Third Of Shaft Research Articles

ГИСТОМОРФОЛОГИЧЕСКОЕ ИЗУЧЕНИЕ КОСТНОЙ СТРУКТУРЫ ПТИЦ ПРИ ИСПОЛЬЗОВАНИИ БИОКОМПОЗИЦИОННОГО ПОКРЫТИЯ ИМПЛАНТОВ

Bone fractures in birds lead to rapidly developing arthrogenic contracture, bacterial contamination, and lack of ability to eat, which in turn leads to an unfavorable outcome. In modern veterinary and humane medicine, the issue of optimizing reparative osteogenesis, aimed at accelerating consolidation, preventing bacterial infection, stabilization method, as well as activation of osteoinductive and osteoconductive properties, is quite acute. This can be achieved with the help of osteoplastic biocomposition coatings of implants. The authors have developed a biointegrable, biocompositional and osteoplastic coating for implants that promotes the pragmatization of osteogenesis of tubular bones of birds. The coating consists of: hydroxyappatite, methyluracil, amoxicillin, polylactide, selenium nanoparticles (nSe), these components have a positive effect on regenerative, antibacterial and metabolic processes of osteogenesis, catalyzing reparative osteogenesis. This study was conducted in order to quantitatively and qualitatively analyze the histological aspects of the fusion of the fracture of the middle third of the humerus diaphysis in birds, in an experiment, with and without biocomposition coating of implants. The material for this study was histotopograms of the humerus bones of birds (pigeons) after consolidation of simulated fractures of the middle third of the diaphysis. In the experimental group, implants with a developed coating were used, in the control group without. Based on clinical, X-ray and histological expertise , it was determined: 1. The osteotherapy process in the experimental group, using the developed coating, took place without signs of inflammation, allergic and cytolytic reactions. 2. The absence of any volume of the developed coating on histotopograms, which indicates the complete biointegration of the developed coating. 3. Reduction of consolidation time by 33% when using implants with a developed biocomposition coating.

EVALUATION OF RESULTS OF NON OPERATIVE TREATMENT OF FRACTURE SHAFT OF THE HUMERUS WITH A FUNCTIONAL BRACE

Introduction: Fractures of the humeral shaft account for roughly 3% of all fractures due to fall on the outstretched hand, motor vehicle accidents and direct loads to the arm. The brace effectively compresses the bulky biceps and triceps muscle allowing early shoulder, elbow, wrist and hand motion with nonunion and radial nerve palsy in a signicant percentage of humeral shaft fractures. This study intends to assess the results of non-operative treatment of fracture shaft of the humerus with a functional brace. Materials and Methods: Prospective observational study was conducted in NMCTH, Birgunj among 50 patients from 16 years onwards of age who presented with fracture of humerus shaft. The patients with open fracture, oating elbow, bilateral humeral fracture, polytrauma, pathological fracture, additional injury of the extremities and patients with neurologic and psychiatric disorders were excluded from the study. The patients were treated with close reduction and immobilization in functional humeral cast brace and were followed up in outpatient department basis once a week for the rst four weeks and every four weeks subsequently till fracture united. After removal of brace functional evaluation of results of upper limb was done according to Hunter's criteria. RESULTS: Six patients out of 50 lost to follow up and was removed from nal analysis . Out of 44 cases, mean age of patient was 34.77 year. Most of them 28(64%) were male. RTA was most common mode of injury 24(54%). Most of the patient 26(59%) had rd fracture on non dominant side. Majority of the fractures 24(55%) were in the middle 1/3 . Thirty two cases (72%) attended the hospital within 24 hours of injury. Union was achieved in 41(93%) patients within a mean time of 11.48 weeks. One transverse and two comminuted fractures in middle and distal third of diaphysis did not unite and were treated surgically. According to Hunter's criteria of evaluation of results, 31(75.6%) of united fractures had excellent (G5) and 10(24.4%) had good (G4) results. Restriction of few degrees of terminal range of movements of shoulder abduction and external rotation present initially improved subsequently after physiotherapy. Mean varus angulation in 39 patients at the time of removal of brace was 7.05° and mean valgus angulation in four patients was 6.00°. Mean anterior angulation of 6.85° was present in 21 patients and mean posterior angulation of 7.11° was present in 20 patients at the time of removal of brace. Mean shortening of 6.5 mm was present in 36 patients. The various angulation deformities and shortening at the end of union did not cause functional and cosmetic effect. Conclusion: Fracture shaft of humerus treated by close reduction and functional bracing has good functional outcomes.

Using Combined Osteosynthesis in Trauma Practice in the Treatment of Diaphyseal Forearm Injuries

The article presents the experience of surgical treatment of a rare pathology of the upper limb – the pseudarthrosis of the middle third of the radial shaft with a bone defect in combination with the pseudarthrosis of the middle and lower third of the shaft of the ulna of the forearm. Determination of reasonable and well-considered treatment tactics is of great importance in the treatment of patients aimed at restoring the anatomy and function of the injured upper limb. A feature of this case is the formation of several false joints at different levels of the forearm bones, the presence of a bone defect of 2.5 cm, which required its replacement with an autograft, and a previously performed surgical intervention using transosseous osteosynthesis. The applied tactics of surgical treatment consisted of several stages: bone osteosynthesis of the ulna with opening of the medullary canals of the ulna; replacement of a bone defect in the area of the pseudarthrosis of the radius with an autograft from the iliac crest using combined stress osteosynthesis in combination with transosseous osteosynthesis. The results of surgical treatment of false joints and bone defects depend on the correct treatment tactics, according to the indications, and the correct implementation of the selected treatment tactics. The surgical tactics of treatment used in this clinical situation made it possible to create conditions for the fusion of fragments of the radius and ulna bones, as well as to replace the defect of the radius, as a result of which the anatomy and function of the damaged segment were successfully restored.

A rare case of plasma cell osteomyelitis with atypical presentation

<p class="abstract">Plasma cell osteomyelitis is an uncommon type of localized chronic osteomyelitis which is characterized by the absence of typical clinical features of infection. It usually affects the metaphysis of long bones and presents as dense thickening of bone without sequestrum formation. We present an atypical case of plasma cell osteomyelitis with a lesion in the diaphysis of long bone and sequestrum formation<em>.</em> A 23 year old male patient came to our OPD with complaint of pain in mid-thigh radiating to the left knee since 2 months. X-ray showed radiolucencies in the medulla of middle third of shaft of femur along with a linear sequestrum suggestive of chronic osteomyelitis. An open biopsy was performed and surgical curettage was done. Histopathological examination was consistent with plasma cell osteomyelitis. Chronic plasma cell osteomyelitis is a rare condition with nonspecific findings and an unclear cause. Histopathology is the definitive tool for obtaining a diagnosis. Knowledge of this condition and proper management can give a better outcome, at the same time avoiding unnecessary investigations and procedures.</p>

EXPERIENCE IN THE TREATMENT OF THE FALSE JOINT OF THE DIAPHYSIS OF THE RADIAL BONE COMBINED WITH A MAJOR DEFECT IN THE ULNAR DIAPHYSIS (CASE FROM PRACTICE)

This article presents the experience of surgical treatment of rare pathology of the upper limb – pseudoarthrosis of the middle third of the diaphysis of the radius, defect pseudoarthrosis of the upper and middle third of the ulnar diaphysis. The definition and compilation of an accurate model and treatment tactics are critical to restoring the anatomy and function of the injured upper limb. The rarity of this case was the size of the ulna defect, which was up to 4.0 cm, the scarring and cicatricial changes in the soft tissues and muscles of the right forearm, due to the severity of the injury and the multitude of surgical interventions on the right forearm. The chosen treatment tactics consisted of several successive stages: resection of the zone of false joint of the right radial bone, combined transosseous osteosynthesis of the right radius bone, resection of the false elbow joint of the right ulna with replacement of the defect with autograft from the lower third of the fibula, combined strained osteosynthesis and transosseous osteosynthesis by external fixation apparatus with rod configuration of the right ulna. The results of surgical treatment of false joints depend on the determination of the correct indications for a certain type of surgical intervention and the competent implementation of the planned treatment plan. The chosen treatment tactics allowed us to successfully restore the anatomy and function of the damaged segment, thus rehabilitating the patient.

The fate of fibular osteotomies performed during high tibial osteotomy.

High tibial osteotomy (HTO) is an important treatment alternative in isolated single compartment knee osteoarthritis. To achieve adequate mechanical axis corrections in the lower extremity fibula is also osteotomized concomitantly. The aim of this study was to compare the union rates of proximal and diaphyseal fibular osteotomies accompanying high tibial osteotomies. Sixty-seven knees of sixty-three patients who had undergone HTO were retrospectively evaluated. The patients were grouped according to the level of the fibular osteotomy (FO). In group I, the level of FO was proximal, and in group II, it was at the level of junction of middle and distal third of diaphysis. The union rates of FOs at two different levels were compared. The influence of the presence of displacement at the osteotomy site and apposition between bone ends on union was also evaluated. Fifty-nine of sixty-seven FOs (88.06%) were united. The union rate of proximal FOs was significantly greater than diaphyseal osteotomies (p<0.0001); 97.9% of proximal FOs were united, whereas this ratio was 65% for the diaphyseal FOs. The presence of displacement at the FO and apposition between bone ends significantly influenced the bony union rate (p values 0.035 and <0.0001, respectively). Union rates and nonunion characteristics of FO might differ according to its level, apposition of bone ends, and contact area. The fate of FO might also affect the union of HTO.

English

BACKGROUND: The recent development of LCP has revolutionized the surgical treatment of fractures by overcoming the few drawbacks of older internal fixators. The fractures of the shaft of humerus are one of the commonest fractures found and the accepted management for fractures shaft of humerus is open reduction and internal fixation using compression plating. Our present study is aimed at the assessment of results of plate osteosynthesis of diaphyseal fractures of humerus using locking compression plate and to assess the functional recovery with this procedure. MATERIALS & METHODS: In the study period of two years, 20 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using Locking Compression Plate. RESULTS: In our series, majority of the patients were males, middle aged, with road traffic accidents being the commonest mode of injury, involving middle third of shaft of humerus. Follow up ranged from 6 weeks to 24 weeks. There was significant improvement in DASH scores (P=0.001) in all the 20 cases indicating the functional recovery. According to Rommen's et al grading, 17 cases had excellent results while 3 cases had good results. CONCLUSIONS: The age incidence varied from 21-40 years (65%) with male predominance (70%), with type A3 as the commonest fracture (50%) involving the mid shaft (70%) of humerus, underwent open reduction and internal fixation using locking compression plate. The results were assessed using DASH score and the significant functional recovery was achieved in all the cases, with Rommen's grading, excellent and good results were achieved.

English

BACKGROUND: The surgical treatment of fractures, according to A O principles has seen a change in the past decade, from anatomical reduction and rigid fixation to the current concept of Biological fixation, precise reduction being a goal only in intra-articular fractures. With the advent of internal fixators like PC-Fix and LISS (Less Invasive Stabilizing System) this was being achieved to some extent. There cent development of LCP has revolutionized the treatment by over-coming the few drawbacks of these internal fixators. The present study is aimed at the assessment of results of plate osteosynthesis of diaphyseal fractures of humerus using locking compression plate and to assess the functional recovery with this procedure. MATERIALS & METHODOLOGY: It is a prospective study which was carried out from October2011 to March 2013 in Sri Siddhartha Medical College & Research Centre, Tumkur. In this study period, 60 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using Locking Compression Plate. RESULTS: In our series, the majority of the patients were males, middle aged, with road traffic accidents being the commonest mode of injury, involving middle third of shaft of humerus. We followed up all the patients and the duration ranged from 6 weeks to 24 weeks. All the fracture eventually united including 3 which had delayed union. Functional recovery was assessed using DASH scoring and Rommens et al grading. There was significant improvement in DASH scores (P=0.001) in all the 60 cases indicating the functional recovery. According to Rommens et al grading, 51 cases had excellent results while 9 cases had good results. CONCLUSION: This is a prospective study with age incidence varied from 21-40 years (65%) with male predominance (70%), with type A3 as the commonest fracture (50%) involving the mid shaft (70%) of humerus, underwent open reduction and internal fixation using locking compression plate. All the cases had adequate physiotherapy started on 3 rd or 4th postoperative day and continued for 3-4 weeks, which had contributed to the excellent functional recovery. The results were assessed using the DASH score and the significant functional recovery was achieved in all the cases (P=0. 001), with Rommen's grading, excellent and good results were achieved. It is a very good procedure for fractures of shaft of humerus, however the small sample size and short duration of study were the limitations of this study.

Distal Radioulnar Joint Instability (Galeazzi Type Injury) After Internal Fixation in Relation to the Radius Fracture Pattern

The purpose of this study was to classify Galeazzi type injuries and determine the association of residual instability after rigid fixation with the fracture pattern of the shaft of the radius, using a system that is based on anatomic landmarks of the radial shaft. The clinical records of 95 patients (72 men and 23 women) with Galeazzi type injuries requiring open reduction and internal fixation of the fractures were retrospectively reviewed. The mean follow-up was 6.8 years (range, 18 mo to 11 y) after injury. Sixty-nine fractures occurred in the distal third of the radial shaft (type I), 17 fractures were in the middle third (type II), and 9 fractures were in the proximal third of the shaft of the radius (type III). Gross instability of the distal radioulnar joint (DRUJ) was determined intraoperatively by manipulation after radial fixation as compared to the uninjured side. Forty patients had DRUJ instability after internal fixation and were treated with temporary pinning with a K-wire placed transversely proximal to the sigmoid notch. Distal radioulnar joint instability after internal fixation was recorded in 37 type I fractures, 2 type II fractures, and 1 type III fracture. Distal radioulnar joint instability following radial shaft fracture fixation is significantly higher in patients with type I fractures than in patients with type II or type III fractures. The location of the radius fracture can be sufficiently used for preoperative estimation of percentage chance of potential DRUJ instability after fracture fixation.

Current Treatment of Radial Nerve Palsy Following Fracture of the Humeral Shaft

The association between radial nerve injury and humeral shaft fracture was described by Berkeley surgeons Holstein and Lewis, 1 Holstein A. Lewis G.B. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg. 1963; 45A: 1382-1388 Google Scholar who observed radial nerve palsy in the setting of spiral fractures of the distal third of the humeral shaft wherein “the distal bone fragment is always displaced proximally with its proximal end deviated radialward” and that “the radial nerve is caught in the fracture site.” Subsequent reports have described cases of radial nerve palsy following fractures of the middle third of the shaft of the humerus as well. 2 Ekholm R. Adami J. Tidermark J. Hansson K. Törnkvist H. Ponzer S. Fractures of the shaft of the humerus, an epidemiological study of 401 fractures. J Bone Joint Surg. 2006; 88B: 1469-1473 Google Scholar , 3 Shao Y.C. Harwood P. Grotz M.R.W. Limb D. Giannoudis P.V. Radial nerve palsy associated with fractures of the shaft of the humerus. J Bone Joint Surg. 2005; 87B: 1647-1652 Google Scholar , 4 Kettelkamp D.B. Alexander H. Clinical review of radial nerve injury. J Trauma. 1967; 7: 424-432 Crossref PubMed Scopus (61) Google Scholar , 5 Packer J.W. Foster R.R. Garcia A. Grantham S.A. The humeral fracture with radial nerve palsy: is exploration warranted?. Clin Orthop. 1972; 88: 34-38 Crossref PubMed Scopus (66) Google Scholar , 6 Pollock F.H. Drake D. Bovill E.G. Day L. Trafton P.G. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg. 1981; 63A: 239-243 Google Scholar , 7 Samardžić M. Grujičić D. Milinković Z.B. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990; 21: 220-222 Abstract Full Text PDF PubMed Scopus (69) Google Scholar , 8 DeFranco M.J. Lawton J.N. Radial nerve injuries associated with humeral fractures. J Hand Surg. 2006; 31A: 655-663 Abstract Full Text Full Text PDF Scopus (95) Google Scholar A recently published anatomical study by Carlan et al. emphasizes that the radial nerve is at risk of injury in these 2 regions: (1) along the posterior mid-aspect of the humerus where the nerve lies in direct contact with the periosteum and (2) along the distal lateral humerus where the nerve pierces the lateral intermuscular septum. 9 Carlan D. Pratt J. Patterson J.M.M. Weiland A.J. Boyer M.I. Gelberman R.H. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg. 2007; 32A: 1177-1182 Google Scholar

8 Mechanical and orthopaedic problems

# 8.1 Aseptic femoral necrosis in a patient with systemic JIA {#article-title-2} A 15 year old girl with a systemic onset of JIA and a persistent systemic course, who had...