentation plating with or without bone grafting in non-union fracture of long bone with IMN in situ

Study of clinical and radiological outcome of augmentation plating with or without bone grafting in non-union fracture of long bone with IMN in situ

A Comparative Study Assessing the Efficacy and Outcomes of Sub-Muscular Plating and Elastic Stable Intramedullary Nailing in Paediatric Diaphyseal Femoral Fractures: A Systematic Review

Abstract Background Femoral shaft fractures are among the most common fractures of long bones. Paediatric diaphyseal femur fractures account for 1.4% to 1.7% of all paediatric fractures; the annual rate of children who present with femoral shaft fractures is estimated at 19 per 100,000. The management of paediatric diaphyseal femoral fractures depends primarily on the age of the child although the bone age and size of a child may determine the choice of treatment. The choice of management may also be determined by surgical experience and local trends in practice. Non- operative management plays a role in some cases still though current practice has veered towards operative fixation as it allows early mobilization and shorter hospital stays. Aim of the Work to evaluate efficacy and outcomes of submuscular plating and elastic stable intramedullary nailing in paediatric diaphyseal femoral fractures. Patients and Methods Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. A total of 303 cases were included with mean age 8.3 years. The majority of them were males. Results The current study showed that regarding Outcome; Mean operative time was 74.35 min in nail group vs 111.19 min in plate group. Mean intraoperative blood loss also was 58.1 ml in nail group vs 112.5 ml in plate group. As regarding hospital stay mean period was 4.4 days in nail group vs 5.5 days in plate group. As regarding time to full weight bearing was 10 wk in nail group vs 8.25 wk in plate group. Time to heal of fracture was 2.28 mn in nail group vs 2.35 in plate group. Total number of union in nail group was 161 cases vs 118 in plate. Our results showed that as regards complications; a total of 60 complications were found among included cases in form of infection in 3 with nail vs 4 with plate, malunion in 14 in nail vs 6 in plate group. Heterotopic ossification in 2 cases with plate fixation. Limb length discrepancy in 6 cases with nail vs 5 cases with plate fixation, refracture in 2 cases with plate fixation, pain in 7 cases with nail fixation. External rotation and antecurvatum in 4 cases with nail fixation vs 3 with plate fixation. Conclusion this review provides evidence that both ESIN and SMP are safe, effective, and minimally invasive surgical methods for the treatment of paediatric diaphyseal femoral fractures, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed carefully.

Morphological Characteristics of the Ulna Fracture Zone in Rats Undergoing Therapy With Modified Mesenchymal Stem Cells in Experimental Osteoporosis

Osteoporosis is a progressive systemic disease characterized by a decrease in bone density. This leads to increased bone fragility and a higher likelihood of fractures. New approaches to cellular therapy have been developed for the effective treatment of this pathology, based on the use of modified osteophilic polymers with mesenchymal stem cells (MSCs) for local action on damaged bone areas. The aim of the study was to morphologically assess the effectiveness of modified osteophilic polymer MSCs on reparative osteogenesis processes during the post-traumatic period in animals with a fracture of the ulna and underlying osteoporosis. Material and methods. The experiment involved Wistar rats (females, n=40; 200–300 g, 3 months old). Osteoporosis was simulated by bilateral ovariectomy, and the fracture was simulated through diaphysis osteotomy of the ulna. All rats were randomly distributed into four groups: Group I (control, n=10; buffered solution); Group II (n=10; osteophilic polymer, 1 mg/ml); Group III (n=10; MSC suspension, 1×106); Group IV (n=10; modified osteophilic polymer MSCs, 1×106). The experiment results were evaluated in 1 and 6 months after the fracture. Results. MSCs were applied after exposure to the osteophilic polymer to restore the pool of osteoblast precursors in the fracture area of the ulna in experimental osteoporosis. In all animals, regeneration foci with varying degrees of structural and functional maturation of cellular and intercellular substrates were formed in the fracture area. The most pronounced processes of bone tissue restoration were observed with the use of modified osteophilic polymer MSCs. This is likely associated with the high concentration of modified osteophilic polymer MSCs and their retention in zones of damaged bone regeneration, subsequently stimulating osteogenesis. The paradigm of provisionality, as a universal model manifestating histogenesis and organogenesis, was utilized to gain a more comprehensive biological understanding and interpretation of the observed changes. Conclusion. MSCs applied after exposure to an osteophilic polymer significantly enhance the process of reparative osteogenesis in fractures of long bones in patients with estrogen-induced osteoporosis, thus making this technology promising for combined therapy.

Minimally Invasive Plate Osteosynthesis for Comminuted Fractures of Long bones: A Prospective Study on Outcomes and Complications

The surge in comminuted bone fractures, attributed to modern lifestyles and increased trauma incidents, poses significant challenges in management. Traditional open reduction and plating methods, while effective, are associated with drawbacks like delayed union and higher infection rates. The evolution of MIPO (Minimally Invasive Plate Osteosynthesis) seeks to overcome these limitations. The potential effects of MIPO in the management of severely comminuted long bone fractures are investigated in this work. The Saveetha Medical College's Department of Orthopaedics carried out a prospective study from March 2022 to March 2024. Patients aged 20 to 60 with fractures of the femur, tibia, and humerus resulting from road traffic accidents were included. The AO Fracture classification system was utilized, and MIPO techniques were employed for fixation. Clinical and radiological assessments were conducted at various follow-up intervals. Statistical analysis using IBM SPSS Version 22.0 assessed outcomes, with a P-value&lt;0.05 countedas significant. MIPO was performed on twenty-four male patients, ages averaging 34.4 years, for severely comminuted fractures. The distal 1/3 of the femur, the tibia, and the humerus shaft were among the fractures. Union was rapid in 15 cases, with delayed consolidation in two requiring secondary bone grafting. Functional outcomes assessed using the Neer–Grantham–Shelton Criteria, demonstrated excellent outcomes- 65%, good- 30%, and fair- 5% of events. Complications included infection (5%), wound gaping (5%), joint stiffness (25%), and limb length discrepancy (20%). This study reinforces MIPO as a promising approach for severely comminuted fractures, showcasing excellent union rates and functional outcomes. Studies highlight its advantages in preserving soft tissue and periosteal circulation. The shift from anatomic reduction to optimal stability in such fractures aligns with current trends. Complications, though present, are manageable. The study contributes to the growing body of evidence supporting MIPO, emphasizing its potential advantages in minimizing surgical trauma and maintaining biological stability. Further research, including comparative studies and exploration of other fixation methods, is warranted for a comprehensive understanding of MIPO's role in fracture management.

Does arelation between bone histomorphometry and fractures exist? The case ofthe equine radius and tibia.

Fractures oflong bones inlimbs are rare traumatic events inhorses. This study investigates whether theincidence and types offractures can berelated tothe histomorphometric features ofthe radius and tibia, which experience different biomechanical stresses and exhibit varying incidences and types offractures. Clinical observations suggest that, inadults, slightly transverse and comminuted fractures are present inthe radius, while thetibia shows ahigher frequency oflongitudinal and spiral fractures. Microscopic observations reveal noapparent distinctive characteristics between the radius and tibia, whereas the histomorphometric data highlight differences inthe osteon density, eccentricity, and diameters ofthe osteons and Haversian canals. Tosum up, tibial osteons are more numerous and smaller than those inthe radius, resulting ina15% higher total extension ofthe cement line inthe tibia compared tothe radius. These histomorphometric differences are anevolutionary adaptation tothe different biomechanical stresses that involve the thoracic and pelvic limbs. Our results could help better understand numerous clinical realities detectable through retrospective analyses and aid inevaluating aspecific bone's predisposition towards traumatic events inall mammals, including humans.