Transverse Osteotomy Research Articles

Hallux Valgus Correction: Comparison of Minimally Invasive Transverse and Chevron Distal Metatarsal Osteotomy Constructs

Category:Basic Sciences/Biologics; BunionIntroduction/Purpose:Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Until recently in the United States, distal chevron osteotomies have been the standard for hallux valgus correction of moderate deformity. To the best of the authors’ knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal metatarsal osteotomy constructs. The purpose of this study was to evaluate the biomechanical strength of transverse and chevron minimally invasive osteotomy techniques using 9 matched cadaveric pairs.Methods:A total of nine matched cadaveric specimens were randomized to transverse or chevron distal metatarsal osteotomies. Each minimally invasive surgical technique was performed by a fellowship trained orthopedic foot and ankle surgeon. Anterior- posterior and lateral radiographic images were obtained following surgical fixation. Biomechanical testing was performed on an Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed across the fixation construct with fulcrum within the metatarsal shaft proximal to screw fixation and compression load at the sesamoid bones. A pre-load of 10N was applied to the sesamoid bones by the compression post to stabilize the sample. Subsequently, a compression rate was applied to the sample at 10mm/min until failure was observed. Mean and standard deviations were assessed and compared across cohorts.Results:All nine cadaveric specimens were male. There was no difference in average percent metadiaphyseal shift among transverse (36%) and chevron (38%) osteotomies. The most common mode of failure among transverse and chevron osteotomies was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). One paired sample was noted to have poor bone quality prior to biomechanical testing. There was a trend towards increased ultimate load to failure (p=0.480) and stiffness (p=0.438) among transverse osteotomy compared to chevron osteotomy, however, no statistically significant difference was observed.Conclusion:Biomechanical testing demonstrates no statistical difference in ultimate load to failure and stiffness between minimally invasive transverse and chevron distal metatarsal osteotomy constructs. A trend towards increased ultimate load and stiffness in the transverse osteotomy cohort was observed. Chevron osteotomies violate the entire plantar cortex and may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure would require cortical bone cutout. Future studies are required to evaluate strength of construct in a larger sample. Analysis is limited, healing may provide additional strength that is not simulated in cadaveric studies.

Treatment of contaminated radial fracture in Sprague-Dawley rats by application of a degradable polymer releasing gentamicin.

Fracture-related infections remain a leading cause of morbidity and mortality. We aimed to establish a simple contaminated radial osteotomy model to assess the efficacy of a biodegradable polymer poly(sebacic-co-ricinoleic acid) [p(SA-RA)] containing 20% w/w gentamicin. A unilateral transverse osteotomy was induced in Sprague-Dawley (SD) rats, followed by application of Staphylococcus aureus suspension over the fracture. After successfully establishing the contaminated open fracture model, we treated the rats either systemically (intraperitoneal cefuroxime), locally with p(SA-RA) containing gentamicin, or both. Control groups included non-contaminated group and contaminated groups that were either untreated or treated with the polymer alone. After 4 weeks, the bones were subjected to micro-CT scanning and microbiological and histopathology evaluations. Micro-CT analysis revealed similar changes in the group subjected to both local and systemic treatment as in the non-contaminated control group. Lack of detectable bacterial growth was noted in most animals of the group subjected to both local and systemic treatment, and all samples were negative for S. aureus. Histopathological evaluation revealed that all treatment modalities containing antibiotics were highly effective in reducing infection and promoting callus repair, resulting in early bone healing. While p(SA-RA) containing gentamicin treatment showed better results than cefuroxime, the combination of local and systemic treatment displayed the highest therapeutic potential in this model.

Total Hip Arthroplasty Combined With Subtrochanteric Transverse Shortening Osteotomy: Factors Associated With Delayed Union at the Osteotomy Site.

Background:Total hip arthroplasty (THA) with subtrochanteric shortening osteotomy for Crowe type IV hips poses the risk of nonunion at the osteotomy site. The aim of this study was to analyze the factors that affect the bone union rate at the osteotomy site.Methods:We retrospectively reviewed a consecutive series of 27 THAs with subtrochanteric transverse shortening osteotomy performed for Crowe type IV hips. The effects of patient-related and surgery-related factors on the risk of delayed union were analyzed using univariate and multivariate regression analyses.Results:The mean follow-up period was 10.0 (1.4 to 19.1) years. The implant survival rate was 87.8% (95% confidence interval: 60.2% to 97.2%) at 10 years. The length of femoral bone resection was the only factor associated with the risk of delayed union. Longer bone resection lengths were significantly correlated with the reduced risk of delayed union (odds ratio: 0.63 [0.030 to 0.90], P = 0.0013). Other variables, including the use of a cement stem (P = 0.34) and the presence of a gap >1 mm at the osteotomy site (P = 0.98), were not associated with the risk of delayed union.Discussion:THA with subtrochanteric transverse osteotomy provides satisfactory long-term results for Crowe type IV hips. For shorter required femoral resection lengths, the risk of delayed union was higher. A longer resection could permit fabrication of longer autologous longitudinal bone struts and likely contributes to enhanced stability at the osteotomy site.

Minimally invasive techniques in rhinoplasty.

To present criteria of minimally invasive surgery, which include minimal and hidden incision lines, reduced injury to tissue and application of endoscopic techniques, when feasible; to analyze techniques in rhinoplasty for their minimally invasive character - in light of recent publications; and to discuss the techniques that best meet the criteria of minimally invasive surgery. The nose consists of about 60 percent soft tissue and 40 percent skeletal elements. Surgery causes injury to both tissue types through various mechanisms, including mechanical traction, separation, incision, heat, desiccation, and others. Multiple aspects including extent of approach and degree of tissue undermining determine the minimally invasive character of techniques and maneuvers in rhinoplasty. A single incision endonasal approach, the subperichondrial and subperiosteal septal plane, the supraperichondrial plane over the cartilaginous dorsum, the subperiosteal plane over the bony dorsum, limited dorsal undermining with endoscopic visualization when feasible, conventional straight lateral osteotomy or percutaneous curved lateral osteotomy; percutaneous transverse osteotomy; conventional straight paramedian osteotomy; piezo and drill paramedian ostectomy; dorsal uncapping osteotomy; conventional rasp gross dorsal contouring; piezo or drill fine dorsal contouring; (cartilaginous) middle vault 'let down'; and minimal access subperiosteal turbinate bone resection were found to best fulfil the criteria of minimally invasive surgery. A classification system for the degree of minimally invasiveness of rhinoplasty techniques is proposed as a basis for discussion.

Percutaneous Surgery for Mild to Severe Hallux Valgus

Percutaneous surgery for hallux valgus correction is increasing in popularity. Third generation techniques under image intensifier control, with rigid internal fixation have improved the reproducibility and reliability of this technique. Percutaneous hallux valgus surgery has been shown to decrease immediate and early postoperative pain compared with open distal osteotomies, with comparable patient reported outcome scores. The transverse osteotomy, under image intensifier guidance gives complete control of metatarsal head correction in all planes of movement. The stability relies on rigid fixation of the first screw in both medial and lateral cortices of the first metatarsal shaft. Accurate screw placement is crucial. Rigid internal fixation allows early full weight-bearing and range of motion exercises, ensuring early return to function. The dorsomedial eminence must be removed to prevent ongoing discomfort. The technique including tips and tricks is described in detail. Level of Evidence: Level II.

Гистоморфометрические характеристики передней большеберцовой мышцы и малоберцового нерва при экспериментальном замещении пострезекционного дефекта голени аппаратом Илизарова в комбинации с методом Masquelet

Objective Explore structural changes in the tibialis anterior muscle (TAM) and the peroneal nerve (PN) in repair of postresection tibial defect using the Ilizarov external fixation and a cement spacer. Material and methods A defect-nonunion was simulated in the proximal tibia of 10 mongrels using the Ilizarov external fixation followed by use of a cement spacer to fill the 2.5 cm defect-diastasis. The spacer was removed after 30 days and tibia distraction commenced with the rate of 1 mm performed 4 times/day following transverse osteotomy in the distal tibia to achieve docking of bone fragments. Animals were sacrificed after 60-day fixation (F60) and 30 days after frame removal (FR30). Histomorphometric parameters of the TAM and PN samples were examined. Results TAM appeared to be denervated with death or decreased size of myons and angular contours noted at F60 and FR30. Degenerated and intact muscle fibers (MF) were shown to increase by 32.5 % and by 1 %, respectively, at FR30. The peak of histogram distributing MF by diameters at F60 indicated to ischemic muscles, and a 2-fold decrease in muscle diameter and the histogram skewed to the left by 4 classes showed increase in muscle atrophy at FR30. Reactive destructive changes were noted in at least 5.4 % of myelinated nerve fibres of the PN at F60 and FR30. A 1.6-to-1.7 times decrease in larger and a 1.6-to-1.8 times increase in smaller fibers, the presence of regenerative clusters indicated to previous destruction of a large number of motor and sensory nerves. Changes in the population structure, destruction of myelinated fibers and loss of non-myelinated fibers were associated with obliteration of epineurial vessels and loss of endoneurial capillaries at F60. Conclusion Reactive destructive changes in the TAM and PN revealed in bone defects repaired with the Ilizarov external fixation and the Masquelet technique should be considered in planning of postoperative pharmacologic thearapy and rehabilitation.

A new sequential animal model for infection-related non-unions with segmental bone defect

BackgroundThe treatment of fracture-related infections (FRI) is still a challenge for orthopedic surgeons. The prevalence of FRI is particularly high in open fractures with extensive soft-tissue damage. This study aimed to develop a new two-step animal model for non-unions with segmental bone defects, which could be used to evaluate new innovative bone substitutes to improve the therapeutic options in humans with FRI and bone defects.MethodsAfter randomization to infected or non-infected groups, 30 Sprague-Dawley rats underwent a transverse osteotomy of the mid-shaft femur with a 5 mm defect. Additionally, the periosteum at the fracture zone was cauterized at both sides. After intramedullary inoculation with 103 CFU Staphylococcus aureus (infected group) or PBS (non-infected group), a fracture stabilization was done by intramedullary K-wires. After 5 weeks, the bone healing process was evaluated, and revision surgery was performed in order to obtain increased bone healing. The initial K-wires were removed, and debridement of the osteotomy-gap was done followed by a more stable re-osteosynthesis with an angle-stable plate. After further 8 weeks all rats were euthanized and the bone consolidation was tested biomechanically and the callus formation quantitatively by micro-CT analysis.ResultsWe developed and presented a new two-stage non-union animal model through a targeted S. aureus infection. After 5 weeks, all animals showed a non-union irrespective of assignment to the infected and non-infected group. Lane and Sandhu score showed a higher callus formation in the infected group. In all infected animals, the inoculated S. aureus strain was detected in the revision surgery. The second surgery did not improve bone healing, as shown by the Lane Sandhu score and in the μ-CT analysis. Similarly, biomechanical testing showed in both groups a significantly lower maximum torque as compared to the contralateral side (p < 0.0001).ConclusionsWe were able to successfully develop a new two-stage non-union animal model, which reflects a genuine clinical situation of an infection-related non-union model with segmental bone defects. This model could be used to evaluate various therapeutic anti-infectious and osteoinductive strategies in FRIs.

Percutaneous CO2 Treatment Accelerates Bone Generation During Distraction Osteogenesis in Rabbits.

Percutaneous CO2 Treatment Accelerates Bone Generation During Distraction Osteogenesis in Rabbits.

Viability of polyamide 12 intramedullary rods coated with hydroxyapatite in experimentally induced fractures in young roosters (white Plymouth rock)

The present study aimed the viability evaluation of solid intramedullary rods made with polyamide 12 and coated with hydroxyapatite in experimentally osteotomized humerus of young roosters (white Plymouth rock). Sixteen animals of 45 days old each were used. After general anesthesia, they underwent to complete transverse osteotomy of the right humerus diaphysis to implant the already described rods which filled the entire length of the medullary cavity and were fixed by two cortical stainless steel screws in each bone fragment. The surgical technique was well succeeded without any trans-operative intercurrence. Through clinical and radiographic examination, it was observed that soon after the anesthesia recovery, six rods (37,5%) broke next to the fracture focus and the same was noticed with the others (62,5%) on seventh day post-surgery. Based on the obtained results, it can be hypothesized that polyamide 12 rods resistance could have been affected by all the thermal stages necessary to its incorporation with hydroxyapatite. Furthermore, the roosters’ age may also have contributed to adverse outcomes. However, future researches will be necessary to confirm those hypotheses.

Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site

BackgroundTotal hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site. MethodsFifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem. ResultsPostoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component. ConclusionSuccessful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.

Biomechanical experimental substantiation of the fixation technique of bone allograft and recipient’s bone

A technique combining bone allografting and arthroplasty — allocomposite replacement (ACR), is widely used in orthopedic oncology. However, the risk of complications after this surgical intervention remains high — non-union of the allograft with the recipient's bone, its lysis, infection.Objective: to substantiate ACR techniques biomechanically using segmental bone allografts with intramedullary fixation in the recipient’s bone. Methods: the experiment was performed on 28 male rats (age 5 months, body weight 350–400 g). ACR of the femur was modeled with transverse (I group) and stepcut (II) osteotomy. The strength of the isolated preparations of the operated animal femurs was examined on a biomechanical stand after 3 and 6 months after the surgery. Digital indicators are processed statistically.Results: in the Ist group of animals (3 months after surgery) the strength of the operated bones was statistically significantly lower compared to the contralateral (t = –2.674; p = 0.037), and in rats with stepcut osteotomy the difference was not significant. In 6 months after surgery, bone strength with stepcut osteotomy was found to be (44.3 ± 15.6) N greater than with transverse (t = –2.838; p = 0.023). At the same time, the strength of the operated bones of animals of the Ist group was comparable with that of the contralateral limbs (t = –1.279; p = 0.248), and in the IInd exceeded them (t = 6,000; p = 0.001).Conclusions: stepcut osteotomy with subsequent fixation of the bone allograft to the recipient’s bone improves the conditions for reparative osteogenesis in the area of their contact and reduces the risk of ACR complications. Bioreconstructive surgical interventions in order to replace post-resection defects of long bones in patients with tumor lesions can improve orthopedic, functional and oncological treatment results.

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

BackgroundWhen reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site.MethodsWe retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R.ResultsN varied from 9.8–15.2 mm and M varied from 20.7–24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5–2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level.ConclusionsOur findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally.Trial registrationRetrospectively registered.

A Review and Modification of Dorsal Preservation Rhinoplasty Techniques.

Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative.Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patient-reported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP.Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

Partial Trapezoid Excision in Thumb CMC Arthroplasty for STT Arthritis: A Cadaveric Study

Thumb carpometacarpal (CMC) joint arthroplasty is one of the most commonly performed surgeries by hand surgeons. A large portion of these patients also have scaphotrapezoidal (ST) arthritis in addition to CMC arthritis. The purposes of this study were to quantify the amount of transverse trapezoid resection necessary to prevent ST impingement and to compare an oblique with a transverse osteotomy of the trapezoid. A total of 9 cadaveric specimens were used and were randomly placed into 2 groups. Group 1 had sequential transverse osteotomies and the space between the scaphoid and trapezoid was measured in various wrist positions. Group 2 had oblique osteotomies and the ST distance was measured in multiple wrist positions. In group 1, there was no contact between the scaphoid and trapezoid in neutral wrist position after any resection. The half and two-thirds transverse osteotomies did not have contact at 20° radial deviation (RD) and 30° wrist flexion (WF). In 1 of the 5 specimens, there was contact at one-third resection in either isolated RD or WF. In 3 specimens, there was contact at one-third resection with 20° of radial deviation combined with 30° WF. In group 2, there was no contact in any specimen in any wrist position tested. At neutral, there was 3.7 mm of space between the scaphoid and trapezoid measured at the radial side. In 20° RD and 0° WF, an average space remaining was 2.8 mm. In 0° RD and 30° WF, there was an average space of 2.3 mm remaining. At 20° RD and 30° WF, there was an average space remaining of 1.8 mm. At the extreme of RD and WF, there was an average space remaining of 1.4 mm. An oblique osteotomy of the trapezoid did not have any ST contact in 20° RD and 30° WF. The transverse osteotomies had contact with only one-third resection. Therefore, if a transverse osteotomy of the trapezoid is performed, more than one-third of the bone should be resected to minimize the risk for bony impingement in positions of WF, RD, or both. In ST arthritis, an oblique osteotomy of the trapezoid may prevent impingement while allowing for less overall bony resection compared with a transverse osteotomy.

Cement augmentation of odontoid peg fractures: the effect of cement volume and distribution on construct stiffness.

The cement augmentation of a conventional anterior screw fixation in type II odontoid process fractures for elderly patients significantly increased stiffness and load to failure under anterior-posterior load in comparison with non-augmented fixation. The amount and quality of bone cement are usually taken ad hoc in clinical practise. In this study, we wanted to clarify the role of bone cement amount and its quality to the stiffness of odontoid and vertebrae body junction. Finite-element method was used to achieve different scenarios of cement augmentation. For all models, an initial stiffness was calculated. Model (1) the intact vertebrae were virtually potted into a polymethylmethacrylate base via the posterior vertebral arches. A V-shaped punch was used for loading the odontoid in an anterior-posterior direction. (2) The odontoid fracture type IIa (Anderson-D'Alonzo classification) was achieved by virtual transverse osteotomy. Anterior screw fixation was virtually performed by putting self-drilling titanium alloy 3.5mm diameter anterior cannulated lag screw with a 12mm thread into the inspected vertebrae. A V-shaped punch was used for loading the odontoid in an anterior-posterior direction. The vertebrae body was assumed to be non-cemented and cemented with different volume. The mean cement volume was lowest for body base filling with 0.47 ± 0.03ml. The standard body filling corresponds to 0.95 ± 0.15ml. The largest volume corresponds to 1.62 ± 0.12ml in the presence of cement leakage. The initial stiffness of the intact C2 vertebrae was taken as the reference value. The mean initial stiffness for non-porous cement (E = 3000MPa) increased linearly (R2 = 0.98). The lowest stiffness (123.3 ± 5.8N/mm) was measured in the intact C2 vertebrae. However, the highest stiffness (165.2 ± 5.2N/mm) was measured when cement leakage out of the odontoid peg occurred. The mean initial stiffness of the base-only cemented group was 147.2 ± 8.4N/mm compared with 157.9 ± 6.6N/mm for the base and body cemented group. This difference was statistically significant (p < 0.0061). The mean initial stiffness for porous cement (E = 500MPa) remains constant. Therefore, there is no difference between cemented and non-cemented junction. This difference was not statistically significant (p < 0.18). The present study showed that the low porous cement was able to significantly influence the stiffness of the augmented odontoid screw fixation in vitro, although further in vivo clinical studies should be undertaken. Our results suggest that only a small amount of non-porous cement is needed to restore stiffness at least to its pre-fracture level and this can be achieved with the injection of 0.7-1.2ml of cement. These slides can be retrieved under Electronic Supplementary Material.

Assessment of neovascularization during bone healing using contrast-enhanced ultrasonography in a canine tibial osteotomy model: a preliminary study.

Blood perfusion of skeletal muscle and callus was evaluated using contrast-enhanced ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.

The Effects of Autologous Platelet-Rich Plasma on the Bone Fracture Healing in Rabbits

The purpose of this study was to evaluate the effects of an autologous platelet rich-plasma on femoral fracture healing in experimentally induced rabbits’ model. In this study, 34 local breed rabbits, around 2-2.5 kg body weight, were divided into two equal groups randomly; Group A: platelet-rich plasma (PRP) and Groups B: Control group. Rabbits in both groups underwent a complete mid-shaft transverse osteotomy of the femur by a fine electrical saw. After fracture induction, the rabbits in group A (PRP group) were treated by application of 0.5 ml of autologous PRP at the site of the fractured bone, while in group B (control), rabbits were injected with distilled water. Samples from the fractured femur were collected at 10th, 20th, 30th days post operation for radiological evaluation and at 10th, 14th, 20th, and 30th days for histopathological evaluation. In radiological study, it was found that the rate of callus formation in rabbits treated with PRP (Group A) were faster than the control group (Group B) at different periods. Similarly, in histological finding it found that the stages of healing were faster in Group A when compared with Group B. It was concluded that using autologous PRP has beneficial effect to enhance the process of bone healing in the rabbit’s model.

Promotion of bone repair of rabbit tibia defects induced by scaffolds of $$\hbox {P(VDF-TrFE)/BaTiO}_{3}$$ composites

In this work, scaffolds made of a novel experimental 0–3 type composite were implanted onto non-critical defects in rabbit tibiae. This work discusses the bone repair promoted by polyvinylidene fluoride-trifluoroethylene $$\hbox {P(VDF-TrFE)/barium titanate (BaTiO}_{3}$$ ) composite that scaffolds with 10 vol% $$\hbox {BaTiO}_{3}$$ . Prior to implant surgery, the $$\hbox {P(VDF-TrFE)/BaTiO}_{3}$$ scaffolds, moulded into a membrane disk, were subjected to a cytotoxicity test (ASTM F895-84). A standardized transverse osteotomy was made with the following dimensions: 4.5 mm in width by 9 mm in length, at the proximal tibial metaphysis, in adult male rabbits, by using a cylindrical drill, cooled with a physiologic solution. These critical defects were filled with blood clot on the left tibiae (control group), whereas the right tibiae were covered with composite scaffolds, measuring 5 mm in thickness and 10 mm in diameter (experimental group); $$n = 12$$ for each group. After 21 days, the rabbits were sacrificed and the tibiae bone fragments were conducted to demineralization routines, from fixation and stain procedures to histological analysis. The scaffolds promote the growth of the bone, resulting in an increased repair with callus formation around the scaffold and high mitotic activity at newly formed bones.

Trehalose enhances bone fracture healing in a rat sleep deprivation model.

The purpose of this study was to investigate whether sleep deprivation (SD) could delay bone fracture healing and evaluate the therapeutic effect of trehalose. Eighteen 300-350 g female Sprague-Dawley rats were created a mid-femoral transverse osteotomy in the right thigh and divided into three groups (i.e., group 1: fracture; group 2: fracture + SD; and group 3: fracture + SD + trehalose). Seven days after surgery, the rats in group 2 and group 3 were started to get sleep-deprived for 18 h per day for 3 weeks. The rats in group 3 were injected with trehalose intraperitoneally at 1 g/kg/d for 3 weeks. Radiological and histological analyses were used to assess fracture healing quality. Circulating cytokines were detected by the end of the study. The expression of M1 and M2 macrophage markers were measured by quantitative real-time polymerase chain reaction (qPCR). X-rays showed group 2 experienced much poorer fracture healing. Micro CT demonstrated that the bone quality of the fracture callus site in group 2 was much worse than that in groups 1 and 3. Both haematoxylin eosin (H&E) and Masson staining revealed that the bone fracture of the group 2 healed worse. Elisa results demonstrated that the interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) of the rats in group 2 were significantly higher. In vitro study showed that 100 mM trehalose enhanced the expression of M2 macrophage markers (Arg-1 and IL-10), and decreased M1 macrophage polarization through the decreasing expression of IL-6. The present study showed (SD) could delay bone fracture healing in a rat model. And, trehalose could promote the healing of delayed bone fracture union by down-regulating pro-inflammatory mediators and enhancing M2 polarization.

The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report

BackgroundTotal hip arthroplasty (THA) is considerably difficult to perform in patients with Crowe type IV developmental dysplasia of the hip (DDH). Some Crowe type IV DDH patients require a femoral subtrochanteric shortening osteotomy to equalize the length of the lower extremities and decrease the difficulty of intraoperative reduction. Subtrochanteric transverse osteotomy has been proven to have superior clinical efficacy, but some cases of nonunion occur.Case presentationWe present the case of a 62-year-old male patient who underwent right THA with femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. Nonunion of the osteotomy occurred during the follow-up period. In July 2017, the patient underwent right THA and femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. In November 2017, a slight feeling of bone rubbing and slight pain in the hip were reported. The ends of the osteotomy had rotated and united poorly. However, the patient requested to undergo continued observation. In December 2017, the patient reported an obvious sensation of bone rubbing and aggravated hip pain. The ends of the osteotomy had rotated and continued to exhibit nonunion. On December 26, 2017, the patient was treated with plate and screw internal fixation with bone morphogenetic protein (BMP) following our suggestion. In August 2018, the ends of the osteotomy had united after internal fixation was applied.ConclusionsTHA with femoral subtrochanteric transverse osteotomy exhibits good efficacy for the treatment of patients with Crowe type IV DDH. However, postoperative nonunion occurs in a small number of cases. The causes of nonunion should be analysed, and effective measures should be taken to prevent this situation. Plate and screw internal fixation with BMP is an effective treatment for nonunion of the ends of an osteotomy.