Intramedullary Wire Fixation Research Articles

Intrafracture Recombinant Platelet-Derived Growth Factor Improves Fracture Healing Process on Wistar Rat

Background: Femoral fracture is associated with high morbidity and mortality, especially in young adults with high-energy injuries. Abnormal fracture healing presents as a significant matter in management of femoral fracture. Platelet Derived Growth Factor (PDGFBB) is proposed as potential agent in fracture healing. Up to this point, PDGF has been scientifically studied improve wound healing by enhancing fibroblast proliferation, extracellular matrix synthesis, and revascularization. This study aims to evaluate role of PDGF on fractured bone healing.Subjects and Method: This was a randomized controlled trial conducted at Animal and Biomedical Laboratory of Udayana University, from March to September 2022. 36 male and healthy Wistar Rats at 34 months old and weighs 140160 grams were selected for this study. The dependent variables were Allen score, type I and type III collagen levels. The independent variable was administration of 10 mcg PDGFBB following femoral osteotomy and intramedullary wire fixation. Type I and III collagen levels are assessed using ELISA methods. Statistical analysis is performed using independent T-test in SPSS ver 25.0 software.Results: Allen score in the PDGFBB group (Mean= 3.89; SD= 1.40) was higher than control group (Mean= 2.28; SD= 1.48), with p=0.002. Type I collagen in the PDGFBB group (Mean= 4.97; SD= 0.54) was higher than control group (Mean= 4.41; SD= 0.74), with p=0.014. Type III collagen in the PDGFBB group (Mean= 12.1; SD= 2.49) was higher than control group (Mean= 10.01; SD= 1.61), with p=0.005.Conclusion: In comparison to the nonPDGFBB group, Wistar rats that had their femurs osteotomized and joined with intramedullary wire in the PDGFBB group has higher mean of Allen score, type I and type III collagen levels.Keywords: femoral fracture, allen score, type I collagen, type III collagen, PDGFBBCorrespondence: IGN Wien Aryana, Consultant of Sports Medicine, Dept. Orthopaedic and Traumatology, Prof IGNG Ngoerah General Hospital, Faculty of Medicine, Udayana University. Jl. Diponegoro, Dauh Puri Klod. Denpasar City, Bali 80113. Email: wienaryanaortho@gmail.com. Mobile: +62811385263.Indonesian Journal of Medicine (2023), 08(02): 136141https://doi.org/10.26911/theijmed.2023.08.02.02

The Promotive Effects of PTHrP on the Union of Femoral Shaft Fracture in a Mouse Model

In order to explore the effects of PTH-related peptide on fracture healing in mice, the intervention effects and mechanism of action of PTH-related peptide on femoral shaft fracture models in mice of different genotypes were analysed to obtain a new approach for promoting the healing fractures clinically. A total of 32 8-week old PTH-related peptide wild-type and PTH-related peptide gene knockout heterozygous (PTH-related peptide +/-) mice were selected as the test system and standard femoral shaft fracture mouse models were constructed by intramedullary wire fixation. After model construction, all mice were randomly divided into the wild type control, the PTH-related peptide +/- control, the wild type treated and the PTH-related peptide +/- treated groups, with 8 mice in each group. Mice in both treated groups were administered with 80 μg/kg/day of PTH-related peptide (1-34) subcutaneously and the control groups received subcutaneous injections of saline. After 2 weeks, all mice were sacrificed and the fractured right femur of each mouse in each group was taken for X-ray examination and micro-CT scan to observe the union of the fracture. Next, the formed callus tissues were paraffin-embedded and stained to analyse and compare the bone formation changes of osteoblasts in the fracture sites of mice. Compared to the wild-type group, the saline-treated mice in the PTH-related peptide +/- group had clear fracture lines with callus volume and bone mineral density significantly reduced; after PTH-related peptide treatment, the fractures in the PTH-related peptide +/- group were tightly connected and a large number of osseous calluses were formed; in addition, the density of the callus was higher, which was significantly different from those in the control group (p<0.05). Compared to the wild-type group, the area of cartilage callus of the saline-treated PTH-related peptide +/- group increased by 97 % (p<0.05); after PTH-related peptide administration, the total callus area and osseous callus area increased significantly, while the area of cartilage osseous significantly decreased compared to the control group and after PTH-related peptide administration, the number of osteoblasts and the percent positive area of collagen I in mice were significantly increased compared to the control group. In conclusion, endogenous PTH-related peptide deficiency could lead to delayed healing of fracture, which could be compensated by PTH-related peptide administration, thereby accelerating the formation of calluses and promoting fracture healing in mice.

The treatment of percutaneous intramedullary wire fixation for distal humeral shaft fractures; two cases report

The treatment of percutaneous intramedullary wire fixation for distal humeral shaft fractures; two cases report

Vitamin K2 Promotes Bone Healing in a Rat Femoral Osteotomy Model with or without Glucocorticoid Treatment

The purpose of the present preclinical study was to determine whether vitamin K(2) would promote bone healing in a rat femoral osteotomy model with or without glucocorticoid (GC) treatment. Thirty-eight 6 week-old female Sprague-Dawley rats underwent a unilateral osteotomy of the femoral diaphysis followed by intramedullary wire fixation and then were randomized into four groups that received the following treatment schedules: vehicle, vitamin K(2), GC + vehicle, and GC + vitamin K(2). GC (prednisolone, 2.5 mg/kg) was administered subcutaneously twice a week. Vitamin K(2) (menatetrenone, 30 mg/kg) was administered orally five times a week. After 8 weeks of treatment, the wires were removed and a bone histomorphometric analysis was performed on the bone tissue inside the callus. Vitamin K(2) administration to GC-untreated rats decreased the osteoclast surface/bone surface (OcS/BS), osteoblast surface (ObS)/BS, eroded surface (ES)/BS, and bone formation rate (BFR)/BS and increased the lamellar area/bone area. Although GC treatment increased the ES/BS and decreased the ObS/BS, BFR/BS, and lamellar area/bone area, vitamin K(2) administration to GC-treated rats decreased the OcS/BS and prevented an increase in the ES/BS and a decrease in the lamellar area/bone area. These results suggested that vitamin K(2) downregulated bone turnover and stimulated lamellar bone formation in GC-untreated rats and prevented an increase in bone resorption while maintaining bone formation and prevented a decrease in lamellar bone formation in GC-treated rats. Thus, vitamin K(2) appears to be effective for promoting bone healing in a rat femoral osteotomy model with or without GC treatment.

Extraarticular Hand Fractures in Adults

This report cites new developments in the treatment of extra-articular hand fractures in adults. Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment. Unilateral excision of the lateral band and oblique fibers of the extensor apparatus of the metacarpophalangeal joint facilitates proximal phalangeal fracture exposure and may improve functional recovery. Results using open mini screw fixation of oblique extra-articular metacarpal and phalangeal fractures may be comparable to those of percutaneous Kirschner wire fixation. Bicortical self-tapping mini screw fixation of extra-articular oblique metacarpal and phalangeal fractures simplifies screw insertion and provides stability comparable to that of fractures fixed with lag screws. Percutaneous intramedullary wire fixation may afford suitable fixation for unstable extra-articular oblique as well as transverse metacarpal fractures. Locked intramedullary nails may offer similar advantages. Unicortical screw fixation of mini plates securing transverse extra-articular metacarpal fractures affords stability comparable to that of bicortical screw fixation while creating less bone damage. The dissection required for plate fixation and the small surface area of transverse fractures delay and occasionally impair bone healing. Primary bone grafting of diaphyseal defects in clean stable wounds may shorten and simplify treatment and decrease morbidity. As little as 1.7 mm of flexor tendon excursion during the first 4 weeks after reduction or repair may substantially diminish peritendonous adhesions at the fracture site. Synchronous wrist and digital exercises may also reduce peritendonous fracture adhesions. Early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment and leads to earlier return to work. Level V (expert opinion).

Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation - introduction of a new treatment concept.

The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.

Kapandji intramedullary wire osteosynthesis in proximal humeral fractures

For operative treatment of proximal humeral fractures minimal invasive techniques reduce the risk of iatrogenic damage of blood supply and periarticular scarring. Reported preliminary results are encouraging. We present our experience achieved with an intramedullary wire fixation adapted from a report of Kapandji in 1989. Between 3/95 and 6/00 29 patients were treated with this technique at our institution. All received early functional treatment. 14 patients (average mean age 56 years at time of trauma) who had a minimum follow up of 24 months (mean 36.4 months) and therefore allowed a preliminary conclusion regarding avascular head necrosis (AVN) were reexamined by use of the Constant Score and x-ray. We examined three unstable 2-part, four 3-part and seven 4-part fractures (5 of them valgus-impacted). The mean Constant Score at follow up was 70 points (31-86 points). We saw one total collapse of the humeral head because of AVN. In one patient the distal end of the wires led to a skin irritation and had to be shortened. We observed no secondary fragment displacement or non-unions. In our hands, this technique offers good results, even in valgus-impacted 4-part fractures of the elderly and allows internal fixation in little displaced but unstable fractures with the benefit of early functional treatment instead of longer immobilization. Based on the experience with intramedullary wiring the previously performed technique using threading wires was abandoned and the indication for primary arthroplasty considerably influenced.

Mallet finger fractures: A comparison of open and closed technique

A mallet finger associated with a fracture of the distal phalanx may be treated by closed or open technique. Traditionally, it has been taught that fractures involving more than one third of the articular surface or where the joint is subluxed require open tratment with anatomic restoration of the articular surface.’ Numerous surgical techniques have been proposed and include the use of a tension band wire,2 intramedullary wire fixation,’ external fixation with Kirschner wires as a tension band device,” and fixation with a small lag screw.5 The relative difficulty of all these procedures has led Wehbe and SchneideP to conclude that most mallet finger fractures

Multiple Intramedullary Wire Fixation of a Radial Fracture in a Dog

Multiple intramedullary wire fixation infrequently can be used as an alternative technique to plating, transfixation devices, single intramedullary pinning, or external coaptation for some radius and ulna fractures.This report describes a comminuted fracture of the radius and ulna with fissures and comminution extending too far into the proximal radius for effective application of a bone plate or Kirschner‐Ehmer apparatus. Resulting fracture instability and collapse prohibited effective use of external coaptation as a primary means of fixation. The radial fracture was repaired and stabilized with full cerclage wires and multiple intramedullary Kirschner wires. The dog was using the leg normally 12 months following surgery.