RESUMEN
Lower extremity fractures pose challenges due to prolonged healing times and limited assessment methods. Integrating wearable sensors with machine learning can help overcome these challenges by providing objective assessment and predicting fracture healing. In this retrospective study, data from a gait monitoring insole on 25 patients with closed lower extremity fractures were analyzed. Continuous underfoot loading data were processed to isolate steps, extract metrics, and feed them into three white-box machine learning models. Decision tree and Lasso regression aided feature selection, while a logistic regression classifier predicted days until fracture healing within a 30-day range. Evaluations via 10-fold cross-validation and leave-one-out validation yielded stable metrics, with the model achieving a mean accuracy, precision, recall, and F1-score of approximately 76%. Feature selection revealed the importance of underfoot loading distribution patterns, particularly on the medial surface. Our research facilitates data-driven decisions, enabling early complication detection, potentially shortening recovery times, and offering accurate rehabilitation timeline predictions.
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Extremidad Inferior , Aprendizaje Automático , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Persona de Mediana Edad , Extremidad Inferior/fisiopatología , Curación de Fractura/fisiología , Estudios Retrospectivos , Adulto , Anciano , Fracturas Óseas , Marcha/fisiologíaRESUMEN
BACKGROUND: Cerclage wiring is commonly used for treating fractures; however, it has several limitations, including mechanical weakness, decreased blood circulation, and technical complexity. In this study, we developed an implant using a shape memory alloy (SMA) and tested its efficacy in treating Vancouver type B1 (VB1) periprosthetic femoral fractures (PFFs) in a canine model. METHODS: The mid-diaphyseal fracture models underwent reduction via the SMA plate (SMA group) or the cerclage cable plate (cable group) method in randomly selected pelvic limbs. An intraoperative evaluation was conducted to assess the surgical time and difficulty related to implant fitting. Clinical assessments, radiography, microcomputed tomography (micro-CT), histological analysis, positron emission tomography (PET)/CT, and galvanic corrosion analysis were conducted for 52 weeks to evaluate bone healing and blood perfusion. RESULTS: The results for bone healing and blood perfusion were not significantly different between the groups (p > 0.05). In addition, no evidence of galvanic corrosion was present in any of the implants. However, the median surgical time was 75 min (range, 53-82 min) for the SMA group and 126 min (range, 120-171 min) for the cable group, which was a statistically significant difference (p = 0.0286). CONCLUSIONS: This study assessed the ability of a newly developed shape memory alloy (SMA) to treat VB1 periprosthetic femoral fractures (PFFs) in canines for over a 52-week period and revealed outcomes comparable to those of traditional methods in terms of bone healing and mechanical stability. Despite the lower surgical complexity and potential time-saving benefits of this treatment, further research is needed to confirm its efficacy.
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Aleaciones , Estudios de Factibilidad , Fracturas del Fémur , Fracturas Periprotésicas , Animales , Perros , Fracturas del Fémur/cirugía , Fracturas del Fémur/diagnóstico por imagen , Proyectos Piloto , Fracturas Periprotésicas/cirugía , Modelos Animales de Enfermedad , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiologíaRESUMEN
OBJECTIVE: Delayed fracture healing is a common complication of fractures that significantly impacts human health. This study aimed to explore the role of LINC00339 (lncRNA) in delayed fracture healing to provide new directions for its treatment. METHODS: This study included 82 patients with fractures healing in a normal manner and 90 patients experiencing delayed fracture healing. Levels of LINC00339, miR-16-5p, and osteogenic marker-related mRNAs were measured using RT-qPCR. The predictive potential of LINC00339 for delayed fracture healing was validated using ROC curve analysis. The interaction between LINC00339 and miR-16-5p was validated using dual-luciferase reporter assays and RIP experiments. CCK-8 was used to assess cell proliferation, and apoptosis rates were measured by flow cytometry. RESULTS: LINC00339 was significantly upregulated in delayed fracture healing patients and exhibited strong predictive ability for this condition. Overexpression of LINC00339 inhibited osteoblast proliferation, promoted apoptosis, and reduced mRNA levels of osteogenic markers (P < 0.05). miR-16-5p was recognized as a target mRNA of LINC00339, with LINC00339 exerting negative regulation on miR-16-5p, while overexpression of miR-16-5p mitigated the inhibitory effects of LINC00339 on fracture healing (P < 0.05). CONCLUSION: This research indicated that LINC00339 may serve as a diagnostic marker for delayed fracture healing and revealed the function of the LINC00339/miR-16-5p axis on fracture healing by regulating osteoblasts.
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Apoptosis , Proliferación Celular , Curación de Fractura , MicroARNs , ARN Largo no Codificante , Curación de Fractura/genética , Curación de Fractura/fisiología , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , Humanos , MicroARNs/genética , Proliferación Celular/genética , Apoptosis/genética , Masculino , Femenino , Osteoblastos/metabolismo , Osteogénesis/genética , Osteogénesis/fisiología , Persona de Mediana Edad , Adulto , Regulación hacia Arriba , Células CultivadasRESUMEN
OBJECTIVE: Delayed fracture healing increases the suffering of patients. An in-depth investigation of the pathogenesis of delayed fracture healing may offer new direction for the prevention and treatment. METHODS: The study included 63 normal healing tibial fractures and 58 delayed healing tibial fractures patients. Long non-coding RNA (lncRNA)TRPM2-AS, microRNA-545-3p (miR-545-3p), bone morphogenetic protein 2 (Bmp2) mRNA and osteogenic differentiation markers, including runt-related transcription factor 2 (Runx2), osteocalcin (Ocn), and alkaline phosphatase (Alp) mRNA expression were determined by Real-time quantitative reverse transcription-polymerase chain reaction in serum and MC3T3-E1 cells. The prediction potential of TRPM2-AS in delayed healing fracture patients was verified by receiver operating characteristic curves. The binding relationship of TRPM2-AS/miR-545-3p/Bmp2 was evaluated by dual luciferase reporter gene assay. Cell proliferation and apoptosis were detected by CCK-8 and flow cytometry. RESULTS: TRPM2-AS was remarkably down-regulated in patients with delayed fracture healing and could better predict the fracture healing status. TRPM2-AS downregulation inhibited osteogenic markers mRNA expression, restrained proliferation, and promoted apoptosis of MC3T3-E1 cells (p < 0.05). In delayed fracture healing, miR-545-3p was dramatically up-regulated and was negatively regulated by TRPM2-AS. Reducing miR-545-3p eliminate the negative effect of TRPM2-AS down-regulation on osteoblast proliferation and differentiation (p < 0.05). miR-545-3p targets Bmp2, which plays a positive role in osteoblast differentiation (p < 0.05). CONCLUSION: This study found that TRPM2-AS has the potential to be a diagnostic marker for delayed fracture healing and revealed that the TRPM2-AS/miR-545-3p/Bmp2 axis affects fracture healing by regulating osteoblast.
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Proteína Morfogenética Ósea 2 , Curación de Fractura , MicroARNs , Proteína Morfogenética Ósea 2/genética , Proteína Morfogenética Ósea 2/metabolismo , Humanos , MicroARNs/genética , Curación de Fractura/genética , Curación de Fractura/fisiología , Ratones , Animales , ARN Largo no Codificante/genética , Femenino , Masculino , Fracturas de la Tibia/genética , Osteogénesis/genética , Osteogénesis/fisiología , Canales Catiónicos TRPM/genética , Proliferación Celular/genética , Diferenciación Celular/genética , Adulto , Apoptosis/genética , Persona de Mediana Edad , Osteoblastos/metabolismoRESUMEN
OBJECTIVES: This study was conducted to verify the effectiveness of Anterior Support Screw (AS2) for unstable femoral trochanteric fractures. DESIGN: A multicenter, prospective, randomized controlled trial SETTING: This study was conducted across 15 academic medical centers in Japan PATIENTS/PARTICIPANTS: We enrolled 240 cases of femoral trochanteric fractures with posterior crushing and intramedullary displacement of proximal bone fragments across 15 institutions in Japan. INTERVENTION: All patients were subjected to a reduction in which the anterior cortex was brought into contact. The patients were randomly assigned to the anterior support screw group (AS2 group) and the non-screw group (control group). MAIN OUTCOME MEASUREMENTS: Two computed-tomography (CT) scans were taken immediately after surgery and early postoperative period (day 14-21) to investigate the reduction loss rate of the anterior cortex and sliding distances in the early postoperative period. RESULTS: The reduction loss rate was 4.5 % in the AS2 group and 16.8 % in the control group, indicating a significantly lower reduction loss rate in the AS2 group (p = 0.003). The average sliding distance was 1.8 mm in the AS2 group and 2.8 mm in the control group, indicating a significantly shorter sliding distance in the AS2 group (p < 0.0001). CONCLUSION: Adding a screw in front of the intramedullary nail significantly reduces reduction loss, and maintains anterior bony contact. This study also showed that these screws suppress the sliding distance during the postoperative period. LEVEL OF EVIDENCE: Therapeutic Level I.
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Tornillos Óseos , Fijación Intramedular de Fracturas , Fracturas de Cadera , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Anciano , Estudios Prospectivos , Fracturas de Cadera/cirugía , Fracturas de Cadera/diagnóstico por imagen , Resultado del Tratamiento , Anciano de 80 o más Años , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Japón , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Curación de Fractura/fisiología , Persona de Mediana EdadRESUMEN
Recent studies report the overall incidence of distal femur fractures as 8.7/100,000/year. This incidence is expected to rise with high energy motor vehicle collisions and elderly osteoporotic fractures in native and prosthetic knees keep increasing. These fractures are more common in males in the younger age spectrum while females predominate for elderly osteoporotic fractures. Surgical treatment is recommended for these fractures to maintain articular congruity, enable early joint motion and assisted ambulation. Over the last two decades, development of minimally invasive and quadriceps sparing surgical approaches, availability of angle stable implants have helped achieve predictable healing and early return to function in these patients. Currently, laterally positioned locked plate is the implant of choice across all fracture patterns. Retrograde with capital implantation of intramedullary nails with provision for multiplanar distal locking is preferred for extra-articular and partial articular fractures. Even with these advancements, nonunion after distal femur fracture fixation can be as high as 19%. Further recent research has helped us understand the biomechanical limitations and healing problems with lateral locked plate fixation and intramedullary nails. This has lead to development of more robust constructs such as nail-plate and double plate constructs aiming for improved construct strength and to minimise failures. Early results with these combination constructs have shown promise in high risk situations such as fractures with extensive metaphyseal fragmentation, osteoporosis and periprosthetic fractures. These constructs however, run the risk of being over stiff and can inhibit healing if not kept balanced. The ideal stiffness that is needed for fracture healing is not clearly known and current research in this domain has lead to the development of smart implants which are expected to evolve and may help improve clinical results in future.
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Placas Óseas , Fracturas Femorales Distales , Fijación Intramedular de Fracturas , Curación de Fractura , Anciano , Femenino , Humanos , Masculino , Fenómenos Biomecánicos , Clavos Ortopédicos , Fracturas Femorales Distales/fisiopatología , Fracturas Femorales Distales/cirugía , Fijación Interna de Fracturas/métodos , Fijación Intramedular de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/fisiopatología , Resultado del TratamientoRESUMEN
INTRODUCTION: In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection. MATERIAL AND METHODS: This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views. RESULTS: Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003). CONCLUSION: This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.
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Curación de Fractura , Fracturas de la Tibia , Humanos , Masculino , Femenino , Curación de Fractura/fisiología , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/fisiopatología , Fracturas de la Tibia/terapia , Persona de Mediana Edad , Estudios Longitudinales , Resultado del Tratamiento , Adulto , Fracturas no Consolidadas/terapia , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/fisiopatología , Geles , Trasplante Autólogo , Plaquetas , Anciano , Trasplante de Médula Ósea/métodos , Plasma Rico en PlaquetasRESUMEN
BACKGROUND: Talar neck non-unions result in significant hindfoot deformity and morbidity and are infrequently reported in the literature. The optimal surgical management for this condition is evolving, with various authors reporting the results of open reduction and internal fixation (ORIF) with bone grafting (BG), ankle fusion and modified Blair fusion. We performed this study to report the clinical and radiological outcomes of a cohort of talar neck non-unions managed by ankle joint preserving reconstruction. METHODS: This was an ambispective study which included 8 patients (7 male and 1 female) with talar neck non-unions. All patients underwent ORIF+BG through dual approaches. Additional medial malleolar osteotomy was done in 2 cases, and calcaneofibular split approach to the subtalar joint in 3. Adjunct subtalar fusion was done in 5 cases. Clinical and radiological evaluation was performed pre- and post-operatively. Functional outcomes were assessed by the Manchester Oxford Foot Questionnaire (MOxFQ). RESULTS: The mean age of patients 32.3 ± 13.1 years. The mean surgical delay was 4.1 ± 1.7 months. As per Zwipp and Rammelt classification of post-traumatic talar deformities, 5 cases were classified as Type 3, 2 were Type 4, and 1 was Type 1. Union was achieved in 7 cases at a mean of 3.4 ± 1.3 months. One case had progressive collapse, which was managed by pantalar arthrodesis. All 3 cases where subtalar fusion was not performed primarily demonstrated subtalar arthrosis, but none required a secondary subtalar fusion. The MOxFQ score from 61.1 ± 10.1 to 41 ± 14.1 postoperatively (P = 0.005). The mean follow-up was 14.6 ± 6.8 months. CONCLUSION: ORIF+BG of the talar neck, with or without subtalar fusion has the potential to achieve solid union, correct the hindfoot deformity and improve functional outcomes. However, larger studies with longer follow-up are needed to evaluate the long-term efficacy of this procedure.
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Articulación del Tobillo , Trasplante Óseo , Fijación Interna de Fracturas , Fracturas no Consolidadas , Radiografía , Astrágalo , Humanos , Masculino , Femenino , Adulto , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Trasplante Óseo/métodos , Artrodesis/métodos , Osteotomía/métodos , Persona de Mediana Edad , Adulto Joven , Curación de Fractura/fisiología , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Rango del Movimiento Articular , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagenRESUMEN
BACKGROUND AND OBJECTIVE: Intra capsular fracture of the neck of femur (FNF) treated traditionally with a dynamic hip screw (DHS) or three cancellous screws (3CS) has a high incidence of complications with reoperation rates between 20 % and 45 %. We hypothesized that FNF unites by primary healing. Therefore, intra-operative compression and absolute stability post-operatively until healing are essential. We postulated that FNF requires 2 types of implants- those which provide absolute stability for young patients with good bone stock and another with sliding mechanism for elderly patients with osteoporosis. We developed three novel fixation systems at our research institute in India using a modified DHS. In patients with good bone stock, locking DHS, called LHS and GSK triangular system (GSKT) provided intra-operative compression and absolute stability during the post-operative period. In those with poor bone stock, the controlled sliding DHS (CSDHS)was used as a locking implant might penetrate the hip joint. MATERIALS AND METHOD: 42 patients of FNF <55 years of age were studied. Among 39 patients with good bone stock, LHS was used in five patients and GSKT system was used in 34 patients. CSDHS was used in three patients with poor bone stock or communition. The patients were followed up for a minimum of eight months up to a maximum of two years, with the average follow up duration of 14 months. RESULTS: 32 out of 34 fractures treated by GSKT system united. Five cases managed by LHS and three by CSDHS, all united. The union rate was 95.2 %. Of the two failed cases, one patient had nonunion (NU), the other had deep infection. Avascular necrosis of the head (AVN) was detected in three patients treated with GSKT system in the second year following surgery. Two of them had hip pain while one was asymptomatic. Eight cases of FNF Pauwels type III underwent a primary valgus osteotomy. All of them united without complications. CONCLUSION: In patients with good bone stock, LHS and GSKT system allowed intra-operative compression and absolute post-operative stability without sliding of head fragment as the triangle construct is biomechanically the strongest. When bones are osteoporotic, a CSDHS provided controlled sliding (1 to 5 mm only). This pilot study showed a promising success rate of 95.2 %. We propose that the GSKT system may be used to treat intertrochanteric and other metaphyseal fractures as well. Further biomechanical studies are underway to strenghten the evidence needed for the widespread use of these implants.
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Tornillos Óseos , Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Curación de Fractura , Humanos , Fracturas del Cuello Femoral/cirugía , Proyectos Piloto , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto , Curación de Fractura/fisiología , India/epidemiologíaRESUMEN
This study proposes a computational framework to investigate the multi-stage process of fracture healing in hard tissues, e.g., long bone, based on the mathematical Bailon-Plaza and Van der Meulen formulation. The goal is to explore the influence of critical biological factors by employing the finite element method for more realistic configurations. The model integrates a set of variables, including cell densities, growth factors, and extracellular matrix contents, managed by a coupled system of partial differential equations. A weak finite element formulation is introduced to enhance the numerical robustness for coarser mesh grids, complex geometries, and more accurate boundary conditions. This formulation is less sensitive to mesh quality and converges smoothly with mesh refinement, exhibiting superior numerical stability compared to previously available strong-form solutions. The model accurately reproduces various stages of healing, including soft cartilage callus formation, endochondral and intramembranous ossification, and hard bony callus development for various sizes of fracture gap. Model predictions align with the existing research and are logically coherent with the available experimental data. The developed multiphysics simulation clarifies the coordination of cellular dynamics, extracellular matrix alterations, and signaling growth factors during fracture healing.
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Análisis de Elementos Finitos , Curación de Fractura , Modelos Biológicos , Curación de Fractura/fisiología , Humanos , Simulación por Computador , Matriz Extracelular , Fracturas Óseas/fisiopatología , AnimalesRESUMEN
UPDATE: This article was updated on September 4, 2024 because of a previous error, which was discovered after the preliminary version of the article was posted online. In the Note listing the members of the Wrist and Elbow Research Group of Canada, the text that had read "Thomas T. Goetz, MD, FRCSC" now reads "Thomas J. Goetz, MD, FRCSC". BACKGROUND: The primary goal after open reduction and internal fixation of an established scaphoid nonunion is to achieve union. Low-intensity pulsed ultrasound (LIPUS) has been reported to increase the rate of union and to decrease the time to union for multiple fractures and nonunions in clinical and animal models. The evidence for LIPUS in the treatment of scaphoid nonunion, however, is sparse. The aim of this study was to assess whether active LIPUS (relative to sham LIPUS) accelerates the time to union following surgery for scaphoid nonunion. METHODS: Adults with a scaphoid nonunion indicated for surgery were recruited for a multicenter, prospective, double-blinded randomized controlled trial. After surgery, patients self-administered activated or sham LIPUS units beginning at their first postoperative visit. The primary outcome was the time to union on serial computed tomography (CT) scans starting 6 to 8 weeks postoperatively. Secondary outcomes included patient-reported outcome measures, range of motion, and grip strength. RESULTS: A total of 142 subjects completed the study (69 in the active LIPUS group and 73 in the sham group). The average age was 27 years, and the cohort was 88% male. There was no difference in time to union (p = 0.854; hazard ratio, 0.965; 95% confidence interval, 0.663 to 1.405). Likewise, there were no differences between the active LIPUS and sham groups with respect to any of the secondary outcomes, except for wrist flexion at baseline (p = 0.008) and at final follow-up (p = 0.043). CONCLUSIONS: Treatment with LIPUS had no effect on reducing time to union in patients who underwent surgical fixation of established scaphoid nonunions. LEVEL OF EVIDENCE: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Fracturas no Consolidadas , Hueso Escafoides , Terapia por Ultrasonido , Humanos , Hueso Escafoides/lesiones , Hueso Escafoides/cirugía , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/terapia , Masculino , Adulto , Femenino , Terapia por Ultrasonido/métodos , Método Doble Ciego , Estudios Prospectivos , Curación de Fractura/fisiología , Fijación Interna de Fracturas/métodos , Adulto Joven , Persona de Mediana Edad , Resultado del Tratamiento , Ondas UltrasónicasRESUMEN
PURPOSE: To assess the use of bone marrow aspirate (BM) and bone marrow aspirate concentrate (BMAC) in the treatment of long-bone nonunion and to understand mechanism of action. METHODS: A systematic review of PubMed and EBSCOHost was completed to identify studies that investigated the use of BM or BMAC for the diagnosis of delayed union and/or nonunion of long-bone fractures. Studies of isolated bone marrow-mesenchymal stem cells (BM-MSCs) and use in non-long-bone fractures were excluded. Statistical analysis was confounded by heterogeneous fracture fixation methods, treatment history, and scaffold use. RESULTS: Our initial search yielded 430 publications, which was screened down to 25 studies. Successful treatment in aseptic nonunion was reported at 79-100% (BM) and 50-100% (BMAC). Septic nonunion rates were slightly better at 73-100% (BM) and 83.3-100% (BMAC). 18/24 studies report union rates > 80%. One study reports successful treatment of septic nonunion with BMAC and no antibiotics. A separate study reported a significant reduction in autograft reinfection rate when combined with BMAC (P = 0.009). Major adverse events include two deep infections at injection site and one case of heterotopic ossification. Most studies note transient mild donor site discomfort and potential injection site discomfort attributed to needle size. CONCLUSION: The current literature pertaining to use of BM/BMAC for nonunion is extremely heterogeneous in terms of patient population and concomitant treatment modalities. While results are promising for use of BM/BMAC with other gold standard treatment methodologies, the literature requires additional Level I data to clarify the impact of role BM/BMAC in treating nonunion when used alone and in combination with other modalities. LEVEL OF EVIDENCE: Level III.
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Trasplante de Médula Ósea , Fracturas no Consolidadas , Humanos , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/terapia , Trasplante de Médula Ósea/métodos , Curación de Fractura/fisiologíaRESUMEN
BACKGROUND: Arthroscopy-assisted closed reduction and percutaneous internal fixation is a minimally invasive technique for medial malleolus fracture treatment. The purpose of the study was to assess the quality and functional outcomes of this technique. METHODS: Seventy-eight patients with combined medial malleolus fractures were treated with arthroscopy-assisted closed reduction and percutaneous screw fixation technique. The surgical procedure was described in detail; the clinical efficacy of this method was evaluated in terms of time of operation, postoperative complications, and fracture healing time; and functional outcomes were analyzed. RESULTS: All of the patients were followed up for a minimum of 12 months without complications of the medial malleolus wound, and all of the medial malleolus fractures healed within 6 to 8 weeks. At the last follow-up, the visual analog scale scores ranged from 0 to 3 and the American Orthopaedic Foot and Ankle Society ankle and hindfoot function scores ranged from 75 to 95. CONCLUSIONS: Arthroscopy-assisted closed reduction and percutaneous internal fixation makes the treatment of medial malleolus fractures less invasive compared with traditional surgical methods and allows simultaneous exploration and management of the articular surface.
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Fracturas de Tobillo , Artroscopía , Fijación Interna de Fracturas , Humanos , Artroscopía/métodos , Fijación Interna de Fracturas/métodos , Masculino , Fracturas de Tobillo/cirugía , Femenino , Adulto , Persona de Mediana Edad , Tornillos Óseos , Resultado del Tratamiento , Curación de Fractura/fisiología , Adulto Joven , Estudios Retrospectivos , Reducción Cerrada/métodos , Anciano , Estudios de Seguimiento , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
The humeral bone is subject to torsional forces. In case of displaced shaft fractures, internal fixation remains the standard of care. This retrospective two-center study assessed the fracture union rate and complications after dual 3.5 mm locking compression plate (LCP) fixation using an anterolateral approach. Over a 9-year period, 38 patients underwent surgery in two centers. They had a mean age of 53.7 years (15-97, ± standard deviation (SD) 26) and there were three open fracture cases (7.9 %). The dominant side was affected in 21 cases (55.3 %) and there were 11 polytrauma patients (29 %). Mean operative time was 78 min (40-124, ± 19.8 SD). Patients were treated with dual 3.5 mm LCP fixation (6 screws on either side of the fracture line, anterolateral approach without a tourniquet). The first two orthogonal views showing at least 3 cortical bridges out of 4 determined fracture healing, as assessed by two independent raters. Pre- and postoperative complications were tabulated. Clinical outcomes included range of motion (ROM) and return to activities, while functional outcomes were assessed with the Disability of the Arm Shoulder and Hand (DASH), the Constant score, the Subjective Shoulder Score (SSV) and the Mayo Elbow Performance Score (MEPS). Minimum follow-up was 1 year. Four patients were given a shoulder immobilizer to wear for 3 weeks; immediate mobilization was the standard of care for the other patients. Fracture union was achieved in all cases within a mean of 11.7 weeks (6-28 ± 7.1 SD) without any heterotopic ossification of the brachialis muscle. There were eight patients with preoperative radial nerve palsy and two cases of postoperative palsy. There was one surgical site infection (2.6 %). Return to work for active patients was possible in 87 % of cases within a mean of 23 weeks (6-72 ± 11 SD). The Constant score was 84.6 (35-100, ± 13.4 SD), the SSV score was 80.7 (60-100, ± 8.2 SD), the DASH score was 13.5 (0-38.3, ± 8.8 SD) and the MEPS score was 85 (55-100, ± 11.9 SD). Traditional fixation methods provide little control over torsional forces, leading to non-union rates between 3 % and 12 % and delayed union (12 to 20 weeks). The simplicity of the technique described here, and the short operative time, may help explain the low infection rate. Dual plate fixation makes it possible to use more screws and allows nerve exploration and decompression in case of preoperative nerve palsy. Dual plate fixation to treat humeral shaft fractures is a simple and reliable technique.
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Placas Óseas , Fijación Interna de Fracturas , Curación de Fractura , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Masculino , Persona de Mediana Edad , Femenino , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Estudios Retrospectivos , Fracturas del Húmero/cirugía , Adulto , Anciano , Resultado del Tratamiento , Curación de Fractura/fisiología , Anciano de 80 o más Años , Complicaciones Posoperatorias , Adolescente , Adulto Joven , Radiografía , Tornillos ÓseosRESUMEN
INTRODUCTION: Treatment of proximal tibial fractures is known to be difficult. We report our own experience of the treatment of these fractures and evaluate our results. The hypothesis was that the clinical and radiological results were good. MATERIAL AND METHOD: From January 2004 to October 2008, fourteen AO-type 41A2-3 and C1 fractures have been treated with a LCP locking plate (8 women and 6 men, average age 60.42). Plating was performed either with an open approach or a minimal invasive approach. Clinical and radiological follow-up was carried out looking for range of motion of the knee joint and autonomy level. RESULTS: Mean follow-up was 32.63 months (12-70). Range of motion was maintained with a mean arch of 117.5° Autonomy was maintained in all cases. Professional, domestic and sports activities were unchanged. No infection or general complication occurred. Bone fusion was obtained in all cases after an average of 13.28 weeks. 6° of valgus deformation, already seen immediately postoperatively was observed once. Secondary displacement was observed in 6 cases, with an average of 2.83° DISCUSSION-CONCLUSION: We report good radiological results, with only one initial malalignment. The hypothesis was confirmed. However, X-ray analysis at consolidation shows 6 secondary displacements, without any satisfactory explanation. Though the clinical consequences of these malunions are minimal. Osteosynthesis with plate, in the sight of this study, yields good clinical results. Radiological evolution concerning the evolution of bone axes puts the emphasis on careful operative technique and adequate time to weight bearing. LEVEL OF EVIDENCE: retrospective study, IV.
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Placas Óseas , Fijación Interna de Fracturas , Radiografía , Rango del Movimiento Articular , Fracturas de la Tibia , Humanos , Masculino , Femenino , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/fisiopatología , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Estudios de Seguimiento , Adulto , Curación de Fractura/fisiología , Estudios Retrospectivos , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatologíaRESUMEN
CONTEXT: Minimally invasive (MI) approaches are purported to present advantages for osteosynthesis when compared with conventional approaches. This study aimed to compare the medium-term clinical and radiological outcomes of patients with proximal humerus fractures treated by plate osteosynthesis with conventional and MI superolateral approaches. METHOD: The study carried out was a retrospective monocentric comparative analysis. Forty-three cases were followed up - 18 were treated with an MI approach and 25 with a conventional approach. Constant-Murley, DASH and SSV scores were established and standard complications were investigated. RESULTS: No significant differences in functional scores or complications were found between the 2 groups. The only significant difference was for pain which was significantly lower for the MI group. The overall revision rate was 18.3 %. The mean adjusted Constant-Murley for the entire population was 80.1 ± 20.2; the mean DASH score was 17.8 ± 15.9 and the mean SSV was 73.2 ± 19.5. CONCLUSION: This study did not demonstrate any significant differences between the 2 approaches. Given the low patient population in our series, the superiority of the MI approach - as indicated in the literature - was not proven.
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Placas Óseas , Fijación Interna de Fracturas , Procedimientos Quirúrgicos Mínimamente Invasivos , Fracturas del Hombro , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Estudios Retrospectivos , Fracturas del Hombro/cirugía , Fracturas del Hombro/diagnóstico por imagen , Masculino , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Anciano , Rango del Movimiento Articular , Adulto , Radiografía , Curación de Fractura/fisiología , Estudios de Seguimiento , Anciano de 80 o más AñosRESUMEN
Isolated fractures of the distal fibula mainly affect young, active people. In most cases, fixation is by open reduction with or without casting for six weeks without weight bearing. The current trend is to reduce this period of non-weight-bearing in order to promote earlier functional rehabilitation. The improved mechanical stability resulting from the use of plates with locking screws has changed the postoperative management of many fractures, but there is little evidence for the ankle. Between October 2013 and August 2015, 36 patients were enrolled in a prospective study to evaluate the performance of internal fixation of isolated distal fibular fractures using a lateral anatomically contoured titanium locking plate (InitialA® plate from Newclip Technics, Haute Goulaine, France) with immediate mobilisation and full weight bearing. No patient required further surgery due to mechanical failure or non-union. The bone healing rate was 100 % at 3 months. Two patients had septic complications requiring plate removal and antibiotic treatment and were eventually cured. The use of anatomically contoured locking plates provides strong and stable fixation, allowing immediate full weight-bearing. Such a technique has the advantage of a short recovery time and an early return to work without additional complications.
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Placas Óseas , Peroné , Fijación Interna de Fracturas , Curación de Fractura , Soporte de Peso , Humanos , Soporte de Peso/fisiología , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Peroné/lesiones , Peroné/cirugía , Masculino , Femenino , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Curación de Fractura/fisiología , Resultado del Tratamiento , Anciano , Tornillos Óseos , Fracturas Óseas/cirugía , Adulto Joven , Recuperación de la FunciónRESUMEN
OBJECTIVE: Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot. INDICATIONS: A. Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (>â¯3â¯mm, >â¯10° dislocation). B. Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte type III). CONTRAINDICATIONS: High grade soft tissue damage or infection at the implant insertion site. SURGICAL TECHNIQUE: A. Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B. Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction. POSTOPERATIVE MANAGEMENT: A. Mobilization with partial weight bearing (20â¯kg) for 6 weeks wearing a stiff sole; implant removal under local anesthesia after 6-8 weeks, followed by a free range of movement and weight-bearing as tolerated (WBAT). B. Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6 weeks, implant removal optional. RESULTS: A. Antegrade nailing of subcapital and shaft fractures of metatarsals II-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B. According to current literature, intramedullary screw osteosynthesis of proximal metatarsal V fractures of zone II and III according to Lawrence and Botte leads to faster bony healing with a lower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.
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Fijación Intramedular de Fracturas , Fracturas Óseas , Huesos Metatarsianos , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Resultado del Tratamiento , Masculino , Femenino , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Adulto , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Traumatismos de los Pies/cirugía , Traumatismos de los Pies/diagnóstico por imagen , Tornillos Óseos , Curación de Fractura/fisiología , Hilos OrtopédicosRESUMEN
OBJECTIVE: Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non-union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing. METHODS: Patients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (-1024 HU-3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X-rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2. RESULTS: A total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra2 = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05). CONCLUSION: The induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique.