Principles Of Fracture Treatment Research Articles

A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention

Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.

Manajemen anestesi pada fraktur multiple os femur dan os tibia: Sebuah laporan kasus

Fracture is a break in the continuity of bone, joint bone, epiphyseal cartilage, which is total or partial. Currently musculoskeletal disease has become a problem that is often found in health care centers around the world. Overall incidence of fractures was 11.3 in 1,000 per year, in males was 11.67 in 1000 per year, whereas in 10.65 in 1,000 women per year. The classic symptom is a history of trauma fracture, pain and swelling in the broken bones, deformity, musculoskeletal dysfunction, breaking the continuity of the bone, and neurovascular disorders. Principles of fracture treatment is to restore the position of the fracture to its original position (reposition) and held that position during the healing of fractures (immobilization). Special in open fractures, must be considered the danger of infection, either general or local infection. Mr. A 30 years old came with complaints of difficulty moving his left leg after a traffic accident 3 months ago and was taken to a sangkal putung but it didn't heal so he was taken to the hospital and got multiple fractures of the tibia and femur. The patient underwent surgery with the ORIF procedure under general anesthesia. Preoperative, intraoperative, and postoperative management needs to be done correctly and completely to support the success of the operation.

Consensus Regarding 16 Recognized and Clinically Proven Methods and Sub-Methods for Placing Corticobasal® Oral Implants.

This Consensus-Document is issued by the International Implant Foundation (Munich/Germany). It describes distinct methods of placement of cortico-basal oral implants in different areas of the jaw bone and the maxillo-facial skeleton. The implants utilize the method of “osseofixation” instead of “osseointegration” for achieving primary, functional stability, hence they work according to the (AO-) principles of fracture treatment. The concept of the technology allows for immediate functional loading, just as it allows for various types of loading following orthopaedic surgery. The 16 methods and sub-methods as described and displayed here have been undergoing extensive observation and testing and they have been approved by the Board of the International Implant Foundation. All Consensus Documents of the International Implant Foundation are revised every three years. This is the 3rd version of the Consensus Document on placement of corticobasal oral implantsLevel of Evidence: S3 (evidence based, systematically developed consensus guideline).

Looking to Asia

The Hungarian Veterinary Orthopaedic Society recently adopted Veterinary and Comparative Orthopaedics and Traumatology as their official journal, and we warmly welcome them. We are very proud to have their support, along with the other societies from Europe and the Americas. We have developed a strong network of collaboration between the members of our societies in these various countries. It is now time to look to the development of veterinary orthopaedic surgery and education in Asia. It would be wonderful to have some societies for veterinary orthopaedics from this region forge a connection with our Journal. Recently I had the privilege to be invited to visit Bangkok, Thailand, with a small group of colleagues to teach the first AOVET course on Principles of Fracture Treatment in Small Animals. The enthusiasm of the veterinarians attending this course was overwhelming because they are so keen to develop their knowledge and skills in orthopaedics. This level of interest is not just confined to Thailand, but exists also in the other Asian countries. Travelling as a visitor in Bangkok, the existence of economic hardship for many people is inescapable, as are the numerous stray animals, especially dogs. However for many Thai people, the care of their pets is a high priority because they put such importance on the human-animal bond. When we visited the Veterinary Teaching Hospital at the Kasetsart University in Bangkok, I was astonished to learn that this could be one of the busiest veterinary teaching hospitals in the world. Typically around 400 to 450 small animals are presented for consultation and treatment in the outpatient clinics every day of the week, year round! Added to this are the emergency care patients, and those treated in the specialty clinics including surgery. The Kasetsart University is fortunate to have huge support from the King of Thailand. Thanks to the King of Thailand, a new nine-story building is being constructed to provide state of the art facilities for each of the specialty clinics to allow the delivery of the highest quality of veterinary care of companion animals. Kenneth A. Johnson

Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum

Background:Osteoporosis is an increasing problem attributed to the greater longevity of the population and the incidence of fractures related to osteoporosis. The presence of osteoporotic bone, comorbidities, and functional status of the patient require adequate solutions to improve the clinical outcome of sacral insufficiency fractures. Conservative treatment by means of prolonged bed rest and analgesics are associated with increased risks and complications. A sacroplasty significantly improves the functional outcome. We describe the trans-iliac-sacral-iliac-bar (TISIB) procedure and our clinical experience to treat insufficiency fractures of the sacrum.Materials and Methods:The records of 19 consecutive patients with a mean age of 71.7 years (range: 57-82 years) who had been managed with a TISIB procedure from 2005 till 2007 were reviewed retrospectively. There were 15 females and 4 males. Predisposing factors for sacral insufficiency fractures were osteoporosis (n = 12, 63%), radiotherapy (n = 6, 32%), and rheumatoid arthritis (n =1). Diagnosis with a mean delay of 3.7 months was mainly made by CT. All patients were preoperatively and at follow-up assessed by means of the visual analogue score (VAS), analgesic consumption, and the ability to perform activities of daily living (ADLs) using a 5-point pain scale: 1, without pain; 2, mild pain; 3, moderate pain; 4, severe pain and, 5 unable to perform ADLs because of pain.Results:The average duration of postoperative follow-up was 9 months (range: 3–24.5 months). No neurological complications occurred during the surgery. A postoperative radiographic study showed a well-positioned bar in every case. The mean VAS improved 44.7 mm (preoperative: 67.8; at follow-up: 23.2). Fifteen patients (79%) consumed narcotic analgesics before surgery, and only one (5%) at follow-up; two patients (10%) consumed NSAIDS before surgery and three (15%) after. Two patients (10%) consumed minor analgesics before, and 11 (58%) after the procedure. Finally, four patients (21%) were not taking any analgesics at follow-up. Before surgery, 9 patients (47%) were able to perform ADLs with a pain score of 4; 6 (32%) with a score of 3, and 4 (21%) a score of 2. At follow-up 1 (5%) did have a score of 4; 1 (5%) a score of 3, 8 (42%) a score of 2 and 9 (47%) a pain score of 1.Conclusion:A TISIB procedure relies on the principles of fracture treatment: fracture stabilisation and compression. The incapacitating problem of an insufficiency fracture of the sacrum can be elegantly solved by means of this minimally invasive procedure. A near-immediate improvement is noticed when looking at the VAS score, analgesics consumption, and the ability to perform ADLs.

The role of the traditional bonesetter in primary fracture care in Nigeria.

In view of the growing interest in the management of fracture worldwide, the traditional bonesetter (TBS) practice in Nigeria was documented. To highlight the role of the TBS in primary fracture care in Nigeria. Rural. Over a 5-year period a qualitative study of the TBS settings and knowledge, diagnostic techniques and principles of fracture treatment in four TBS centres in Nigeria was carried out by active participation, on the spot assessment, interactive dialogues and oral interviews. It was found that TBS services are well preserved as a family practice, and training is by apprenticeship. Records are kept by oral tradition. There is no prescribed fee and the patronage is high. Fracture diagnosis is based on physical assessment and experience. The TBS relies solely on the conservative method of fracture treatment, and all fractures are reduced by the closed method and stabilised with an external traditional splint and a protracted period of immobilisation. The outcome of TBS treatment is good for closed fractures of the shaft of the humerus, ulna, radius and tibia, but poor for peri-articular and open fractures. Non-union, malunion, traumatic osteomyelitis and limb gangrene were the common major complications of TBS treatment. Despite criticisms and antagonism from orthodox medical practitioners TBS practice is well patronised by Nigerians. In order to guarantee safety and efficiency of the TBS practice in primary fracture care service delivery in Nigeria, there is therefore a need both to educate the community and to train the TBS.

Osteochondritis Dissecans of the Knee: Treatment of Juvenile and Adult Forms.

Osteochondritis dissecans (OCD) and juvenile osteochondritis dissecans (JOCD) are distinct entities that require different management. Although both conditions result from stress fractures of the subchondral bone, JOCD has a much better prog-nosis; treated conservatively, 50% of cases will heal, probably providing a normal knee during adult life. In contrast, OCD often is followed by the early onset of degenerative arthritis. The treatment of JOCD and OCD, whether nonoperative or operative, should be based on the principles of fracture treatment. Unfortunately, surgical correction of either of these conditions is unlikely to succeed unless the joint surface is perfectly restored.

About indications for surgical treatment of bone fractures

It can be noted with satisfaction that there is unanimity among traumatologists regarding the principles of fracture treatment.