Long Bone Fractures Research Articles

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

Background: 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. Methods: 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 &lt;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 &lt; 0.05. Results: 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 &lt; 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 &lt; 0.0001) than in those with upper-extremity fractures (HR, 2.11; 95% CI: 1.84, 2.32; p &lt; 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. Conclusions: 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 &lt;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. Level of Evidence: 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.

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.

Exoskeletal-assisted walking combined with transcutaneous spinal cord stimulation to improve bone health in persons with spinal cord injury: study protocol for a prospective randomised controlled trial

IntroductionPersons with non-ambulatory spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have marked loss of bone mineral density below the level of lesion that...

Combination of Elastic Nail(s) and Cementoplasty to Treat Pathological Fractures in Long Bones of the Upper Limb.

To describe and study retrospectively the combination of elastic nails and cementoplasty to stabilize pathological fractures in the upper limb and present the results on pain and mobility. Between January 2022 and April 2024, six patients with a median age of 65 were treated with elastic nailing and cement injection. Pathological fractures were located in the clavicle (n = 3), humerus (n = 1) and radius (n = 2). Displacement at the fracture site was noted in two cases. All nails were inserted successfully. Two nails were used for the humerus (n = 1) and the radius (n = 2), and a single nail was used for the clavicle (n = 3). A median volume of 6.5cc of PMMA was injected. Median duration of the procedure was 155min. Median pain score dropped from 8/10 the day before intervention to 3.5/10 at 10days of follow-up and 3/10 at one-month follow-up. Three patients could move their upper limb without limitation. For the five patients for whom imaging was available, no fracture displacement was recorded at a median last follow-up of 3months. There was no delayed complication. The combination of elastic nail and cementoplasty is feasible and allows to reduce pain and restore limb function. It may offer an alternative to patients suffering from pathological fractures in the upper limb and who are not candidates for surgery.

Do we have to redefine type B-fractures of the rib cartilage?

Aim of this work was the evaluation and validation of the AO/OTA classification of the anterior chest wall, here especially for the rib cartilage. Study design was a retrospective analysis of patients who were hospitalized with fractures of the thoracic wall in the years 2010-2016. This resulted in a collective of n = 124 patients. All fractures of the anterior chest wall were classified according to their location, dislocation and fracture type according to the AO classification. An analysis of possible subtypes was carried out. 29.0% (36) of the patients had fractures of the rib cartilage. 23 of the 36 (64%) patients had multiple fractures, the total number of single fractures amounted to 94. 53.2% (50) of these fractures were in the right hemithorax, 46.8% (44) in the left hemithorax. 95.7% (90) of the fractures were A-fractures, 4.3% (4) were C-fractures. There were no B fractures. The C fractures also consisted exclusively of A fractures (AA fractures). 59.6% (56) of the fractures showed a dislocation. 30.9% (29) were avulsion fractures of either the osteochondral (22.3% (21)) or the sternocostal junction (8.5% (8)). The costal cartilage obviously does not show typical B fractures as we know them from shaft fractures of long bones. We have compiled a structured analysis in the attached manuscript and validated the classification proposal. In conclusion, we propose an adaptation of the classification proposal based on our data with redefining type B fractures as fractures of the osteochondral joints.

Improving Time to Antibiotics for Long-Bone Open Fractures: A Quality Improvement Initiative.

Open fractures, which are exposed to the external environment, are at a high risk of infection. Administering antibiotics within 60 minutes of emergency department (ED) arrival is crucial to prevent infection. However, this is difficult to achieve due to high ED patient volumes. The purpose of our project was to improve time to antibiotics for patients presenting with long-bone open fractures at a Level 1 trauma center ED. We used the Lean Six Sigma Define, Measure, Analyze, Improve, and Control project framework to guide our efforts. Our interventions composed of developing educational initiatives, creating an electronic medical record order set, and restructuring the ED workflow to prioritize long-bone open fractures for immediate evaluation and antibiotic administration in our critical care zone. After our intervention, the time to antibiotics for long-bone open fractures improved significantly, decreasing from 76 to 40 minutes ( p < .001), with the percentage of patients receiving antibiotics within 60 minutes of ED arrival increasing from 64% to 92% ( p < .001). Age, sex, mechanism of injury, antibiotic choice, and location of the open fracture remained consistent between the two groups. Our results highlight the successful application of process improvement methodologies in improving antibiotic administration time for long-bone open fractures.

Management of closed diaphyseal fractures in children in two black African countries: Preliminary results and epidemiological profile

Objectives: The objective of this study was to describe the clinical evolution and the epidemiological profile of long bone fractures in children in two African countries. Methods: This was a five-year retrospective study of closed fractures of long bones in children aged 9.7 years (Ranging 4–16). Seventy-two fractures were treated by elastic stable intramedullary nailing and plate osteosynthesis. The results were evaluated according to Oestern and Tscherne criteria, and parental satisfaction was assessed using an individual investigation form. Results: The treatment of closed fractures of long bones in children is marked by complications such as infection (16.6%), implant migration (19.4%), non-union (11.1%), and malunion (2.7%). According to the assessment criteria, 33.3% were excellent, 45.8% were good, and 20.8% were poor. Twenty percentages of parents were very satisfied, 61% were satisfied, and 18% were disappointed with the outcome. Conclusion: Osteosynthesis is only indicated in common pediatric trauma if the capabilities of remodeling a callous are insufficient. It should not be the first choice in children’s fracture therapeutic options.

Bone Transport through Induced Membrane Technique versus Conventional Bone Transport Technique in Management of Bone Defects of Lower Limbs

Abstract Objectives To assess whether Bone transport through induced membrane (BTM) has better outcomes regarding docking site union and infection recurrence than conventional bone transport (BT) or not in the treatment of infected lower limb long bones defects. Methods A prospective randomized controlled study in a single institution was conducted. A total of 30 patients with infected non united fractures of long bones of lower limbs were divided into 15 patients (10 femurs, 5 tibias) treated by BTM and 15 patients (3 femurs,12 tibias) treated by BT. The outcome measures includes external fixation time (EFT), external fixation index (EFI), docking time (DT), bone and functional outcomes evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, postoperative complications evaluated by Paley classification and number of additional operations. Results The mean docking time (DT) was significantly lower in BTM group in comparison to BT group (3.67 ± 0.82 months vs 4.80 ± 0.86 months respectively) (p value 0.001). Docking site nonunion and infection recurrence were significantly lower in BTM group in comparison to BT group (0% vs 40% respectively) (p value 0.02) and (0% vs 33.3% respectively) (p value 0.04). Mean number of additional operations per patient was significantly lower in BTM group in comparison to BT group (0 vs 0.80 ± 1.08 operations respectively) (p value 0.01) Conclusion Both BTM and BT achieved satisfactory postoperative bone and functional outcomes in patients with infected long bones defects of lower limbs, while BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates and lower number of additional operations needed at the expense of 2 staged procedure in comparison to BT.

Is the Spectrum of Bacterial Infection in Open Long-bone Fractures of the Lower Limb Changing?

Introduction: Recent literature suggests a significant risk of infection by Gram-negative bacilli (GNB) in open Grade III fractures. Our prospective study aimed to identify the rate of infection with multidrug-resistant GNB (MDR-GNB) in open Grade III fractures and also study its clinical outcome. Materials and Methods: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long-bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics, and index procedure were noted. Length of hospital stay, number of additional surgeries, and occurrence of complications were also noted. In infected open fractures, bacteriology and resistance pattern of the isolated microorganism were noted. Clinical outcomes of all included study patients were measured at 9 months. Results: A total of 231 patients with 275 open fractures involving femur, tibia, or fibula were studied. There was clinical suspicion of infection in 84 patients (36.4%) with 99 fractures (36%). Culture was positive in 43 patients (51.2%). MDR-GNB infection was seen in 19 patients representing 8.2% of all included study patients. Patients with MDR-GNB infection required a significantly higher percentage of additional surgical procedures than patients with non-MDR-GNB infection (2.2% vs. 0.8%, P &lt; 0.0001) and had a lower return to work status (5.3% vs. 30.7%, P = 0.03), suggesting MDR-GNB infections have a worse outcome. Conclusion: Our study showing a high rate of MDR-GNB infection in open fractures highlights the therapeutic challenges involved in treating this nosocomial problem. MDR-GNB infection in open fractures is a serious cause of morbidity and poor outcome.

Assessment of radiation exposure risks in patients undergoing elastic stable intramedullary nailing: Insights from intraoperative fluoroscopy

IntroductionElastic stable intramedullary nailing (ESIN) is a well-defined and appropriate treatment of choice for long bone fractures. Despite its benefits, the risk of cancer from imaging devices is of particular concern for younger adults. So, this survey was conducted to estimate the doses administered to patients undergoing ESIN of long bone fractures utilizing a 2-dimensional (2D) C-arm fluoroscopy machine during surgery, as well as the carcinogenic risk associated with the use of the machine. MethodsThis study was conducted on 147 patients who required ESIN for long-bone fractures. Patients' demographic data, surgical data and imaging information were collected. For each patient, the organ doses and the effective doses were computed with the Monte Carlo PCXMC 2.0 simulation software. The cancer risk models proposed in the Biological Effects of Ionizing Radiation VII (BEIR VII) Phase 2 report were used to evaluate the risk of exposure-induced cancer death (REID) values. ResultsFor all patients, the highest organ dose was delivered to the gonads. The mean effective dose was 0.026 ± 0.015 mSv and 1.3E-04 ± 1E-04 mSv for ESIN of femur and tibia fractures, respectively. Males had a mean REID of 1 per million, while females had a mean REID of 0.19 per million. The younger males had considerably higher REID values. The effective dose was significantly correlated with age, gender, and irradiation time. ConclusionLow levels of effective doses and cancer risks associated with the utilization of the fluoroscopy machine in current practice were found in ESIN treatment of long-bone fractures. Implications for practiceThis outcome will help to raise surgeons' awareness of radiation risks and encourage them to initiate measures to keep radiation dose and exposure time as low as reasonably achievable.

Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

An observational study of gastric contents in pediatric patients with long bone fracture using gastric ultrasound.

The retention of gastric contents at surgery presentation is a risk factor for perioperative aspiration. A preoperative fasting (nil per os; NPO) interval is widely used to reduce this risk, but this approach is based on assumptions about the prevalence of typical gastric emptying rates. We assessed NPO guidelines' reliability with ultrasound (US) imaging and suction in pediatric patients presenting for single long-bone fracture repair after appropriate NPO intervals, when nearly all should have had empty stomachs. This prospective cross-sectional observational study comprised 200 pediatric surgical patients. As their NPO times varied by food/drink type, we defined "weighted NPO units" as the lowest multiple of elapsed recommended NPO times between consumption and surgery for each type of food or drink. We used US to image the stomach and its contents before anesthesia induction, followed by gastric suction. We evaluated the relationships between weighted NPO units, US gastric contents grade, opioid analgesic dosage and timing, and suctioned volume. Despite meeting typical NPO standards (median 14 h fasting), many patients retained nontrivial quantities of gastric contents at surgery. Weighted NPO units did not exhibit statistically-significant relationships with either suctioned volume or US grade. However, suctioned volume did correspond well to US grade. NPO status may be a less reliable predictor of gastric contents at anesthesia induction in this patient population than has been assumed. Bedside US screening appears to provide more useful information for the planning of airway management.

An Outcome Analysis of Pediatric Diaphyseal Fractures Treated Surgically With the Titanium Elastic Nailing System.

Introduction Pediatric fractures account for one-fourthof all pediatric injuries. Stabilizing the fracture, regulating the length and alignment, encouraging bone healing, and minimizing morbidity and problems for the child and family are the objectives of treatment for diaphyseal fractures of long bones in children. Our goal is to investigate how pediatric diaphyseal long bone fractures are treated with a titanium elastic nailing system (TENS). Methods A prospective interventional study was conducted on 24 children who had displaced diaphyseal fractures of major long bones, involving 31 diaphyseal fractures of long bones. Utilizing Flynn's grading standards, the result was examined. Results The mean age was 12.20 years. The youngest child was seven years old and the eldest child was 16 years old. There were 20 boys (83.33%) and four girls (16.67%). The male-to-female ratio was noted to be 5:1. The commonest mode of injury was road traffic accidents (12 cases, 50%), followed by falls while playing (10 cases, 41.67%). Other causes included falls from height (one case, 4.17%)and blunt trauma (one case, 4.17%). The commonest bone to get fractured was the femur (37.50%), followed by both bones of the forearm (29.17%), tibia (20.83%), humerus (8.33%), and ulna alone (4.17%). The middle third (21 fractures, 67.74%) was the most prevalent location for fractures. Five fractures each (16.13%) accounted for in the proximal and distal thirds. Twelve fractures (38.71%) were detected on the left side, while the majority of fractures (19 fractures, 61.29%) were seen on the right side. Most of the fractures in this group were transverse fractures (18 fractures, 58.06%) followed by oblique fractures (eightfractures, 25.81%). Comminuted fractures accounted for five fractures (16.13%). Of the 31 fractures, open reduction had to be done in two fractures, after unsuccessful attempts at closed reduction. Closed reduction was done in 29 fractures. There were 15.12 weeks in the average union term. The range is six weeks to 39 weeks. The most frequent side effect was discovered to be skin irritation at the entry site. The extraosseous portion of nails caused irritation at two entry sites (6.45%). A case had delayed union (3.23%) and restricted knee range of movements. Conclusion For the treatment of juvenile diaphyseal fractures of the long bones, the TENSis the best option. It is a quick, straightforward, safe, dependable, and efficient way to treat pediatric long-bone fractures in patients aged five to 16 years. The healing process takes a fair amount of time, while the surgery takes less time. It does away with the necessity for extended bed rest and significantly shortens hospital stays. It provides stability and elastic mobility, which is perfect for early mobilization and quick union at the fracture site. It has a low rate of complications and produces excellent functional results.