Long Bone Fractures Research Articles

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.

Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.

Effect of reverse hammering on fracture union in transverse fracture of long bone nailing

Reverse hammering is the method applied during nailing of transverse long bone fracture to decrease the gap between fracture ends to ensure healing. This study aims to asses the effectiveness of reverse hammering on fracture union in transverse fracture of long bone nailing as well as possible complications of this method. Seventy six patients with transverse fracture of long bone (femur, tibia, & humerus) treated with close reduction and internal fixation with interlocking nailing were enrolled in a prospective study conducted at the department of orthopaedics, BMC Sagar from Dec. 2012 to March 2021. Union grading was done to asses union as per Hammer criteria. Mean time to achieve bony union was 4.5 months. In our study seven out of seventy six patient at the end of three month were having radiological grade three or less union which at the end of nine month only two patient out of seventy six patient were having nonunion. Our results have been encouraging. The operation is technically demanding but provides an excellent method to achieve union in intramedullary nailing of long bones. This method to reduce fracture gap should be considered for patients requiring a faster return to function after the injury.

Predictors for infection severity for open tibial fractures: major trauma centre perspective

IntroductionOpen diaphyseal tibial fractures are the most common long-bone fractures and require a rapid approach to prevent devastating complications. Current literature reports the outcomes of open tibial fractures. However, there is no robust, up-to-date research on the predictive indicators of infection severity in a large open tibial fracture patient cohort. This study investigated the predictive factors of superficial infections and osteomyelitis in open tibial fractures.Materials and methodsA retrospective analysis of the tibial fracture database was carried out from 2014 to 2020. Criteria for inclusion was any tibial fracture including tibial plateau, shaft, pilon or ankle, with an open wound at the fracture site. Exclusion criteria included patients with a follow-up period of less than 12 months and who are deceased. A total of 235 patients were included in our study, of which 154 (65.6%), 42 (17.9%), and 39 (16.6%) developed no infection, superficial infection, or osteomyelitis, respectively. Patient demographics, injury characteristics, fracture characteristics, infection status and management details were collected for all patients.ResultsOn multivariate modelling, patients with BMI > 30 (OR = 2.078, 95%CI [1.145–6.317], p = 0.025), Gustilo-Anderson (GA) type III (OR = 6.120, 95%CI [1.995–18.767], p = 0.001), longer time to soft tissue cover (p = 0.006) were more likely to develop a superficial infection, and patients with wound contamination (OR = 3.152, 95%CI [1.079–9.207], p = 0.036), GA-3 (OR = 3.387,95%CI [1.103–10.405], p = 0.026), longer to soft tissue cover (p = 0.007) were more likely to develop osteomyelitis.Univariate analysis also determined that risk factors for superficial infection were: BMI > 35 (OR = 6.107, 95%CI [2.283–16.332], p = 0.003) and wound contamination (OR = 2.249, 95%CI [1.015–5.135], p = 0.047); whilst currently smoking (OR = 2.298, 95%CI [1.087–4.856], p = 0.025), polytrauma (OR = 3.212, 95%CI [1.556–6.629], p = 0.001), longer time to definitive fixation (p = 0.023) were for osteomyelitis. However, none of these reached significance in multivariate analysis.ConclusionHigher GA classification is a significant risk factor for developing superficial infection and osteomyelitis, with a stronger association with osteomyelitis, especially GA 3C fractures. Predictors for superficial infection included BMI and time to soft tissue closure. Time to definitive fixation, time to soft tissue closure, and wound contamination were associated with osteomyelitis.

Features of routing, diagnosis and combined treatment of pathological fractures of long tubular bones of tumor etiology

Introduction. In the structure of fractures of long tubular bones, pathological fractures account for about 1 %, and 2/3 of all cases are pathological fractures associated with bone metastases. Primary bone tumors are complicated by the development of a pathological fracture in 1– 10 % of cases, bone metastases in 8–30 % of cases. With a pathological fracture, as the primary manifestation of the tumor process, as a rule, patients come to the attention of orthopedic traumatologists providing emergency care. In the practice of oncologists, there are often patients with bone tumors who have performed deliberately non-radical surgical interventions associated with insufficient oncological alertness of traumatologists.Aim. To study and present the results of combined treatment of patients with bone tumors complicated by a pathological fracture.Materials and methods. The results of treatment and observation of 159 patients with tumors of long tubular bones complicated by a pathological fracture or the threat of its development, who received combined or surgical treatment and were observed in the polyclinic of the Republican Oncological Dispensary from 2008 to 2020, were analyzed.Results. A pathological fracture that has taken place, in the absence of somatic contraindications, is not a contraindication to neoadjuvant treatment, which allows performing organ-preserving surgical treatment with optimal local and systemic control. However, with verified bone metastases, when segmental bone resections are not shown, and the diagnosis of myeloma (solitary plasmocytoma) is established, it is permissible to perform surgery in a trauma hospital, after consulting an oncologist.Conclusion. The combined approach in the treatment of malignant bone tumors complicated by a pathological fracture makes it possible to perform a functional-saving, organ-preserving surgical intervention, significantly reducing the risk of tumor recurrence and systemic progression.

Fat embolism syndrome with a typical manifestation on brain magnetic resonance imaging: a case report

Fat embolism (FE) occurs frequently after trauma, particularly the fracture of long bones in the lower extremities. FE syndrome (FES) is defined as the clinical symptoms and signs of organ dysfunction caused by the obstruction of capillaries by fat emboli and inflammatory reaction. Cerebral involvement, respiratory insufficiency, and petechial rash constitute classical triad. Brain magnetic resonance imaging (MRI) is a sensitive imaging technique for diagnosing cerebral involvement and severity of damage in FES. This study presents a case of FES that was diagnosed based on typical manifestation on brain MRI and treated conservatively without complications.

Accuracy and Reliability of Cortical Buckling or Bulging: A Reliable Indicator of Ultrasound in Diagnosing Buckle or Torus Fracture of Long Bones in Children

Accuracy and Reliability of Cortical Buckling or Bulging: A Reliable Indicator of Ultrasound in Diagnosing Buckle or Torus Fracture of Long Bones in Children

CRITERIA FOR PREDICTING RISKS IN THE CASE OF REPLACING AN EXTERNAL FIXATOR WITH AN INTERNAL FIXATOR DURING THE TREATMENT OF GUNSHOT FRACTURES OF THE EXTREMITIES

In the treatment of victims with gunshot fractures of the long bones of the limbs, important importance is attached to determining the need and conditions for performing conversion (replacing the fixation method) with the formulation of reasoned indications. At the first stage of specialized care, such patients are fitted with external fixators, which provides adequate stabilization and simple wound care. Their conversion at the second stage to intraosseous increases the effectiveness of treatment. The aim: To analyze the results of using a scoring scale to substantiate the replacement of the fracture fixation method in the system of treatment of victims with combat limb injuries. Methods. The medical documentation for the period 2014-2021 was studied. The number of patients with gunshot fractures of long bones was 350, the average age was (36.4 ± 1.42) years. Patients were divided into two groups: the main group (193 wounded) — in the preoperative period, the authorʼs scale «Assessment of the possibility of conversion» was used; comparison (157 people) — point assessment was not performed. Methods. Descriptive, comparative analysis, systematic approach, statistical. The SF36 questionnaire was used to assess patients' quality of life. Results. The analysis of treatment results in the long term (1.2‒1.5 years) showed that the use of the author's scale in the preoperative period and the subsequent treatment made it possible to improve the subjective quality of life indicator by an average of 22.2 %. Conclusions. Justification of the expediency of replacing the fixation method during the treatment of patients with gunshot fractures of long bones using the developed scoring scale makes it possible to avoid unjustified conversion, reduce risks and minimize the occurrence of infectious complications.

Features of the use of osteosynthesis in the treatment of flammable fractures of long bones

Treatment of gunshot fractures of long bones is a complex and multi-stage process. The patient has to go through the path from primary fixation by extrafocal osteosynthesis to the moment of full fusion and restoration of function of the damaged limb. At the same time, determining the need for osteosynthesis in order to treat the patient is of great importance. The purpose of the work: to conduct an analysis of the effectiveness of using osteosynthesis in the treatment of victims with gunshot wounds of the limbs. An analysis of the treatment of ATO/JFO for the period 2014-2021 was carried out. the number of patients with gunshot fractures of long bones was 470. Conclusions: the analysis of the effectiveness of the replacement of the fixation method determined a significant (p>0.05) reduction in the risk of the development of gunshot osteomyelitis, delayed consolidation with the possible subsequent development of false joints, and contributed to the timely union of fractures and the reduction of the development of persistent contractures by 26.5% (p<0.01).

Prevalence of primary malignant tumours, rates of pathological fracture, and mortality in the setting of metastatic bone disease.

The modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype. The Premier Healthcare Database was queried to identify all patients who were diagnosed with metastatic bone disease from January 2015 to December 2020. The prevalence of all primary tumour subtypes was tabulated. Rates of long bone pathological fracture, 90-day mortality, and 360-day mortality following surgical treatment of pathological fracture were assessed for each primary tumour subtype. Patient characteristics and postoperative outcomes were analyzed based upon whether patients had impending fractures treated prophylactically versus treated completed fractures. In total, 407,893 unique patients with metastatic bone disease were identified. Of the 14 primary tumours assessed, metastatic bone disease most frequently originated from lung (24.8%), prostatic (19.4%), breast (19.3%), gastrointestinal (9.4%), and urological (6.5%) malignancies. The top five malignant tumours resulting in long bone pathological fracture were renal (5.8%), myeloma (3.4%), female reproductive (3.2%), lung (2.8%), and breast (2.7%). Following treatment of pathological fractures of long bones, 90-day mortality rates were greatest for lung (12.1%), central nervous system (10.5%), lymphoma (10.4%), gastrointestinal (10.1%), and non-renal urinary (10.0%) malignancies. Finally, our study demonstrates improved 90-day and 360-day survival in patients treated for impending pathological fracture compared to completed fracture, as well as significantly lower rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and blood transfusion. This study defines the contemporary characteristics of primary malignancies resulting in metastatic bone disease. These data should be considered by surgeons when prognosticating patient outcomes during treatment of their metastatic bone disease.

Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ2-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.

Is There an Association between BMI, Height, and Gender and Long-Bone Fractures during Childhood and Adolescence? A Large Cross-Sectional Population Study of 911,206 Subjects

Introduction: Traumatic long-bone fractures (TLFs) among children and adolescents are relatively common, with morbidity and economic consequences. Obesity has become a significant global concern. Studies have found an association between TLFs and BMI in the past but not in a large cross-sectional population study. Our study objective was to measure the incidence of TLFs in the 17-year-old general population and evaluate its association with BMI, body height, and gender. Methods: Data from a medical database containing all 17-year-old candidates’ records before recruitment into mandatory military service were retrieved as BMI, height, gender, and history of TLFs. Logistic regression models assessed the association between BMI and height to TLFs. Results: The records of 911,206 subjects (515,339 males) were reviewed. In total, 9.65% had a history of TLFs (12.25% and 6.25% for males/females, respectively). Higher BMI was associated with TLF, with a linear trend in the odds ratio (OR) for having TLFs. The strongest association was found between obese females and TLFs (OR = 1.364, p &lt; 0.0001). Height was an independent factor positively associated with TLFs. The OR for a TLF in the highest height quintile was 1.238 (p &lt; 0.001) for males and 1.411 (p &lt; 0.001) for females compared to the lowest quintile. Although TLFs were more common in males, the OR for TLFs was more prominent in females. Conclusions: There is an association between BMI, body height, and TLFs in healthy adolescents. TLFs are more common in males, but the strongest association between overweight and obesity is evident in females.

Impact of a Femoral Fracture on Outcome after Traumatic Brain Injury-A Matched-Pair Analysis of the TraumaRegister DGU®.

Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU® to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI.

Early Definitive Care (EDC) VS Damage Control Orthopedics (DCO) in the Management of Femoral Shaft Fractures in Polytrauma Patients

In the case of diaphyseal fractures of long bone, the stabilization of the fracture site must be performed as early as possible as it reduces the risk of complications. However, the realization of a definitive osteosynthesis early, in particular the centromedullary nailing, will be responsible for an additional aggression for the patient, called second hit, which can create or aggravate respiratory or multi-visceral failure. Orthopedic damage control (DCO) is a simple surgical technique that has as a principle, the temporary stabilization of fracture sites by the use of external fixators. DOC reduces blood loss intraoperative, the operative times, and especially the intensity of the surgical aggression source of secondary complications. The broader clinical benefits of DOC compared to permanent early osteosynthesis, however, remain controversial. Most experts still recommend DOC for shocked or severely injured patients. For borderline patients, stable but with a risk of degradation due to surgery, its use remains highly debated. For the less severe patients, DOC is not recommended, except in cases of significant local tissue or bone decay. The initial DOC strategy is associated in most cases with a secondary reoperation to perform definitive osteosynthesis. The definitive osteosynthesis must ideally take place between the 4th and the 15th or 21st day to minimize the local risk or general complications. Thus, the choice of the initial strategy, as the optimal timing of secondary recovery should be discussed between the surgeon and the anesthesist.

Association Between Race and Usage of Pain Medications in Children With Long Bone Fractures in US Emergency Departments, 2011-2019.

The purpose of this study was to determine the association between race and analgesic administration for children with long bone fracture (LBF) in US emergency departments. Previous studies have shown conflicting results regarding association between race and analgesic administration for pediatric LBFs. We conducted a retrospective analysis of pediatric emergency department visits for LBF using the 2011-2019 National Hospital Ambulatory Medical Care Survey-Emergency Department. We investigated the diagnostic workup and analgesic prescription rate among White, Black, and other pediatric emergency department visits for LBF. Of the estimated 292 million pediatric visits to US emergency departments from 2011 to 2019, 3.1% were LBFs. Black children were less likely to be seen for a LBF than White or other children (1.8% vs 3.6% and 3.1%, P < 0.001). There was no association between race and subjective pain scale ( P = 0.998), triage severity ( P = 0.980), imaging (x-ray, P = 0.612; computed tomography scan, P = 0.291), or analgesic administration (opioids, P = 0.068; nonsteroidal antiinflammatory drugs/acetaminophen, P = 0.750). Trend analysis showed a significant decrease in opioid administration for pediatric LBF from 2011 to 2019 ( P < 0.001), with 33.0% receiving opioids. There was no association between race and analgesic administration, including opioids, or diagnostic workup in pediatric LBF. In addition, there was a significant downtrend in opioid administration for pediatric LBF from 2011 to 2019.

Investigation of the effects of inflammatory and metabolic factors on fracture union in head trauma and long bone fractures

Background/Aim: Fractures are the most common form of trauma in current orthopedic practice. Although studies have shed light on the relationship between the factors affecting the healing process after fracture, this process is still not fully understood. In this study, we aimed to investigate the changes in serum biomediator levels and fracture healing in different trauma patterns, such as head trauma (HT), long bone fracture (LBF), a combination of HT + LBF injury (CI), and in different time points of the healing period.&#x0D; Methods: Forty Wistar rats were included in the study and divided into five groups. Group 1, the donor group, included rats with HT; Group 2 included rats with LBFs who were administered the serum taken from rats in Group 1; Group 3 included the rats with isolated LBFs; and Group 4 the rats with CI. Group 5 comprised the control rats. An experimental closed HT and fracture model was applied to rats. The rats in Groups 2, 3 and 4 were sacrificed on the 10th, 20th, and 30th days. The biomediator levels in the serum taken after sacrification were studied, while closed femoral fracture models were examined radiologically.&#x0D; Results: Statistically significant differences were found among the groups regarding radiological scores on the 10th, 20th, and 30th days. On Day 10, Group 2a had significantly higher scores than Group 3a (P=0.03), and Group 3a had lower scores than Group 4a (P=0.01). On Day 20, Group 2b had significantly higher scores than Group 3b (P=0.004) but lower than Group 4b (P=0.03). On Day 30, Group 2c had significantly higher scores than Group 3c but lower than Group 4c (P=0.001). The mean Ca, TGF beta 1, beta-catenin, IL-10, IL-17A, TNF alpha, CRP, Wnt-16, ALP, GH, PTH, IL-1 beta, IL-6, and IL-22 levels were significantly different among the groups (P&lt;0.05). No significant difference was observed in the biomediator levels among the groups at different time points of the healing period.&#x0D; Conclusion: We concluded that inflammatory cytokines (IL-1 beta, IL-6, IL-17A, IL-17F, IL-23, and TNF alpha) were elevated in the early period in individuals with isolated head trauma and that this effect could be transferred to other individuals by serum transfer. On the other hand, the negative relationship between the IL-10 level, which is a negative modulator in fracture union, and callus thickness was significant. Our study contributes by providing a molecular description of the positive union effect transferred between individuals by serum. We believe our findings will play a significant role in developing new therapeutic agents for fracture healing.

Predictive factors of malunion and nonunion at the Aristide le Dantec hospital

Background: Malunion and nonunion are late complications that can occur during the fracture healing process. The aim of this study was to determine the predictive factors for malunion and nonunion Methods: This was a retrospective study over a period of 43 months. Predictive factors were sought from patient, fracture and initial management data Results: We recorded 72 consolidation disorders in 69 patients. malunion accounted for 54.1% and nonunion for 45.9%. The study population was divided as follows: 53 men and 16 women. The average age was 37.8 years. The patients lived in urban areas in 81.2% of cases. Comorbidities were present in 14.5%. The circumstances of fracture occurrence were dominated by traffic accidents, especially for 39 patients. The initial fracture was closed in 91.3%. Long bones were involved in 97.2% of cases, with a diaphyseal location in 52.8%. The fracture was simple in 79.1%, with 84.7% of the fractures being transverse. The tibia was the bone most affected by malunion (53.8%). Nonunion occurred in the humerus, femur and tibia in 27.3% each. Initial treatment was undertaken in 91.3% of patients. Conclusions: Malunion and nonunion are a reality in our daily practice. These consolidation problems occur in young patients who are victims of road traffic accidents. Diaphyseal fractures of long bones with a transverse line have been the most frequently incriminated. conservative treatment and traditional practice have favoured the development of these complications.

Long Bone Fractures and Mineral-Bone Disorders in Patients with Chronic Kidney Disease Treated with Hemodialysis

Background. At the turn of the 20th and 21st centuries, the world community was faced with a global problem that has not only medical, but also great social economic significance – a pandemic of chronic non-communicable diseases that annually claim millions of lives, lead to severe complications associated with disability and the need for high-cost treatment. Among them is chronic kidney disease (CKD), which occupies an important place due to its significant prevalence in the population, a sharp decrease in the quality of life, high mortality of patients, and which leads to the need for expensive methods of renal replacement therapy (RRT).&#x0D; Objective: to determine the 3-year cumulative fracture rate (proportion of adults with fractures of the femur, forearm, or proximal part of the humerus) at least once during 3 years of follow-up, and the level of calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase and vitamin D in patients who are treated with programmed hemodialysis and have long bone fractures.&#x0D; Materials and Methods: To determine the 3-year cumulative fracture rate (proportion of adults with fractures of the femur, forearm, or proximal part of the humerus) at least once during the 3-year follow-up, 512 patients treated with hemodialysis for more than 3 years were observed. 50 bone fractures were diagnosed during 2019-2022 (femur – 25, tibia – 6, proximal part of the humerus – 6, forearm – 4, pelvis – 2, ribs – 2, vertebrae – 5).&#x0D; Results. A more detailed study of indicators of mineral metabolism was conducted on 154 patients with CKD stage V who were treated with hemodialysis at the MNPE “Kyiv Regional Clinical Hospital” of the KCC. Subsequently, the patients were divided into 2 groups: (1) patients on hemodialysis with fractures of long bones of the skeleton (n=41: femur – 25, tibia – 6, proximal part of the humerus – 6, forearm – 4) who were treated at the regional trauma center, and (2) patients without skeletal fractures (n=118) in 2019- 2022.&#x0D; Conclusions. The study showed that the 3-year cumulative fracture rate in a study of 512 patients treated with hemodialysis for more than 3 years was 9.76%. Compared with patients without fractures, patients with fractures of long bones had increased levels of phosphorus and PTH and decreased levels of calcium and vitamin D in the blood serum. The level of alkaline phosphatase in the presence of fractures was twice as high as in the group of patients without fractures (p&lt;0.001). The data indicate that disorders of mineral metabolism are the etiological factors of fractures in patients with CKD who are treated with hemodialysis.

Highlighting Paradoxical Cerebral Fat Embolism: Potentially Fatal Sequela of Road Traffic Accident. (P9-7.006)

<h3>Objective:</h3> We present a case of severe neurologic decline secondary to paradoxical cerebral fat embolism (CFE) following bilateral femur fractures after a road traffic accident (RTA). <h3>Background:</h3> Fat embolism syndrome (FES) is a triad of petechial rash, deteriorating mental status and progressive respiratory insufficiency, caused by embolization of fat particles into multiple organs. When neurological signs and symptoms predominate, cerebral fat embolism must be kept high in differential. It usually occurs within 24–72 hours of trauma with traumatic long-bone fractures or an orthopedic surgery. Its incidence ranges from 0.9–11% with a mean mortality rate around 10%. Pathophysiology involves either paradoxical embolism or lung filtration. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> 17-year-old, boy with type 1 diabetes mellitus, presents after having a RTA resulting in bilateral femoral and L1 spine burst fractures with mesenteric contusions. On scene, he had a self-resolving loss of consciousness followed by GCS 14 in ER with some confusion and unremarkable CT head. Had gradual improvement throughout the day, being more conversant within 24 hours. Later, he suddenly developed paroxysmal sympathetic hyperactivity with GCS 7 and normal CT head, followed 2 hours later by episodes concerning for decorticate posturing, requiring Lorazepam and Levetiracetam load with maintenance. He underwent internal fixation and intubated subsequently the next day. MRI brain obtained within 48 hours showed “starfield pattern” on DWI sequence, characteristic for CFE. Echocardiography showed patent foramen ovale. Mental status improved gradually over two-weeks with ability to follow simple commands. Managed supportively, underwent tracheostomy and peg-tube placement and transferred to a rehab hospital. <h3>Conclusions:</h3> FES complicated with CFE is an uncommon, but fatal sequela of RTA. A missed diagnosis of neurologic dysfunction due to CFE may inappropriately guide assessment of patient’s prognosis and subsequently decisions regarding escalation or even withdrawal of care. <b>Disclosure:</b> Dr. Asif has nothing to disclose. Evan Fields has nothing to disclose. Dr. Mahmoud has nothing to disclose. Dr. Shoaib has nothing to disclose. Dr. Anadani has nothing to disclose.

Differences in Decreasing Bacteria Colonization Wound Irrigation using 0.9% Nacl Compared with Wound Irrigation using Active Ingredients Polyhexanide 0.1% and 0.1% Betaine in Open Fractures of Long Bone

BACKGROUND: An open fracture is an emergency case that must be treated quickly to prevent infection. The use of an irrigation solution containing 0.1% of the antimicrobial polyhexanide and 0.1% of the surfactant betaine has been associated with more satisfactory wound healing. AIM: This study was comparing irrigation with polyhexanide 0.1% and betaine 0.1% (P + B) in reducing bacterial colonization of open fractures compared to using 0.9% natrium chloride (NaCl) solution. METHODS: This study uses a pre- and post-control group design. Sampling was carried out in the operation room of the emergency care installation, inpatient installation, and outpatient installation of prof. Hospital. Dr. I.G.N.G Ngoerah Denpasar, between September and November 2022. From a sample population suffering from open fractures of the lower extremities, samples of patients were taken who were irrigated with 0.9% NaCl solution with a mixture of polyhexanide 0.1% and betaine 0.1%. The presence or absence of bacterial colonization was examined using a surgical wound base swab with the Levine technique. RESULTS: In the 30 patients in this study, there was a significant decrease in bacterial levels (Log colony-forming unit [CFU]/g) after irrigation, both from irrigation with NaCl (p = 0.04) and NaCl + P + B (p &lt; 0.001). The reduction in bacterial levels was more significant with NaCl + P + B compared with NaCl alone, at post-irrigation (p &lt; 0.001), H+3 (p = 0.003), and H + 7 (p &lt; 0.001). CONCLUSION: Wound irrigation using a combination of 0.9% NaCl, 0.1% polyhexanide, and 0.1% betaine reduced bacterial colonization more than using 0.9% NaCl-only solution in open fractures of long bones.

Outcomes of Surgical Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents through Open Reduction and Intramedullary K-Wire Fixation at Yopougon Teaching Hospital, Abidjan (Côte d’Ivoire)

Outcomes of Surgical Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents through Open Reduction and Intramedullary K-Wire Fixation at Yopougon Teaching Hospital, Abidjan (Côte d’Ivoire)