Intramedullary Kirschner Wire Fixation Research Articles

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

Functional Outcome of Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures in Children

Pediatric patients with unstable radius-ulna fracture can be treated with intramedullary Kirschner wire fixation. Objective: To determine the functional outcome of Intramedullary Kirschner Wire fixation in unstable radius-ulna fractures in children. Methods: All pediatric age patients were enrolled into the study with unstable radius and ulna fracture. Informed consent was taken before study. Proper history, examination and X-rays of the forearm was taken after taking consent from the guardian of the patient. Under general anesthesia and tourniquet, control radius was first fixed through a small volar incision by drilling a k wire at fracture site in radius so that the wire exits on the dorsolateral side of the radius. The fracture was than reduced and the wire tapped with hammer to the radial head. Similarly, ulna was fixed by first drilling the wire up to the olecranon process and after reduction of the fracture down to the styloid process. After checking stability both bones, both wounds were washed with normal saline and closed in reverse order and above elbow cast was applied for three to four weeks. Results: In this study, as per functional outcomes, 5(4.0%) patients had good outcome, 80(64%) patients had excellent outcomes whereas 40(32%) patients had poor outcomes. Conclusions: This study demonstrates excellent functional outcome of Intramedullary Kirschner Wire fixation in unstable both bone forearm fractures in children.

Retrospective comparative analysis between intramedullary kirschner wire fixation and conservative treatment for displaced 5th metacarpal neck fractures

Retrospective comparative analysis between intramedullary kirschner wire fixation and conservative treatment for displaced 5th metacarpal neck fractures

Comparison of Frequency of Union with Percutaneous Intramedullary Kirschner Wire versus Interfragmentary Screw Fixation in Displaced Extra-articular Metacarpal Fractures

Objective: To compare the frequency of union in cases treated with percutaneous intramedullary kirschner wire versus interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Study Design: Randomized controlled trial. Place and Duration: The Department of Othropedic surgery, Ghurki Trust Teaching Hospital Lahore, Pakistan from May 2021 to November 2021. Methodology: A total of 70 cases (35 in each group) of both genders aged 18-60 years with displaced extra-articular metacarpal fracture were included. Surgery was performed with the patient under peripheral anesthesia adopting pneumatic tourniquet and image intensification. Patients were randomly divided into 2 groups, undergoing either percutaneous intramedullary K-wire fixation or interfragmentary Screw Fixation. Patients were followed up till 16th week to see the union. Results: The mean age of patients in K-wire group was 37.89±9.34 years and in screw fixation group was 40.17±12.82 years. In K-wire group, there were 24 (68.57%) male and 11(31.4%) female cases while in Screw fixation group there were 17 (48.6%) male and 18 (51.4%) female cases. In K-wire group, 20 (57.1%) cases reported union while in Screw fixation group, 33 (94.3%) cases reported union at the final follow up (p<0.001). Practical Implications: Interfragmentary screw fixation in displace extra-articular metacarpal fractures yielded better outcomes. Conclusion: Significantly more cases treated with interfragmentary screw fixation of displaced extra-articular metacarpal fractures reported union in comparison to percutaneous intramedullary kirschner wire. Keywords: Metacarpal fractures, internal fixation, intramedullary K-wire, screw fixation, union.

Management of gunshot-related forearm bone defect by sequential internal fixation and deferred bone grafting: experience from a tertiary hospital in Mogadishu

Gunshot-related forearm fractures are rare injuries, usually incurring bone defect. The aim of the study was to report clinical and radiological results for sequential internal fixation and bone grafting in acute civilian forearm gunshot fractures with bone defect. The procedure involves staged techniques consisting of bone debridement, soft-tissue closure and temporary intramedullary Kirschner wire fixation, followed by deferred bone grafting. To our knowledge, the present study is the first to investigate this surgical sequence in such injuries. Between June 2018 and September 2019, 6 civilian cases (5 male, 1 female) with a mean age of 26 years (range, 19–36 years) were operated on by sequential internal fixation and bone grafting for acute forearm gunshot fractures with segmental bone defect. Demographics, injury characteristics and surgical features were recorded. The Tang classification system was used to evaluate clinical and radiological results at final follow-up. Mean follow-up was 27 months (range: 21–32 months). Defect location was in the radius in 4 patients and in the ulna in 2, with a mean defect size of 3.75 cm (range, 2–8 cm). Union was achieved in 5 patients, at a mean 7 months (range, 4-10 months). Functional outcome was excellent in 4 patients, good in 1 and fair in 1. Sequential internal fixation and bone grafting seems a reliable option in the treatment of acute forearm gunshot fractures with bone defect. Level of evidenceLevel IV – Retrospective study.

FUNCTIONAL OUTCOME OF DISPLACED AND UNSTABLE DIAPHYSEAL FRACTURES OF BOTH BONES OF FOREARM IN CHILDREN TREATED WITH INTRAMEDULLARY KIRSCHNER WIRE FIXATION.

Introduction Diaphyseal fractures of forearm are very common in children. 90% of the fractures can be managed with closed reduction and cast immobilisation. Surgical intervention is needed in displaced, unstable fractures to prevent angulation and rotation deformity. This work is done to analyse the Functional outcome of displaced and unstable diaphyseal fracture of both bones of forearm in children treated with intramedullary kirschner wire fixation in Department of Orthopaedics, Adichunchanagiri institute of Medical Sciences,B G Nagara, Mandya. In ou Method r series of 30 cases there were 22 males and 8 females, maximum age of 12 years and minimum age of 3 years with mean age of 8.63 years. Fracture reduction and fixation were done with closed reduction and percutaneous nailing or mini open reduction and intramedullary fixation. Our average union time was 8.6 weeks and average kirschner wire removal time was 12.23 weeks. Patients were closely monitored for compartment syndrome and osteomyelitis. Th Results e functional outcome based on Price criteria was excellent in 83.3% (25) of cases, good in 10% (3) of cases and fair in 6.7% (20 of cases. There was no case with poor outcome. 2 patients had refracure other 5 patients had minor complication (pin tract infection(3 cases) , superficial radial nerve injury(1 case) and delayed union(1 case). From this study we consider that intramedullary kirschner wire fixation for unstable and displaced diaphyseal fracture of both bones of forearm in children is an excellent treatment modality. 1.Treatment of displaced and unstable diaphyseal fract Conclusion ures of the both bone forearm with Kirschner wires is an effective method of maintaining reduction 2.This is simple for fracture fixation with preservation of fracture haematoma. 3.Shorter period of surgery with minimal exposure . 4.Minimum invasive surgery with minimum expertise.

Retrograde Intramedullary Kirschner Wire Fixation as an Alternative for Treating Distal Fibular Shaft Fractures Combined with Distal Tibial Pilon Fractures.

Treatment or management techniques for pilon fractures are associated with high complication rates and poor outcomes. No consensus exists regarding the optimal surgical option for pilon fractures, especially for pilon fractures combined with distal fibular fractures. Accordingly, we explored the use of fibular fixation for treating pilon fractures involving distal fibular shaft fractures. We hypothesized that retrograde intramedullary Kirschner wire (K-wire) fixation is a suitable alternative technique for distal fibular fixation. We retrospectively reviewed the data of 156 patients who underwent surgery for pilon fractures at our hospital from May 2013 to May 2021. The radiographic and functional outcomes were comparable between the fibular intramedullary nailing (Group A; n = 80) and the fibular plating (Group B; n = 76) groups. Groups A and B differed significantly in total hospitalization time (11.4 vs. 18.2 days, p = 0.024), length of postoperative admission (6.8 vs. 11.4 days, p = 0.012), and total admission cost (USD 3624 vs. USD 6145, p = 0.004). We also noted that poor Olerud and Molander ankle scores were significantly associated with age (p = 0.008), smoking (p = 0.012), and preoperative admission length (p = 0.018). Retrograde intramedullary K-wire fixation produced a comparable 12-month functional outcome to plate fixation for distal fibular shaft fractures, rendering it a viable alternative method based on soft tissue condition.

Fifth Metatarsal Bunionette Correction Using a Stable Intramedullary Device

Category:Lesser ToesIntroduction/Purpose:Fifth metatarsal osteotomies for correction of a bunionette deformity are stabilized with a variety of techniques. The fifth metatarsal is a small bone with a unique blood supply and anatomy. Most of the described osteotomies are distal, making stable fixation technically demanding. The use of minimal incision surgery (MIS), also presents further challenges in the placement of stable fixation and current recommendations are to use either no fixation or intramedullary Kirschner wire fixation. Extensive translational osteotomies have not had documentation on healing as have first metatarsal osteotomies. This paper presents the results of 2 fellowship-trained orthopedic surgeons utilizing a new surgical implant that is both intramedullary and intramedullary. The patients were assessed with an endpoint of radiographic healing.Methods:A consecutive series of 21 de-identified patients who underwent a fifth metatarsal osteotomy for bunionette correction were radiographically followed until healing. Each patient was pre-operatively classified following the Coughlin classification of bunionette deformity. Postoperative radiographic assessments were made to include: 1. Bridging bone 2. The formation of medial bridging from the metatarsal head to the shaft. 3. Change in the 4-5 Intermetatarsal angle. Also, there was made a notation of complications: Time to weight-bearing, pain, and function were not assessed. There was only a small sample of patients that were treated with an isolated bunionette procedure. The other procedures were impactful and would skew the functional results. We also evaluated for hardware complaints that would need removal.Results:19 patients, 21 feet were evaluated with ages ranging from 51-77 years (Avg 63 years). 17 women and 2 men. Only one patient was a revision of prior surgery. Only 4 patients had an isolated bunionette correction. The other surgical procedures including; double osteotomy bunionectomy, distal metatarsal osteotomies (MIS), phalanx osteotomies of the great and lesser toes, Lapidus bunionectomy, first metatarsophalangeal arthrodesis. Coughlin grading; one Grade one, ten Grade 2, ten Grade 3. The average time to radiographic healing was 8 weeks. 5 patients underwent a traditional open incision and a chevron osteotomy with a saw, the remainder of the osteotomies were percutaneous transverse osteotomies performed with a 2x12mm Shannon burr.The mean 4-5 intermetatarsal angle improved from 10 degrees preoperatively to 3 degrees at follow-up. The amount of shift varied whether the lateral eminence was or was not excised. The numbers are not large and meaningful statistics are difficult to extrapolate.Conclusion:This is the first documented use of a novel surgical implant designed specifically for fifth metatarsal osteotomies used for bunionette correction. The implant is simple to use, provides for stability to prevent malunion and nonunions. It is low profile and has not caused irritation requiring removal in this pilot group. It is versatile and can be used with either an MIS approach and a transverse osteotomy or a classic open incision with a chevron osteotomy.

Relative Strengths of Intramedullary K-Wire Techniques for Digital Deformities

Hammertoe deformity correction surgery is one of the most common procedures performed by foot and ankle surgeons. Recent foot and ankle medical literature presents conflicting opinions regarding the optimal intramedullary fixation device and techniques for use in digital deformity correction. There are a number of varying fixation constructs of intramedullary Kirschner wire fixation reported for proximal interphalangeal joint arthrodesis; however, there are no reports of relative loading strength of the fixations. In this study, 90 sawbone models were divided equally into 3 groups of different intramedullary Kirschner wire fixation techniques: Group A- single straight, Group B- single bent, Group C- double bent. Each fixation construct underwent controlled axial loading and failure points were observed. Results showed no significant difference in load failure from all 3 groups with mean maximum force of Group A = 20N, Group B = 19.1N, and Group C =17.5N. We conclude that all Kirschner wire fixation options for digital deformity correction, will provide similar resistance to sagittal plane axial loads.

Retrospective analysis of Intramedullary K-Wire fixation of Metacarpal Fractures

Introduction: The majority of fractures of the metacarpal bones occur at a young age.Most of thetimes these metacarpal fractures can be treated conservatively in a POP slab(cock up slab)producing good functional results.Surgery was indicated in patients with palmar dislocation of >30°and shortening of >5 mm.Our study aimed to evaluate the clinical results of all metacarpal fracturestreated surgically by intramedullary Kirschner-wire fixation presented in our hospital.Materials andMethods: It was a retrospective study in which we included 50 patients with metacarpalfractures(both open andclosed) that came in our hospital, treated surgically by closed reduction andwere fixed with two intramedullary k-wires. Result: K-wires were removed after 4 weekspostoperatively,under local anaesthesia in the OPD. Metacarpal joint functions (flexion, extension,rotation) were clinically followed up in all patients, on the median periodof6 months (3 months to 9months). In our study, we found in all patients,flexion and extension were normal on bothsides.Conclusion: Closed reduction and intramedullary k-wire fixation of metacarpal bone fracturesproduce good functional results in the longterm. We found a very low rate of complication and thusrecommendthis surgical method for the stabilization of all these types of fractures.

The effects of intravenous and local tranexamic acid on bone healing: An experimental study in the rat tibia fracture model

BackgroundTranexamic acid (TXA) is an antifibrinolytic agent. It has long been used to reduce the need for perioperative blood loss in various surgeries. Few studies have investigated the effects of local and intravenous administration of TXA on fracture healing. Thus, we aimed to evaluate if TXA influences hematoma volume and fracture healing in the rat tibia fracture model. Materials and methodsA tibia fracture with intramedullary Kirschner wire fixation was created in all animals. Rats were randomly divided into three groups as local TXA, intravenous TXA, and control. A dose of 50 mg/kg local and intravenous TXA was administered to the study groups. Hematoma volume was measured on the first and third days of the study. The animals were sacrificed on the 14th and 21st days for radiological and histopathological examinations. ResultsThere was no significant difference between the groups in terms of hematoma volume measured on Day 1 and the mean decrease of hematoma volume from Day 1 to Day 3 (p = 0.158 and p = 0.239, respectively). The total radiological scores of Day 14 and Day 21 were similar in all groups (p > 0.05 for all). There was also no significant difference between the histological staging of the fracture repair on Day 14 and Day 21 for all groups (p > 0.05 for all). ConclusionOur findings suggest that TXA's local and intravenous application makes no significant difference in fracture healing.

Second Place Award: Long-term patient-reported outcomes after intramedullary Kirschner-wire fixation for displaced subcapital fractures of the fifth metacarpal bone: A retrospective cohort study

Background: The objective of this study was to analyze complications and patient-reported functional outcome after antegrade intramedullary Kirschner-wire fixation of displaced subcapital fractures of the fifth metacarpal bone. Methods: All consecutive patients treated from January 2010 to December 2015 were retrospectively identified using patient logs and radiographic images. Indications for operative fixation were angulation greater than 40 degrees, shortening less than 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-Rated Wrist/Hand Evaluation (PRWHE) and Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaires, both ranging from 1-100. Results: Fifty-one patients could be included, with two patients lost to follow-up. The mean outpatient follow-up was 9 wk, and the interval for functional assessment was 34 mo with 40 patients (78%) having responded to the questionnaires. Forty-seven patients (92%) proceeded to fracture union, while the recovery of two patients was complicated by migration of the Kirschner wires through the distal cortex into the metacarpophalangeal joint respectively 5 and 6 wk after primary surgery. Eight minor complications were registered, including a superficial skin infection, mild local dysesthesia or a 10- to 20-degree extension lag at the end of outpatient follow-up. Overall, in 41 patients (80%) the Kirschner wires were removed. Long-term functional outcome was excellent with mean PRWHE and DASH scores of, respectively, 3 and 6 points. Conclusions: If surgical treatment is considered, we recommend temporary antegrade intramedullary Kirschner wire fixation as a reliable therapeutic method with a low complication rate and excellent long-term functional outcome. Level of Evidence: Level III.

The effect of topical and systemic tranexamic acid on fracture healing in rats.

The aim of the present study was to determine the effect of topical and systemic tranexamic acid (TXA) on fracture healing in a rat surgical model. We created standard, right-sided, open, diaphyseal femoral fractures with intramedullary Kirschner wire fixation in 48 male rats and divided them into three groups: a topical TXA (10 mg/kg) group, a systemic TXA (10 mg/kg) group, and a control group. Fracture healing was evaluated radiographically and histologically after early (week 2) and late (week 4) postoperative sacrifice. The radiological scores differed significantly among the all groups (p=0.001), as did the week 2 and 4 scores (p=0.003 and p=0.010, respectively). Radiologically, the topical TXA group exhibited better bone healing at both 2 (p=0.001) and 4 (p=0.007) weeks than the control group, and the systemic group showed better healing at both 2 (p=0.027) and 4 (p=0.023) weeks than the control TXA group. Moreover, bone healing was better in the group treated with topical rather than systemic TXA on radiological examinations performed at 2 (p=0.001) and 4 (p=0.007) weeks postoperatively (p=0.001 and p=0.007, respectively). Histologically, the groups differed significantly (p=0.001). The histological scores differed significantly among the all groups (p=0.001). At 2 weeks, the topical TXA group exhibited significantly better bone healing than the control group (p=0.001). Our results suggested that topical application of TXA in fracture patients may accelerate healing, whereas systemic administration may adversely affect healing.

Humeral shaft fractures treated by closed retrograde intramedullary kirschner wire fixation

Context: Flexible intramedullary nails have been reported to provide a stable humeral fixation with satisfactory results in terms of union and complications. In this study, Kirschner wire (K-wire) was used to achieve a closed intramedullary fixation of humeral shaft fractures. Subjects and Methods: This study included forty cases of the displaced diaphyseal fracture of the humerus based on inclusion and exclusion criteria. The study was done at Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, between the periods January 2003 and November 2006. All the cases were operated after clinical evaluation. The final evaluation of the result was done by Qidwai's clinical and radiological criteria. Results: A total of forty cases were available for the study. K-wire of different sizes was used; the average duration of surgery was 45.3 ± 7.2 min. The average time taken for radiological union was 12.1 ± 1.9 weeks. The patients were analyzed by Qidwai's criteria and had excellent result in 30 (83.3%) cases, good in 4 (11.1%) cases, and poor in 2 (5.6%) cases. Three patients were lost to follow-up, and one patient was died due to medical illness. Conclusion: Intramedullary K-wire fixation is a satisfactory, safe, simple, minimally invasive technique and cost-effective treatment for humeral shaft fractures. It gives elastic mobility and stability.

Antegrade Percutaneous Intramedullary Fixation Technique for Metacarpal Fractures: Prospective Study on 150 Cases.

The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible. Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing. Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction. Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.

The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation

The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation

Antegrade intramedullary Kirschner-wire fixation of displaced metacarpal shaft fractures

PurposeThe objective of this study was to analyze complications and patient-related functional outcome after antegrade intramedullary Kirschner-wire fixation of metacarpal shaft fractures.MethodsAll consecutive patients treated from January 2010 until December 2015 were retrospectively analyzed using patient logs and radiographic images. Indications for operative fixation were angulation > 40°, shortening > 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-rated wrist/hand evaluation (PRWHE) and Disabilities of the Arm, Shoulder, and Hand score (DASH) questionnaire both ranging from 1 to 100 after a minimum follow-up of 6 months.ResultsDuring the study period, 34 fractures of 27 patients could be included. Mean outpatient follow-up was 11 weeks (range 4–24 weeks). The mean interval for functional assessment was 30 months (range 8–62 months) and 19 patients (70%) responded to the questionnaires. During outpatient follow-up, all fractures proceeded to union with no signs of secondary fracture dislocation or implant migration. One re-fracture after a new adequate trauma was seen and one patient underwent tenolysis due to persistent pain and impaired function. In 26 cases (81%), the K-wires were removed of which 23 (68%) were planned removals. Functional outcome was excellent with mean PRWHE and DASH scores of 7 and 5 points, respectively.ConclusionsIf surgical treatment for metacarpal shaft fractures is considered, we recommend antegrade intramedullary K-wire fixation. This technique results in low complication rates and excellent functional outcome.

Excessive skeletal muscle fibrosis and its correlation of tumor growth factor-.BETA. in rats with traumatic osteomyelitis

Objective To examine excessive fibrosis of the skeletal muscle in rats with traumatic osteomyelitis and its correlation with tumor growth factor-β (TGF-β). Methods Eighty male Wistar rats were randomized into osteomyelitis group (n=40) and control group (n=40), according to the random number table. Rats in osteomyelitis group were subjected to soft tissue injury, intramedullary Kirschner wire fixation and bacterial infection with 102 CFU/ml Staphylococcus aureus. In control group, aseptic normal saline was used instead of bacteria solution. At postoperative 3, 7, 14 and 28 d, muscular tissues surrounding the injury site were harvested to detect histopathologic changes and expression of TGF-β by HE staining and immunohistochemistry. Results HE staining showed more severe pathological changes in osteomyelitis group than in control group, such as inflammation, necrosis and fibroplasia. Positive immunohistochemical staining was detected, but a strong positive staining was recognized within both myocyte and matrix in osteomyelitis group versus only myocyte in control group. At postoperative 3 d, expression of TGF-β was similar between osteomyelitis group (19.4±2.7) and control group (18.6±2.8) (P>0.05) .At postoperative 7, 14 and 28 d, expressions of TGF-β in osteomyelitis group were 25.3±1.9, 28.5±2.7 and 36.0±1.8 respectively, higher than 21.7±2.5, 25.6±1.8 and 34.2±1.6 in control group (P<0.05). After operation, expressions of TGF-βin both groups showed gradual increase and peaked at 28 d. Conclusion Traumatic osteomyelitis can increase skeletal muscle fibrosis and the process is related to the increased expression of TGF-β. Key words: Osteomyelitis; Transforming growth factor beta; Fibrosis

A bio-artificial poly([D,L]-lactide-co-glycolide) drug-eluting nanofibrous periosteum for segmental long bone open fractures with significant periosteal stripping injuries

Biodegradable poly([d,l]-lactide-co-glycolide) (PLGA) nanofibrous membrane embedded with two drug-to-polymer weight ratios, namely 1:3 and 1:6, which comprised PLGA 180 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, and PLGA 360 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, respectively, was produced as an artificial periosteum in the treatment of segmental femoral fractures. The nanofibrous membrane’s drug release behavior was assessed in vitro using high-performance liquid chromatography and the disk-diffusion method. A femoral segmental fracture model with intramedullary Kirschner-wire fixation was established for the in vivo rabbit activity study. Twenty-four rabbits were divided into two groups. Twelve rabbits in group A underwent femoral fracture fixation only, and 12 rabbits in group B underwent femoral fracture fixation and were administered the drug-loaded nanofibers. Radiographs obtained at 2, 6, and 12 weeks postoperatively were used to assess the bone unions. The total activity counts in animal behavior cages were also examined to evaluate the clinical performance of the rabbits. After the animals were euthanized, both femoral shafts were harvested and assessed for their torque strengths and toughness. The daily in vitro release curve for lidocaine showed that the nanofibers eluted effective levels of lidocaine for longer than 3 weeks. The bioactivity studies of vancomycin and ceftazidime showed that both antibiotics had effective and sustained bactericidal capacities for over 30 days. The findings from the in vivo animal activity study suggested that the rabbits with the artificial drug-eluting periosteum exhibited statistically increased levels of activity and better clinical performance outcomes compared with the rabbits without the artificial periosteum. In conclusion, this artificial drug-eluting periosteum may eventually be used for the treatment of open fractures.

Biodegradable nanofiber-membrane for sustainable release of lidocaine at the femoral fracture site as a periosteal block: In vitro and in vivo studies in a rabbit model

The aim of this study was to evaluate the efficacy of a biodegradable, lidocaine-embedded, nanofibrous membrane for the sustainable analgesic release onto fragments of a segmental femoral fracture site. Membranes of three different lidocaine concentrations (10%, 30%, and 50%) were produced via an electrospinning technique. In vitro lidocaine release was assessed by high-performance liquid chromatography. A femoral segmental fracture, with intramedullary Kirschner-wire fixation and polycaprolactone stent enveloping the fracture site, was set-up in a rabbit model for in vivo assessment of post-operative recovery of activity. Eighteen rabbits were randomly assigned to three groups (six rabbits per group): group A comprised of rabbits with femoral fractures and underwent fixation; group B comprised of a comparable fracture model to that of group A with the implantation of lidocaine-loaded nanofibers; and group C, the control group, received only anesthesia. The following variables were measured: change in body weight, food and water intake before and after surgery, and total activity count post-surgery. All membranes eluted effective levels of lidocaine for more than 3 weeks post-surgery. Rabbits in group B showed faster recovery of activity post-operatively, compared with those in group A, which confirmed the pain relief efficacy of the lidocaine-embedded nanofibers. Nanofibers with sustainable lidocaine release have adequate efficacy and durability for pain relief in rabbits with segmental long bone fractures.