Treatment Of Bone Fractures Research Articles

Clinical outcome of femoral diaphyseal fractures in adults treated with open verses closed interlocking nail

BACKGROUND & OBJECTIVE: There are different methods for treatment of the long bone fractures, including femoral diaphyseal fractures, ranging from closed intramedullary nail, open intramedullary nail to flexible nail, plating, and external fixator in open type 3 B and 3C fractures. The aim of this study was to compare the functional outcome of open versus closed techniques in treating femoral diaphyseal fractures in skeletally mature adults.
 METHODOLOGY: A simple observational study was conducted at the Department of Orthopedics, Allied Hospital Faisalabad, from January 2018 to January 2020 with a total of 60 skeletally mature patients with mean age 38.4+1.2 who fulfilled the inclusion criteria were operated, and five patients lost in follow-up. Group A consisted of 27 patients (18 males and 9 females) who were operated with closed interlocking technique. Group B consisted of 28 patients (12 males and 16 females) who were operated with open technique. Both groups were followed prospectively for two years to evaluate the outcome. T-test was used for statistical analysis.
 RESULTS: The rate of union in group A was better than in group B. Patients in group A had a reunion 1.99±0.86 weeks earlier than group B a significant difference between the two groups with p<0.001. Nonunion occurred in 02(7.40%) patients of group A and 03(10.71%) patients of group B. Only 01 (3.7%) patient from group A and 02 (7.40%) patient of group B suffered from deep infections.
 CONCLUSION: Closed interlocking for femoral diaphyseal fractures provides earlier reunion of the bone and should be considered the treatment of choice. In case of lack of technical availabilities, open interlocking should be considered as a suitable option.

Nano‐hydroxyapatite reinforced polylactic acid bioabsorbable cancellous screws for bone fracture fixations

AbstractBioabsorbable polymer implants aid the fracture treatment to overcome the limitations of metallic implants like stress shielding, corrosion, and revision surgeries. The cancellous screw is one of the internal fixation implants more frequently used in fixation procedures. In this work, nano‐hydroxyapatite (nHAp) reinforced polylactic acid cancellous screws were developed for bone fracture treatment. The biocompatibility and mechanical tests were performed before and after in‐vitro hydrolytic degradation studies. The addition of nanofillers (10 wt% nHAp) enhanced the pullout strength, torsional strength, and shear strength by 18%, 48%, and 5%, respectively. The performed thermal studies confirmed that the nanohydroxyapatite facilitates the crystallization process. A mass loss of about 18% in the case of neat PLA and 12% in the case of 10 wt% nHAp was observed for 90 days of in‐vitro hydrolytic degradation studies. So, the developed combination of biocomposite could help fabricate patient‐specific bioabsorbable fixation devices like screws and plates.

A self-degradable “nanoarmor” coating of medical implant potentiates bone fracture healing

Bionic functional coating plays a pivotal role in promoting internal fixation treatment of bone fracture. However, post-traumatic microenvironment characterized by hypoxia and acidic milieu, as well as high oxidative stress, may largely weaken the function of established coatings. Herein, we anchor two-dimensional H-silicene nanosheet (H-Si) onto hydroxyapatite (HA)-coated metal implant to develop a H-Si@HA composite coating. Benefiting from the intrinsic pH-responsive characteristics, the H-Si@HA maintains stable structure and functionalities in acidic milieu and simulates the superoxide dismutase and peroxidase-like activities, resulting in reactive oxygen species depletion, high oxidative stress suppression and further reversal of the acidic microenvironment. Meanwhile, H-Si@HA protects cells by inducing cellular autophagy. Sequentially, Si4+ release accompanying the degradation of the H-Si in neutral milieu promotes fracture healing by improving osteogenic-related gene expression of bone mesenchymal stem cells (BMSCs) and SOD1 expression of osteoprogenitor cells. Particularly, differentiated gene expression of BMSCs by the H-Si@HA coating was identified using absolute quantitative transcriptome sequencing, revealing that the H-Si could effectively modulate the expression of core mRNAs which are highly associated with osteogenesis and bone formation through regulating autophagy. Such a self-degradable nanoarmor coating illustrates the great clinic potential to achieve hierarchical and synergistic effect of fracture healing promotion.

NiTi Shape Memory Clamps with Modified Surface for Bone Fracture Treatment.

Using NiTi alloys with shape memory for long-term medical implants requires modification of their surface due to the possible occurrence of corrosion. Hence, the surface of the staples used to join fractured bone within the craniofacial region was modified by applying a titanium oxy-nitrogen layer and a hydroxyapatite coating. Surface-modified clamps were tested in vivo using New Zealand white rabbits. After determining the mechanical characteristics of the bone and considering the initial state and surface modification, the diameter of the wire (used to make the clamps with the appropriate compression force) was selected. Implantation was performed on two groups of rabbits: experimental and control. In the experimental group, an intentionally induced bone fracture was treated in one tibia. On the second tibia, two additional clamps were applied to increase the possibility of a negative impact of the NiTi alloy on a living organism. After 6 weeks of application, a proper joining of the broken bone fragments was stated. Whereas after twelve weeks, no negative impact of the clamp material on a living organism, i.e., a rabbit, was found. Hence, the clamp with the modified surface can connect bone fragments in humans as well as small and medium-sized animals, with an extended range of use up to 12 weeks.

A retrospective study on the treatment of bone fractures in 14 wild birds of different species and ages by bone muffs

Various kinds of fracture fixation methods have been applied in bird orthopedics. Although each one has comparative advantages and disadvantages, the best results can be obtained with the orthopedic technique chosen according to the location, shape and type of the fracture. In addition, postoperative care of animals, especially rehabilitation of wild birds, will yield positive results. The aim of this retrospective study was to evaluate the advantage of bone muffs in comparison to other routine fracture treatment methods, such as a bandages, intramedullary pins, and cerclage applications. Several wild birds with leg and wing fractures were admitted to the Clinical and Animal Hospital of the F.Ü. Veterinary Faculty between 1986 and 2011, and were treated with bandages, cerclage, and intramedullary pin techniques. Of these, 14 birds were treated with bone muffs. The animals were anesthetized for osteosynthesis with Pentobarbital (Nembutal sodium 50 mg/cc, ABBOTT) or ketamine (ketalar 50 mg/ml PARKE-DAVİS). Appropriately sized cattle and bird bone muffs were firmly fixated onto fractured bone fragments and their recovery was monitored. After the operation, the animals were taken for post-operative care. Animals with muff transplants did not need to be treated with bandages, and hence they were calmer, more comfortable and healed quickly. In birds treated with a bone muff, the bone to which the muff was applied was observed by histopathology to have normal callus formation and it was reported that a bone callus formed at that region. On the other hand, animals treated with other routine fracture management methods and bandaged animals were uncomfortable, aggressive, and were observed to be under stress. These bandaged birds had a longer recovery time, and during this time, most of the animals refused to eat and died. Due to the bandage, the animals could not find their balance on a single wing, they became disturbed psychologically, and did not continue to feed, so began to vomit when fed by hand and died in a short time. From this point of view, bone muffs provided significant advantages over other routine applications, as they did not cause psychological stress to animals because they were light and the birds did not require bandages, and they were easily resorbed because they were made of bone tissue. Recovery time was also shorter. The study showed that bone muffs may be better than conservative treatment, however, further research is needed as real long-term results are lacking.

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

Background: Fractures are typically evaluated and monitored using plain radiographs, but in the pediatric population the goal is always to reduce radiation exposure when possible. Dual-energy X-ray absorptiometry (DXA) is an imaging modality that uses less radiation. The evaluation of upper and lower extremity fractures in the pediatric population using DXA imaging has not yet been studied.Method: Radiographs of 19 patients treated for forearm or tibia fractures were compared to images taken with a DXA machine. The angulation and translation of the fractures were measured twice each by two independent observers. Correlation of these values between plain radiographs and DXA scans along with intra- and inter-observer reliability was calculated.Results: A total of 19 patients with a forearm or tibia fracture were enrolled in the study. Correlation with conventional radiographs for angulation was r=0.77, p<0.001, while for translation was r=0.76, p<0.001. The mean difference between the methods was 0.5 degrees (range of -6.7 to 7.7) for angulation and 4% (range of -28% to 37%) for translation. For plain radiographs the inter-rater reliability was 0.90 (95% confidence interval of 0.84-0.93) for angulation and 0.89 (0.68-0.95) for translation. The inter-rater reliability for DXA imaging was 0.77 (0.69-0.83) for angulation and 0.76 (0.41-0.88) for translation.Conclusion: Our study showed that DXA imaging correlates well with plain radiographs when measuring angulation and translation of forearm and tibia fractures in the pediatric population. This study is a proof of concept that DXA, a low-dose radiation alternative to plain radiographs, may be useful in the management of pediatric fractures.Level of Evidence: Level III Key Concepts•Decreasing radiation exposure in the pediatric population is an ongoing goal in pediatric orthopaedics.•Fracture follow-up imaging in the pediatric population currently is mainly restricted to plain radiographs.•A lower dose imaging modality might be an alternative to plain radiographs to monitor long bone fracture alignment.

Causes, Types and Management of Zygomatic Bone Fracture in Patients Presenting at Tertiary Care Hospital

Aim: To assess the frequency of different causes, types and management options of zygomatic bone fractures. Method: A cross sectional study was conducted from March 2022 to March 2023 at Oral &amp; Maxillo-Facial Surgery Department, Nishtar Institute of Dentistry, Multan. Seventy two zygomatic bone fracture patients were included meeting inclusion &amp; exclusion criteria after complete clinical &amp; radiological examination.Patient's demographic data, cause, type of fracture and treatment modality executed were collected on a specially designed proforma. Data was analyzed using SPSS version 22. Frequencies, percentages, mean ± standard deviation were taken. Results: Male to female ratio was 3.8:1 with male predominance. Road traffic accident was the leading cause of zygomatic bone fractures (n= 43,60.6%)while Rowe &amp; Kelly’s type IV (inward &amp; posterior) Fracture was most common type of fracture(n=21, 29.2%). ORIF with Two-point fixation was the most common treatment modality executed(n=27,37.5 %). Conclusion: Etiology varies due to geographic area, socio-economic status °ree of RTA. Type fracture depends upon side of impact and Open reduction is modality of choice for the treatment of zygomatic bone fractures. Keywords: Road traffic accidents (RTA);Open reduction &amp; internal fixation (ORIF); zygomatic bone fracture.

Methods of surgical treatment of pelvic bone fractures in dogs and postoperative rehabilitation

Pelvic ring injury is one of the most severe forms of musculoskeletal injury in small domestic animals. They usually do not survive due to the development of traumatic shock and complications from the pelvic organs, which develop in the post-traumatic period. In this article on the topic: "Methods of surgical treatment of pelvic bone fractures in dogs and postoperative rehabilitation" performed by a number of authors from the Kazakh National Agrarian Research University, examples of surgical intervention for various pelvic fractures in dogs are given, using various methods of fixing them.Such as: internal methods of fixing fractures of the pelvic ring, using plates, screws, various types of wires designed for osteosynthesis of bones; external methods of fixing fractures of the pelvic ring, using the spokerod method. The studies were carried out on 18 dogs for a year and a half in the veterinary clinic "Center for Veterinary Medicine" and in the "Daria Pankova Rehabilitation Center" in Almaty. The studied animals were aged from 1 year to 3.5 years. Breedchar-acteristic sranged from small breeds such as Chihuahuasand Dachshundstolarge out breds and CaneCorso .As well as the use of early rehabilitation in the postoperative period to eliminate various complications, such as muscle atrophy, neurological deficits of varying degrees, loss of limb sensitivity, and so on.The recovery rate of bone and cartilage tissue in the application of food additives in the nutrition of operated animals was estimated, with the data obtained being recorded every 10 days. The analysis of the data obtained shows that the use of additional dietary supplements significantly accelerates the process of formation of a callus and rapid consolidation of bone fractures.

Impact of Dementia on Treatment of Peripheral Arterial Disease, Hip and Vertebral Bone Fracture

Impact of Dementia on Treatment of Peripheral Arterial Disease, Hip and Vertebral Bone Fracture

Bioactive calcium and mangnesium phosphate bone adhesive for enhanced vascularization and bone regeneration

Bone adhesive is a promising material for the treatment of bone fractures, which is helpful for the fast and effective reduction and fixation of broken bones. However, the existing adhesives bond weakly to bone tissues, and are non-absorbable, or hard to cure under wet conditions. Herein, inspired by the cement-based adhesive used in the industry field, we report a bioactive calcium and magnesium phosphate bone adhesive (MPBA) with the properties of facile preparation, robust adhesion, and bioactive. MPBA is equipped with similar strength to cancellous bones and shows reliable bonding performance for various interfaces, such as Ti6Al4V, Al2O3, and poly(ether-ether-ketone). MPBA achieves excellent bonding ability for the above interfaces with the bonding strengths of 2.28±0.47, 2.32±0.15, and 1.44±0.38 MPa, respectively. Besides, it also shows reliable fixation ability for bovine bone surfaces. The bonding behavior to materials and bones suggests that MPBA could be used for both fracture treatment and implant fixation. Meanwhile, MPBA possesses good biological activity, which could promote the vascularization process and osteogenic differentiation. Finally, in vivo experiments confirmed MPBA can effectively restore bone strength and promote bone regeneration.

Exogenously delivered iPSCs disrupt the natural repair response of endogenous MPCs after bone injury

Promoting bone healing including fracture non-unions are promising targets for bone tissue engineering due to the limited success of current clinical treatment methods. There has been significant research on the use of stem cells with and without biomaterial scaffolds to treat bone fractures due to their promising regenerative capabilities. However, the relative roles of exogenous vs. endogenous stem cells and their overall contribution to in vivo fracture repair is not well understood. The purpose of this study was to determine the interaction between exogenous and endogenous stem cells during bone healing. This study was conducted using a standardized burr-hole bone injury model in a mesenchymal progenitor cell (MPC) lineage-tracing mouse under normal homeostatic and osteoporotic conditions. Burr-hole injuries were treated with a collagen-I biomaterial loaded with and without labelled induced pluripotent stem cells (iPSCs). Using lineage-tracing, the roles of exogenous and endogenous stem cells during bone healing were examined. It was observed that treatment with iPSCs resulted in muted healing compared to untreated controls in intact mice post-injury. When the cell populations were examined histologically, iPSC-treated burr-hole defects presented with a dramatic reduction in endogenous MPCs and cell proliferation throughout the injury site. However, when the ovaries were removed and an osteoporotic-like phenotype induced in the mice, iPSCs treatment resulted in increased bone formation relative to untreated controls. In the absence of iPSCs, endogenous MPCs demonstrated robust proliferative and osteogenic capacity to undertake repair and this behaviour was disrupted in the presence of iPSCs which instead took on an osteoblast fate but with little proliferation. This study clearly demonstrates that exogenously delivered cell populations can impact the normal function of endogenous stem/progenitor populations during the normal healing cascade. These interactions need to be better understood to inform cell and biomaterial therapies to treat fractures.

Secondary Treatment of Mandibular Bone Fracture Using Sagittal Split Osteotomy and Segmentation of the Mandible: A Case Report

The secondary treatment of mandibular bone fractures poses a great challenge due to the complexity of several factors, such as incorrect primary fracture repositioning, inadequate internal fixation, nonunion, necrosis, local inflammation and infection, tooth loss, and malocclusion, serving as obstacles encountered by surgical teams. The aim of this case report is to detail the planning process, surgical technique, and outcome of the secondary treatment of the post-traumatic deformation, bone exposure, and partial necrosis of the mandible. The new approach described herein incorporated 3D planning and printing procedures, employing surgical techniques such as the segmentation of the mandible with unilateral sagittal split osteotomy and the vertical osteotomy of the mandibular body. New, stable occlusion; appropriate spatial relations; and proper osteosynthesis of the mandible were achieved. The encouraging results obtained demonstrate that the described method can be incorporated in similar cases of the secondary treatment of mandibular fractures and possibly lead to shorter hospitalization and convalescence and lower the associated costs.

A Novel Balloon Catheter Dilation Apparatus for the Treatment of Depressed Nasal Bone Fracture

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a depressed nasal bone fracture which often leads to iatrogenic injury. In this article, a new balloon catheter dilation apparatus for nasal bone fracture is hypothesized by the authors. This device aims to repair nasal bone fracture via dilated balloons under fractured nasal bone and used as nasal internal packing system after operation. Compared with the conventional approach, it is proposed that this balloon dilation apparatus could be a potential powerful, less invasive approach to treat depressed nasal bone fractures.

Kielin/chordin-like protein enhances induction of osteoblast differentiation by Bone Morphogenetic Protein-2.

Bone morphogenetic proteins (BMPs) play a key role in embryonic differentiation for osteoblast and bone formation. Kielin/chordin-like protein (Kcp) is known to enhance the effects of BMP signaling. Here, we present ALP activity, gene expression, and calcification data demonstrating that Kcp affects the differentiation of C2C12 myoblasts into osteoblasts. We report that the presence of Kcp enhances the ability of BMP-2 to induce differentiation of C2C12 myoblasts into osteoblasts. Additionally, BMP-2-mediated stimulation of phosphorylated Smad1/5 was apparently enhanced in the presence of Kcp. The present findings may contribute to progression towards the clinical use of BMPs for treatment of bone fracture, osteoarthritis, and other similar conditions.

Encapsulation of β-NGF in injectable microrods for localized delivery accelerates endochondral fracture repair.

Introduction: Currently, there are no non-surgical FDA-approved biological approaches to accelerate fracture repair. Injectable therapies designed to stimulate bone healing represent an exciting alternative to surgically implanted biologics, however, the translation of effective osteoinductive therapies remains challenging due to the need for safe and effective drug delivery. Hydrogel-based microparticle platforms may be a clinically relevant solution to create controlled and localized drug delivery to treat bone fractures. Here, we describe poly (ethylene glycol) dimethacrylate (PEGDMA)-based microparticles, in the shape of microrods, loaded with beta nerve growth factor (β-NGF) for the purpose of promoting fracture repair. Methods: Herein, PEGDMA microrods were fabricated through photolithography. PEGDMA microrods were loaded with β-NGF and in vitro release was examined. Subsequently, bioactivity assays were evaluated in vitro using the TF-1 tyrosine receptor kinase A (Trk-A) expressing cell line. Finally, in vivo studies using our well-established murine tibia fracture model were performed and a single injection of the β-NGF loaded PEGDMA microrods, non-loaded PEGDMA microrods, or soluble β-NGF was administered to assess the extent of fracture healing using Micro-computed tomography (µCT) and histomorphometry. Results: In vitro release studies showed there is significant retention of protein within the polymer matrix over 168 hours through physiochemical interactions. Bioactivity of protein post-loading was confirmed with the TF-1 cell line. In vivo studies using our murine tibia fracture model show that PEGDMA microrods injected at the site of fracture remained adjacent to the callus for over 7 days. Importantly, a single injection of β-NGF loaded PEGDMA microrods resulted in improved fracture healing as indicated by a significant increase in the percent bone in the fracture callus, trabecular connective density, and bone mineral density relative to soluble β-NGF control indicating improved drug retention within the tissue. The concomitant decrease in cartilage fraction supports our prior work showing that β-NGF promotes endochondral conversion of cartilage to bone to accelerate healing. Discussion: We demonstrate a novel and translational method wherein β-NGF can be encapsulated within PEGDMA microrods for local delivery and that β-NGF bioactivity is maintained resulting in improved bone fracture repair.

Delayed cortical bone healing due to impaired nuclear Nrf2 translocation in COPD mice

The effect of the pathogenesis of chronic obstructive pulmonary disease (COPD) on bone fracture healing is unknown. Oxidative stress has been implicated in the systemic complications of COPD, and decreased activity of Nrf2 signaling, a central component of the in vivo antioxidant mechanism, has been reported. We investigated the process of cortical bone repair in a mouse model of elastase-induced emphysema by creating a drill hole and focusing on Nrf2 and found that the amount of new bone in the drill hole was reduced and bone formation capacity was decreased in the model mice. Furthermore, nuclear Nrf2 expression in osteoblasts was reduced in model mice. Sulforaphane, an Nrf2 activator, improved delayed cortical bone healing in model mice. This study indicates that bone healing is delayed in COPD mice and that impaired nuclear translocation of Nrf2 is involved in delayed cortical bone healing, suggesting that Nrf2 may be a novel target for bone fracture treatment in COPD patients.

Molecular profiling of osteoprogenitor cells reveals FOS as a master regulator of bone non-union

Despite the advances in bone fracture treatment, a significant fraction of fracture patients will develop non-union. Most non-unions are treated with surgery since identifying the molecular causes of these defects is exceptionally challenging. In this study, compared with marrow bone, we generated a transcriptional atlas of human osteoprogenitor cells derived from healing callus and non-union fractures. Detailed comparison among the three conditions revealed a substantial similarity of callus and nonunion at the gene expression level. Nevertheless, when assayed functionally, they showed different osteogenic potential. Utilizing longitudinal transcriptional profiling of the osteoprogenitor cells, we identified FOS as a putative master regulator of non-union fractures. We validated FOS activity by profiling a validation cohort of 31 tissue samples. Our work identified new molecular targets for non-union classification and treatment while providing a valuable resource to better understand human bone healing biology.

Applications and Future Perspective of Pulsed Electromagnetic Fields in Foot and Ankle Sport-Related Injuries

Foot and ankle injuries are common in many sports. One of the main athletes issues is the time for sport resumption after trauma. Recently, extensive efforts have been made to speed up the athletes’ return-to-sport and to prevent joint degeneration. Among the conservative treatment options, biophysical stimulation with pulsed electromagnetic fields (PEMFs) is listed. This narrative review aims to outline current applications of PEMFs in main foot and ankle sport-related injuries, in particular in the treatment of bone marrow edema, osteochondral defects, fractures, and nonunions. Despite further high-quality studies on foot and ankle injuries are needed, PEMFs seem to be a valid aid to enhance the endogenous osteogenesis, to resolve the bone marrow edema, to inhibit the joint inflammation, preserving articular cartilage degeneration, and to relieve pain.

Comparison of Osteogenic Capacity and Osteoinduction of Adipose Tissue-Derived Cell Populations.

Stromal vascular fraction (SVF) is the primary isolate obtained after enzymatic digestion of adipose tissue that contains various cell types. Its successful application for cell-based construct preparation in an intra-operative setting for clinical bone augmentation and regeneration has been previously reported. However, the performance of SVF-based constructs compared with traditional ex vivo expanded adipose tissue-derived mesenchymal stromal cells (ATMSCs) remains unclear and direct comparative analyses are scarce. Consequently, we here aimed at comparing the in vitro osteogenic differentiation capacity of donor-matched SVF versus ATMSCs as well as their osteoinductive capacity. Human adipose tissue from nine different donors was used to isolate SVF, which was further purified via plastic-adherence to obtain donor-matched ATMSCs. Both cell populations were immunophenotypically characterized for mesenchymal stromal cell, endothelial, and hematopoietic markers after isolation and immunocytochemical staining was used to identify different cell types during prolonged cell culture. Based on normalization using plastic-adherence fraction determination, SVF and ATMSCs were seeded and cultured in osteogenic differentiation medium for 28 days. Further, SVF and ATMSCs were seeded onto devitalized bovine bone granules and subcutaneously implanted into nude mice. After 42 days of implantation, granules were retrieved, histologically processed, and stained with hematoxylin and eosin (HE) to assess ectopic bone formation. The ATMSCs were shown to be a homogenous cell population during cell culture, whereas SVF cultures consisted of multiple cell types. All donor-matched comparisons showed either accelerated or stronger mineralization for SVF cultures in vitro. However, neither SVF nor ATMSCs loaded on devitalized bone granules induced ectopic bone formation on subcutaneous implantation, as opposed to control granules loaded with bone morphogenetic protein-2 (BMP-2), which triggered ectopic bone formation with 100% incidence. Despite the observed lack of osteoinduction, our findings provide important in vitro evidence on the osteogenic superiority of intra-operatively available SVF as compared with donor-matched ATMSCs. Consequently, further studies should focus on optimizing the efficacy of these cell populations for implementation in orthotopic bone fracture or defect treatment.

Polylactic acid reinforced with nano-hydroxyapatite bioabsorbable cortical screws for bone fracture treatment

Polylactic acid reinforced with nano-hydroxyapatite bioabsorbable cortical screws for bone fracture treatment