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Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Of the 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success. [ABSTRACT FROM AUTHOR]

The combination of plate and intramedullary nailing has been established as the treatment of proximal tibial fractures. Nevertheless, at the distal end of the tibia, the application of the plate-assisted intramedullary nailing is rarely applied as a therapeutic technique. This technical note demonstrates the use of the reduction plating technique for nail insertion as the management of distal tibia fractures. [ABSTRACT FROM AUTHOR]

Abstract Background Bone adhesives have been on the forefront of orthopedic surgery research for decades due to the potential benefit they may have in fracture management. Current publications and research being conducted on bone adhesive could be applied to our current hypothesis for the benefit of a novel minimally invasive treatment option for a select cohort of fractures, Jones fractures. The select fracture’s gold standard of treatment would be nonoperative, but with risk of complications including nonunion and delayed union. Presentation of hypothesis We hypothesize that percutaneous application of bone adhesive will provide an additional treatment option for fracture patterns that do not require operative fixation, but would benefit from additional stability. The primary outcome measures would be (1) duration of time required for bony consolidation (defined as 3 of 4 bridging cortices) and (2) duration of absenteeism (inability to work), and pain levels within the first week after the procedure. Secondary outcome measures would be the incidence of nonunion or delayed union. We hypothesize that the select bone adhesive would accelerate bony consolidation, decrease absenteeism, decrease pain levels within the first week after procedure, and decrease the incidence of delayed union and/or nonunion. Testing of hypothesis We propose a prospective multicenter, randomized, and open label trial clinical trial to test the bone adhesive via percutaneous injection into acute non-displaced or minimally displaced Jones fractures. Implications of hypothesis Bone adhesives are a new frontier in treatment of fractures, currently in laboratory and animal testing phases. The appropriate bone adhesive formula has not been approved for clinical trial use, but the implications of the bone adhesive may go beyond decreased complications and ease of stabilizing a select cohort of closed fractures. With the injectable compound illustrated (Fig. 1), the adhesive could be applied percutaneously in hopes of achieving improved outcomes compared to non-operative treatment. The overall goal of the clinical trial is to provide patients a safe treatment option for improved bone union rates of nonoperative fractures compared to the current gold standard management of the same fracture with earlier pain control, early bony consolidation and lower risk of delayed union/nonunion. The ideal patient population for use of a percutaneous bone adhesive in future studies would be for those with multiple medical comorbidities for whom surgical risks outweigh the benefits, in addition to patients at high risk for nonunion based on fracture pattern or systemic biology.

BACKGROUND: Gutta-percha has low yield strength and shows hard and tough mechanical properties. On this basis, a sports protective gear that can be freely shaped according to the body shape has been developed, and it has been preliminarily confirmed that this performance can reduce the damage to athletes caused by external impact forces. OBJECTIVE: To evaluate the effect of gutta-percha splint on fracture fixation. METHODS: Thirty-five adult male New Zealand rabbits were used to establish closed fracture models of the left tibia by the modified three-point stress method. Totally 30 successful models were randomly divided into two groups (n=15) and fixed with gutta-percha splint and gypsum, respectively. The effects of the two external fixation methods were compared by X-ray imaging and fracture healing was observed at 2 hours, 4 and 6 weeks after fixation. After 6 weeks of fixation, the tibia specimens were observed for gross and histological morphology. RESULTS AND CONCLUSION: (1) X-ray films: Clear fracture line was seen 2 hours after fixation, without obvious periosteal reaction. After 4 weeks, the fracture line became blurred, and a large area of spindle low-density callus shadow was seen at the broken end. After 6 weeks, the fracture line nearly disappeared; the callus connected together to form a cortical bone bridge, and the bone marrow cavity was partially canalized, and partially close to recanalization. After 6 weeks, gray value at the fracture site was higher in the gutta-percha splint group than that in the gypsum group (P < 0.05). (2) General observation: In the gutta-percha splint group, except for three rabbits with malunion, the fracture line of the rest of the rabbits basically disappeared; part of the outer callus was absorbed, and the cortical bone density was close to the normal level. In the gypsum group, except for four rabbits with malunion, the fracture line of the rest of the rabbits disappeared, a small part of the outer callus was absorbed, and the cortical bone density was close to the normal level. (3) Histological morphology: In the gutta-percha splint group, new bone trabeculae were thick; the trabecular space was reduced and fused to form lamellar bone, and the medullary cavity had been partially recanalized. In the gypsum group, new bone trabeculae were reticular, forming a woven bone, and a large number of transected small arteries, veins and capillaries could be seen in the medullary cavity. (4) Complications: Within 6 weeks of fixation, the extremity swelling, purple darkening, displacement and malunion, and the number of local pressure ulcers in the gutta-percha splint group tended to be less than those in the gypsum group, but there was no significant difference in statistical analysis (P > 0.05). (5) The results showed that gutta-percha splint could play a similar fixation effect to plaster on the rabbit model of closed tibial fracture. [ABSTRACT FROM AUTHOR]

Background: Bone adhesives have been on the forefront of orthopedic surgery research for decades due to the potential benefit they may have in fracture management. Current publications and research being conducted on bone adhesive could be applied to our current hypothesis for the benefit of a novel minimally invasive treatment option for a select cohort of fractures, Jones fractures. The select fracture's gold standard of treatment would be nonoperative, but with risk of complications including nonunion and delayed union. Presentation of hypothesis: We hypothesize that percutaneous application of bone adhesive will provide an additional treatment option for fracture patterns that do not require operative fixation, but would benefit from additional stability. The primary outcome measures would be (1) duration of time required for bony consolidation (defined as 3 of 4 bridging cortices) and (2) duration of absenteeism (inability to work), and pain levels within the first week after the procedure. Secondary outcome measures would be the incidence of nonunion or delayed union. We hypothesize that the select bone adhesive would accelerate bony consolidation, decrease absenteeism, decrease pain levels within the first week after procedure, and decrease the incidence of delayed union and/or nonunion. Testing of hypothesis: We propose a prospective multicenter, randomized, and open label trial clinical trial to test the bone adhesive via percutaneous injection into acute non-displaced or minimally displaced Jones fractures. Implications of hypothesis: Bone adhesives are a new frontier in treatment of fractures, currently in laboratory and animal testing phases. The appropriate bone adhesive formula has not been approved for clinical trial use, but the implications of the bone adhesive may go beyond decreased complications and ease of stabilizing a select cohort of closed fractures. With the injectable compound illustrated (Fig. 1), the adhesive could be applied percutaneously in hopes of achieving improved outcomes compared to non-operative treatment. The overall goal of the clinical trial is to provide patients a safe treatment option for improved bone union rates of nonoperative fractures compared to the current gold standard management of the same fracture with earlier pain control, early bony consolidation and lower risk of delayed union/nonunion. The ideal patient population for use of a percutaneous bone adhesive in future studies would be for those with multiple medical comorbidities for whom surgical risks outweigh the benefits, in addition to patients at high risk for nonunion based on fracture pattern or systemic biology. [ABSTRACT FROM AUTHOR]

Abstract Background To determine an optimized treatment protocol during the COVID-19 epidemic for patients with closed fracture and delayed surgery. Methods The epidemic data of three hospitals, randomly selected from different administrative regions of Wuhan, were analyzed retrospectively from 23 January to 31 March 2020. Changes in the number of confirmed cases per day (cumulative and new) of each region were tracked as a reflection of changing epidemic risk levels. The risk level map was drawn. The epidemic status, treatment protocols, and treatment efficiencies for patients with closed fracture in the three hospitals were compared. Results Overall, 138 patients with closed fracture were admitted. Each hospital had established its own protocol, according to the initial perceived risk. Based on the risk level map, over the study period, the risk levels of the three regions changed independently and were not in sync. All patients recovered and were timely discharged. No staff member was detected with COVID-19. Conclusions The COVID-19 risk level of each area is dynamic. To optimize medical resources, avoid cross-infection, and improve efficiency, changes in epidemic risk should be monitored. For patients with closed fracture, treatment protocols should be adjusted according to changes in epidemic risk.

Introduction: Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region.Methods: This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region.Inclusion Criteria: Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF.Results: Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26).Conclusion: Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes. [ABSTRACT FROM AUTHOR]

Background: To determine an optimized treatment protocol during the COVID-19 epidemic for patients with closed fracture and delayed surgery.Methods: The epidemic data of three hospitals, randomly selected from different administrative regions of Wuhan, were analyzed retrospectively from 23 January to 31 March 2020. Changes in the number of confirmed cases per day (cumulative and new) of each region were tracked as a reflection of changing epidemic risk levels. The risk level map was drawn. The epidemic status, treatment protocols, and treatment efficiencies for patients with closed fracture in the three hospitals were compared.Results: Overall, 138 patients with closed fracture were admitted. Each hospital had established its own protocol, according to the initial perceived risk. Based on the risk level map, over the study period, the risk levels of the three regions changed independently and were not in sync. All patients recovered and were timely discharged. No staff member was detected with COVID-19.Conclusions: The COVID-19 risk level of each area is dynamic. To optimize medical resources, avoid cross-infection, and improve efficiency, changes in epidemic risk should be monitored. For patients with closed fracture, treatment protocols should be adjusted according to changes in epidemic risk. [ABSTRACT FROM AUTHOR]

Introduction: Much of the emergency medical research on sedation-assisted orthopedic reductions has been undertaken with two physicians—one dedicated to the sedation and one to the procedure. Clinical practice in community emergency departments (EDs), however, often involves only one physician, who both performs the procedure and simultaneously oversees the crendentialed registered nurse who administers the sedation medication and monitors the patient. Although the dual-physician model is advocated by some, evidence in support of its superiority is lacking. Methods: In this electronic health records review we describe sedation-assisted closed reductions of major joints and forearm fractures in three suburban community EDs. The type of procedure and sedation medication, need for specialty assistance, success rates, and intervention-requiring adverse events are reported. Results: During the 18-month study period, procedural sedation was performed 457 times on 442 patients undergoing closed reduction for shoulder dislocations (n=111), elbow dislocations (n=29), hip dislocations (n=101), and forearm fractures (n=201).  In the vast majority of this cohort (98.4% [435/442]), a single emergency physician simultaneously managed both the procedural sedation and the initial orthopedic reduction without the assistance of a second physician. The reduction was successful or satisfactory in 96.6% (425/435; 95% confidence interval [CI], 95.8-98.8%) of these cases, with a low incidence of intervention-requiring adverse events (2.8% [12/435]; 95% CI, 1.5-4.8%).Conclusion: Sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely in the ED using a one physician/one nurse model. A policy that requires a separate physician (or nurse anesthetist) to administer medications for all sedation-assisted ED procedures appears unwarranted. Further research is needed to determine which specific clinical scenarios might benefit from a dual-physician approach. [West J Emerg Med.2013;14(1):47-54.]

Objective: To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures., Methods: A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups ( P >0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups., Results: All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group ( P <0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups ( P >0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points ( P <0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation ( P >0.05)., Conclusion: Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.

Necrotizing soft tissue infections (NSTIs), characterized by extensive soft tissue destruction, are rare but life-threatening. We present a case of a NSTI in a healthy 65-year-old woman following a closed distal radius fracture. The patient presented with severe pain, fever, and lethargy 4 days after her index injury, with physical examination of the right upper limb revealing erythema and swelling to the mid-humeral level and blisters of the fingers and hand. Multiple surgical debridements were required to control the infection, which was caused by Streptococcus pyogenes . This case highlights the rapid progression and devastating consequences of NSTI, which can occur even in the setting of closed injuries in patients without comorbidities. Prompt diagnosis, early surgical intervention, and appropriate antimicrobial therapy are crucial in managing this pathology. Level of Evidence: Level 5., Competing Interests: Statement of Human and Animal RightsThere are no conflicts regarding human and animal rights with respect to this manuscript. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Surgically-managed fractures, particularly open fractures, are associated with high rates of surgical site infections (SSIs). To reduce the risk of an SSI, orthopaedic surgeons routinely clean open fracture wounds in the emergency department (ED) and then apply a bandage to the open wound. Prior to the surgical incision, it is standard practice to prepare the fracture region with an antiseptic skin solution as an additional SSI prevention strategy. Multiple antiseptic solutions are available. Objectives To explore the variation in practice patterns among orthopaedic surgeons regarding antiseptic solution use in the ED and antiseptic preparatory techniques for fracture surgery. Methods We developed a 27-item survey and surveyed members of several orthopaedic associations. Results Two hundred and-ten surveys were completed. 71.0% of respondents irrigate the open wound and skin in the ED, primarily with saline alone (59.7%) or iodine-based solutions (32.9%). 90.5% of responders indicated that they dress the open wound in the ED, with 41.0% applying a saline-soaked bandage and 33.7% applying an iodine-soaked dressing (33.7%). In their surgical preparation of open fractures, 41.0% of respondents used an iodine-based solution, 26.7% used a chlorhexidine gluconate (CHG)-based solution, and 31.4% used a combination of the two. In closed fractures, 43.8% of respondents used a CHG-based solution, 28.1% used an iodine-based solution, and 27.1% used a combination. Despite theoretical concerns about the use of alcohol in open wounds, 51.4% used alcohol-based solutions or alcohol alone during skin preparation of open fractures. Conclusions A lack of consensus exists regarding use of antiseptic surgical preparation solutions for fractures. High-quality clinical research is needed to assess the effectiveness of different surgical antiseptic preparation solutions on patient outcomes in fracture populations.

Aim: To evaluate the effect of the treatment of locked intramedullary nails in adult patients with tibia diaphysis fractures. Patients and Methods: Forty-eight adults that were treated with reamed locked intramedullary nails for tibia shaft fractures were evaluated. 27 of the patients were male (56,25%) and 21 were women (43,75%). Mean age was 42,6(18-59). 29 of the fracture were right leg and 19 were left. There wasn’t any patient that had bilateral tibia shaft fracture. AO fracture classification system was used and every patient except 2 had concurrent fibula fracture. Patients’ injury mechanism, date of referral, date of operation, time of bne union (seeing 3 cortices bridging at X-ray), time to return to work, malalignment and joint range of motion were evaluated. Results: We found that mean union time was 14,2 weeks and mean time to return to work was 18,4 weeks. Out of 10 open fracture patients; 1 had superficial infection, 2 had pseudarthrosis, 1 had delayed union. Distal locking screw breaking occurred at 4 patients. Bone union time was delayed for 22 months at patient that had superficial infection. Patient was treated by providing dynamizition and giving antibiotics. Conclusions: We came to the conclusion that reamed locked intramedullary nails have high success rates, low complication rates, better functional results and provides rapid return to work; therefore, being a suitable surgical method it is still accepted as gold standard treatment.

Background: Severe musculoskeletal trauma can trigger an inflammatory response, and an excessive inflammatory response can lead to systemic inflammatory response syndrome and multiorgan failure. High-mobility group box 1 (HMGB1) is an early mediator pro-inflammatory cytokine in sterile injuries and a late cytokine mediator in infection and sepsis. Previous research has shown that administration of systemic lidocaine can inhibit HMGB1 expression in macrophages of septic rats. The aim of this study was to demonstrate the efficacy of systemic lidocaine to inhibit HMGB1 mRNA and protein in a BALB/c mouse model of sterile inflammation due to closed fracture musculoskeletal injury. Materials and Methods: Twenty adult male BALB/c mice were divided into lidocaine and control groups. The closed fracture musculoskeletal injury was performed by breaking the left thigh bone of the mice. Four hours after undergoing the closed fracture, the lidocaine group was treated with lidocaine intravenous (2 mg/kg). The same volume of distilled water was injected into the control group instead of lidocaine. HMGB1 mRNA expression was examined with real-time polymerase chain reaction, and HMGB1 protein level was determined with enzyme-linked immunosorbent assay. Results: The expression of HMGB1 mRNA and protein levels in mice that sustained inflammation due to a closed fracture musculoskeletal injury was significantly decreased in the lidocaine group (P < 0.00 and P < 0.00 for mRNA and protein, respectively). Conclusions: Intravenous administration of lidocaine effectively inhibited the inflammatory process in BALB/c mice that underwent closed fracture musculoskeletal injury by suppressing HMGB1 mRNA transcription and HMGB1 protein translation.

• The incidence of closed infected fracture is rare. • Any patient can become infected even with closed fracture and despite being an immunocompetent host. • In this patient, the risk factors of closed infected tibial plateau fracture are subdural hematoma and multiple skin abrasions. • Any sign of surgical site infection with sepsis is an indication perform, the surgeon should operate to irrigation and debridement. Acute hematogenous osteomyelitis in a closed fracture usually occurs pediatric and/or immunocompromised patients and only rarely in an immunocompetent patient. We report the case of a 44-year-old female patient who was diagnosed as acute hematogenous osteomyelitis in a tibial plateau fracture. Following a motorcycle accident she was diagnosed as having a subdural hematoma at the right parietal lobe and combined closed fracture of the left tibial plateau and avulsion of tibial tubercle. Intraoperatively a cloudy fluid was found at the fracture site of left tibial plateau that was cultured and grew Staphylococcus aureus. The risk factors for acute hematogenous osteomyelitis in a closed fracture of this patient were the subdural hematoma and multiple abrasion wounds around her left knee. Not only open fractures have a risk of acute hematogenous osteomyelitis but closed fractures also have a chance of developing this infection. The surgeon should be concerned about this type of infection if the patient has risk factors such as evidence of head injury or multiple abrasion wounds. [ABSTRACT FROM AUTHOR]

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Introduction: Kirschner Wires (K-wires) are widely used in orthopaedic procedures. The most common complication of K-wire fixation is pin site infection. There are only few studies which compare the infection rate between buried and unburied K-wires and there is no consensus regarding whether the K-wires should be buried under the skin or left unburied after fracture fixation, to reduce the chance of post operative infection. While some advocate there is definite advantage of burying K-wires in terms of post operative pin site infection, some studies have shown that the infection rate is similar in both the groups. Aim: To determine whether there is a difference in the incidence of pin site infection between buried and unburied K-wire fixation techniques of fracture fixation. Materials and Methods: A multi centric retrospective, cohort study in two tertiary care centres in Puducherry, in patients who underwent K-wire fixations for various fractures in upper limbs and lower limbs during the time period between January 2010 to August 2017. Data were retrieved from medical records and radiology archives. Results: A total of 474 patients were included in the present study. Their median age was 32 years (range: 2-87 years), 409 (86%) were males and 65 (14%) were females. Surgeons buried K-wires in 141 patients and left K-wires unburied in 333 patients. Overall, post operative infection rates were lower in buried K-wire fixation compared to unburied K-wire fixation. However, the difference was not statistically significant. In the sub analysis of closed fractures, infection rates were significantly lower in the buried K-wire technique compared to unburied K-wire technique. Among open fractures, post operative infection rates were not significantly different between these two groups. Conclusion: Significant lower infection in buried K-wire fixations compared to unburied K-wire fixations in closed fractures. Hence, we recommend that K-wires should be kept buried after fracture fixation in closed fractures.

Background: The speed and degree of functional recovery over time after surgery for tibial shaft fracture has been previously described using subjective methods.Questions/Purpose: This study aimed to quantitatively measure recovery of isokinetic strength in the injured leg after surgical repair of isolated closed tibial shaft fracture.Methods: In this prospective case series, patients were recruited after intramedullary nailing for isolated closed tibial shaft fracture at an academic medical center from January 2012 to December 2015. Recovery of isokinetic strength was quantified using an isokinetic dynamometer. Eight measures of isokinetic strength at 3, 6, and 12 months’ follow-up were used to compare strength in the injured leg to the healthy leg.Results: In 36 patients recruited, there was a significant difference in strength between the healthy and injured legs at 3 months for seven of the eight metrics used, at 6 months for five of the eight metrics, and at 12 months for none of the eight metrics. Observing recovery of strength longitudinally, we saw significant improvement between 3 and 6 months for four of eight metrics and overall between 3 and 12 months for five of the eight metrics. All four metrics that showed a significant improvement between 3 and 6 months involved plantar flexion. No metrics showed significant improvement between 6 and 12 months.Conclusions: Patients exhibited equal strength between their healthy and injured legs at 12 months after surgery. Improvement in strength occurred to a greater extent between 3 and 6 months after surgery than between 6 and 12 months. Plantar flexion appeared to improve more rapidly than dorsal extension. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture., Methods: The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation., Results: Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing., Conclusion: The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A closed fracture was performed on the left tibia of 3-month-old Wistar rats weighing 250 to 350 g that were either healthy (N = 24) or made diabetic with alloxan (N = 24) to investigate the effect of alloxan-induced diabetes on the course of bone fracture healing. Histomorphometric analysis of the fracture site was performed at 7, 14, 25, and 35 days. After 7 days, diabetic rats had significantly less cartilage (P = 0.045) and greater fibrous connective (P = 0.006) tissue formation at the fracture site compared to controls. In contrast, marked callus formation was seen in diabetic rats with significant osteogenesis (P = 0.011, P = 0.010, P = 0.010, respectively, for 14, 25, and 35 days) and chondrogenesis (P = 0.028, P = 0.033, P = 0.019) compared to controls. Radiographic analysis revealed a displaced fracture with poor bone fragment alignment and delayed consolidation at these times in the diabetic group. The levels of alkaline phosphatase were significantly higher in diabetic rats at 25 days (P = 0.009). These results suggest that the initial excessive formation of fibrous connective tissue associated with delay in chondrogenesis and osteogenesis may not provide suitable stability of the fractured site, contributing to the inappropriate alignment of fragments and an increase in the volume of callus in later stages of repair. The resulting displaced fracture in diabetic rats requires long periods for remodeling and complete bone consolidation.

Introduction: Kirschner Wires (K-wires) are widely used in orthopaedic procedures. The most common complication of K-wire fixation is pin site infection. There are only few studies which compare the infection rate between buried and unburied K-wires and there is no consensus regarding whether the K-wires should be buried under the skin or left unburied after fracture fixation, to reduce the chance of post operative infection. While some advocate there is definite advantage of burying K-wires in terms of post operative pin site infection, some studies have shown that the infection rate is similar in both the groups. Aim: The aim of the present study was to determine whether there is a difference in the incidence of pin site infection between buried and unburied K-wire fixation techniques of fracture fixation. Materials and Methods: We conducted a multi centric retrospective, cohort study in two tertiary care centres in Puducherry, in patients who underwent K-wire fixations for various fractures in upper limbs and lower limbs during the time period between January 2010 to August 2017. Data were retrieved from medical records and radiology archives. Results: A total of 474 patients were included in the present study. Their median age was 32 years (range: 2-87 years), 409 (86%) were males and 65 (14%) were females. Surgeons buried K-wires in 141 patients and left K-wires unburied in 333 patients. Overall, post operative infection rates were lower in buried K-wire fixation compared to unburied K-wire fixation. However, the difference was not statistically significant. In the sub analysis of closed fractures, infection rates were significantly lower in the buried K-wire technique compared to unburied K-wire technique. Among open fractures, post operative infection rates were not significantly different between these two groups. Conclusion: The present study shows significant lower infection in buried K-wire fixations compared to unburied K-wire fixations in closed fractures. Hence, we recommend that K-wires should be kept buried after fracture fixation in closed fractures. [ABSTRACT FROM AUTHOR]

Objective: Translation of promising treatments for post-traumatic osteoarthritis (PTOA) to patients with intra-articular fracture (IAF) has been limited by the lack of a realistic large animal model. To address this issue we developed a large animal model of IAF in the distal tibia of Yucatan minipigs and documented the natural progression of this injury.Design: Twenty-two fractures were treated using open reduction and internal fixation with either an anatomic reduction or an intentional 2-mm step-off. Pre-operatively, and 3 days, 1, 2, 4, 8, and 12 weeks post-operatively, animals were sedated for synovial fluid draws and radiographs. Limb loading was monitored at the same time points using a Tekscan Walkway. Animals were sacrificed at 12 weeks and the limbs were harvested for histological evaluation.Results: All animals achieved bony union by 12 weeks, facilitating nearly complete recovery of the initial 60% decrease in limb loading. TNFα, IL1β, IL6, and IL8 concentrations in the fractured limbs were elevated (P < 0.05) at specific times during the 2 weeks after fracture. Histological cartilage degeneration was more severe in the step-off group (0.0001 < P < 0.27 compared to normal) than in the anatomic reconstruction group (0.27 < P < 0.99 compared to normal).Conclusions: This model replicated key features of a human IAF, including surgical stabilization, inflammatory responses, and progression to osteoarthritic cartilage degeneration, thereby providing a potentially useful model for translating promising treatment options to clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To review the outcomes of patients treated with the Ilizarov method for an isolated, closed, simple diaphyseal, Tibial fracture at our institution over the last decade.Methods: The Ilizarov frame database was used to identify 76 skeletally mature patients who sustained an isolated, closed, extra-articular, simple, diaphyseal Tibial fracture; the injury also known as a "nail-able Tibial fracture."Results: The average age of the patient was 38 (17-70). All 76 patients progressed to union. The average time until union was 148 (55-398) days. The coronal and sagittal alignment was 3° (0-17°) and 4° (0-14°) respectively. No patient suffered from compartment syndrome. No patient developed septic arthritis. No patient had documented anterior knee pain or secondary knee specialist input post frame removal. On average, there were 9(4-29) follow up appointments and 10(5-26) radiographs post frame application. There is a 59% chance of a patient having a difficulty post frame application. The malunion rate was 5%. Persisting pinsite infection post frame removal occurred in 5 patients (6.5%). Drilling of the pinsite sequestrum resolved the infection in four of these patients, giving a deep infection rate of 1.3%.Conclusions: The Ilizarov method has a role to play in the treatment of simple closed Tibial shaft fractures in patients who need to kneel. Patient education is a priority however; the patient must be made aware of the difficulty rate associated with the Ilizarov method when compared to the complication profile of alternative treatments. [ABSTRACT FROM AUTHOR]

Introduction:  Supracondylar fractures of the humerus are the most common elbow fracture reported in children. When closed reduction fails, open reduction and pinning will be used as a definitive procedure. In this study, we compare the functional outcome of lateral and posterior approaches of open reduction and assess the range of elbow movements and carrying angle by using Flynn's criteria., Methods: This is a prospective study conducted on 30 children with supracondylar fracture of the humerus in Adichunchanagiri Hospital from a period of December 2018 to August 2020. A total of 30 children were selected for this study. Fifteen children underwent open reduction and pinning using the lateral approach (group 1) and 15 children underwent open reduction and pinning using the posterior approach (group 2) and all were followed up for six months. Functional outcome was assessed at the end of six months using Flynn's criteria., Results: There were 20 boys and 10 girls in the study group. The mean age was 9.43 ± 1.69 years. The majority of children sustained injury due to falls on an outstretched hand (80%). One case of pin tract infection occurred in both the study groups. One patient had a superficial infection (6.7%) with the lateral approach, whereas two patients had a superficial infection with the posterior approach (13.33%). The lateral group fared better than the posterior group in comparison using Flynn criteria., Conclusion: Lateral approach might be better than the posterior approach for unreduced supracondylar fractures necessitating open reduction and k wire fixation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kashyap et al.)

Background There is no consensus with regard to optimum prophylactic antibiotic regimen in orthopaedic fracture surgery. Objective A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infection in patients undergoing operative treatment of low-energy closed fractures. Data resources Medline, Medline in Process and other non-indexed citations, Embase, Cochrane database of systematic reviews and conference proceedings were searched. Review methods Studies were included if they were randomized or quasi-randomized trials comparing the results of a single antibiotic prophylaxis versus multiple doses of the same antibiotic in patients undergoing surgical fixation of closed fractures. Results Four studies were found to meet the searching criteria. The mean score for quality assessment of these studies was 16 (8-24 points). Only two out of four studies had detailed analysable data and therefore were included in the final analysis. 921 patients were pooled using a random-effects model. Compared to multiple-dose prophylaxis, administration of a single preoperative dose demonstrated no significant difference regarding the overall surgical site infection rate (risk ratio (RR) = 0.3, 95% confidence interval ( CI): 0.07-1.25). Multiple-dose antibiotic prophylaxis is marginally more effective than single dose in reducing the incidence of deep surgical wound infection (risk ratio: 0.13, 95% CI: 0.02 to 0.99). Conclusion There is lack of definite evidence that multiple-dose antibiotic prophylaxis is superior to single preoperative dose in low-energy closed fracture surgery. [ABSTRACT FROM AUTHOR]

Abstract: Fracture healing is impaired in osteoporotic bone. Low-magnitude high-frequency vibration (LMHFV) has recently been proven to be osteogenic in osteoporotic intact bone. Our previous study found that LMHFV significantly enhanced fracture healing in adult rats. This study was designed to explore whether LMHFV was able to promote fracture healing in osteoporotic bone by enhancing callus formation, remodeling, and mineralization and to compare with age-matched nonosteoporotic ones. Nine-month-old ovariectomy (OVX)-induced osteoporotic rats were randomized into control (OVX-C) or vibration group (OVX-V); age-matched sham-operated rats were assigned into control (Sham-C) or vibration group (Sham-V). LMHFV (35 Hz, 0.3 g) was given 20 min/day and 5days/week to the treatment groups, while sham treatment was given to the control groups. Weekly radiographs and endpoint micro-CT, histomorphometry, and mechanical properties were evaluated at 2, 4, and 8 weeks post-treatment. Results confirmed that the fracture healing in OVX-C was significantly inferior to that in Sham-C. LMHFV was shown to be effective in promoting the fracture healing in OVX group in all measured parameters, particularly in the early phases of healing, with the outcomes comparable to that of age-matched normal fracture healing. Callus formation, mineralization and remodeling were enhanced by 25–30%, with a 70% increase in energy to failure than OVX-C. However, Sham-V was found to have lesser fracture healing enhancement, with significant increase in callus area only on week 2 and 3 than Sham-C, suggesting non-OVX aged bones were less sensitive to mechanical loading. The findings of this study provide a good basis to suggest that proceeding to clinical trials is the next step to evaluate the efficacy of LMHFV on osteoporotic fracture healing. [Copyright &y& Elsevier]

Abstract: Acute haematogenous infection of a closed fractures is rare. A 68-year-old diabetic male sustained a burst fracture of a lumbar vertebra (L2) after a fall onto his back. After 5days of conservative management, he developed a chest infection and amoxicillin was commenced empirically. However, after 6days his previously moderate focal L2 back pain had become more severe. Pyrexia and systemic inflammatory markers continued to rise despite administration of antibiotics. Blood cultures and a CT-guided biopsy of L2 both revealed Staphylococcus aureus which was sensitive to flucloxacillin. The patient’s symptoms and signs gradually normalised following administration of flucloxacillin for 6weeks, and the use of a cast brace. We conclude that haematogenous infection can be successfully managed non-operatively. [Copyright &y& Elsevier]

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Recently, bioactive agents to stimulate bone formation have been available in the orthopedic field. We have shown previously that a single, local injection of basic fibroblast growth factor (bFGF) contributes to the formation of a larger cartilage (soft callus) but does not promote replacement of the cartilage by osseous tissue during experimental closed femoral fracture healing. Aiming at a clinical application, the present study was undertaken to clarify the effects of locally injected bFGF on bone (hard callus) formation and the mechanical properties of the callus in closed fracture healing in rats. Immediately after fracture, a carrier (200 μL of fibrin gel) containing 100 μg of bFGF or carrier alone was applied to the fracture site. At days 42 and 56 postfracture, the bone union rate, bone mineral density (BMD), and mechanical properties (strength and stiffness) of the callus were evaluated. Unexpectedly, with the exception of reduced stiffness in the FGF-injected callus at day 56, none of these parameters showed a significant difference between the control and the FGF-injected groups. Furthermore, the temporal expression pattern of OPN mRNA during healing was very similar between groups. We conclude that, in the healing of closed fractures of long bones, administration of bFGF forms a larger callus but does not necessarily accelerate the healing process. [ABSTRACT FROM AUTHOR]

Abstract: We herein report on a novel locking intramedullary nail system in a murine closed femur fracture model. The nail system consists of a modified 24-gauge injection needle and a 0.1-mm-diameter tungsten guide wire. Rotation stability was accomplished by flattening the proximal and distal end of the needle. Torsional mechanical testing of the implants in osteotomized cadaveric femora revealed a superiority of the locking nail (3.9±1.0° rotation at a torque of 0.9Nmm, ) compared to the unmodified injection needle (conventional nail; 52.4±3.2°, , ). None of the implants, however, achieved the rotation stability of unfractured femora (0.3±0.5°, ). In a second step, we tested the feasibility of the in vivo application of the locking nail to stabilize a closed femoral midshaft fracture in C57BL/6 mice. Of interest, none of the 10 animals showed a dislocation of the locking nail over a 5-week period, while 3 of 4 animals with conventional nail fracture stabilization showed a significant pin dislocation within the first 3 days (). Mechanical testing after 5-weeks stabilization with the locking nail revealed an appropriate bone healing with a torque at failure of 71.6±3.4% and a peak rotation before failure of 68.4±5.3% relative to the unfractured contralateral femur. With the advantage that closed fractures can be fixed with rotation stability, the herein introduced model may represent an ideal tool to study bone healing in transgenic and knockout mice. [Copyright &y& Elsevier]

Abstract: This contribution discusses why and how bones break, the stages of fracture healing, and the factors that influence these processes. The treatment of these fractures is then discussed in detail. [Copyright &y& Elsevier]

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• Theoretical research on the interaction between elastic waves and cracks. • Programming to realize the interaction between elastic waves and cracks. • Realize the geometric recovery of cracks through simulation results. • Compare and verify the results obtained by simulation and test results. Over the past few years, intelligent detection and fast and precise positioning for fracture have been hotspots in the field of geological engineering. The propagation of elastic wave in fracture inclusive one-dimensional line segment was obtained through simulation, and then Densely Connected Convolutional Networks (DenseNets) were used to learn waveform. Moreover, the key features of the fracture were obtained automatically from elastic wave to achieve fast, precise, and intelligent detection for fractures in line segment. Furthermore, the Schoenberg linear slippage model was used to describe the contact behavior of closed fractures on two-dimensional plane. The propagation of elastic wave on fracture inclusive plane was obtained by simulation, and the plane is divided into several horizontal and vertical straight lines in which elastic wave was collected. The sampled data were analyzed by the trained neural network model, and geometrical reconstruction was implemented for fractures on the plane based on the detection results of each line and row. Finally, three-dimentional scanning laser Doppler vibrometry was used to experimentally obtain propagation of elastic wave on granite plane under incentive effect, and then experimental data were input into the neural network. This has accurately recovered the geometrical shape of fracture in granite and further verified the precision of the neural network. [ABSTRACT FROM AUTHOR]

Aeromonas hydrophilia can cause soft tissue infection in both immunocompromised and healthy persons. A healthy 15-year-old adolescent fell into a ditch after a scooter accident and sustained a right distal tibial shaft closed fracture, a right femoral shaft closed fracture, and a dirty laceration over the medial aspect of the distal thigh above the right knee. After empiric antibiotics and radical debridement of the contaminated wound, a femoral interlocking nail and tibial external fixator were applied. However, acute osteomyelitis later presented in his femur and tibia, and Aeromonas hydrophilia grew in cultures from the knee wound and the fracture sites. During the follow-up, his tibia became an infected nonunion, and was successfully treated with the induced membrane technique. In an otherwise healthy patient with a closed fracture, Aeromonas hydrophilia can cause acute osteomyelitis and necrotizing fasciitis by spreading from a nearby contaminated wound. Exposure to water is a risk factor for Aeromonas hydrophilia infection.

Fracture healing requires the integration of many cell types, growth factors, and cytokines that cannot be adequately studied using in vitro and in silico models. This has prompted the development of highly informative in vivo animal models to understand the complexities of fracture repair. Here, we describe a modified procedure for mice, first developed for rats by Bonnarens and Einhorn, that does not require a skin incision or suturing. This procedure involves boring a hole through the skin and articular surface of the femoral condyle with a 25-gauge needle, fixation with a K-wire, and creation of a transverse mid-diaphyseal fracture using a three-point bending fracture device. Fracture healing can be assessed using a variety of techniques, including microcomputed tomography, torsion testing, histological and histomorphometric analyses, and assessment of gene expression. There are many orthopedic trauma applications of this murine femoral fracture model ranging from assessment of safety and efficacy of novel therapeutics to the influence of specific genes on bone repair.

In this paper, we present 14 cases with depression fracture of the occipital bone in pediatric age. There were 7 males and 7 females. Their ages ranged from 1 year to 15 years with a median of 5.8 years. The most common causes were: falling (8 cases); traffic accidents (2); assault (2 cases). Five of our 14 cases had compound fractures and the remaining 9 had closed fractures. Epidural and subdural hematomas were observed in 5 and 1 cases, respectively. There was significant improvement in 11 cases: two patients died. [ABSTRACT FROM AUTHOR]

Background: Severe musculoskeletal trauma can trigger an inflammatory response, and an excessive inflammatory response can lead to systemic inflammatory response syndrome and multiorgan failure. High-mobility group box 1 (HMGB1) is an early mediator pro-inflammatory cytokine in sterile injuries and a late cytokine mediator in infection and sepsis. Previous research has shown that administration of systemic lidocaine can inhibit HMGB1 expression in macrophages of septic rats. The aim of this study was to demonstrate the efficacy of systemic lidocaine to inhibit HMGB1 mRNA and protein in a BALB/c mouse model of sterile inflammation due to closed fracture musculoskeletal injury., Materials and Methods: Twenty adult male BALB/c mice were divided into lidocaine and control groups. The closed fracture musculoskeletal injury was performed by breaking the left thigh bone of the mice. Four hours after undergoing the closed fracture, the lidocaine group was treated with lidocaine intravenous (2 mg/kg). The same volume of distilled water was injected into the control group instead of lidocaine. HMGB1 mRNA expression was examined with real-time polymerase chain reaction, and HMGB1 protein level was determined with enzyme-linked immunosorbent assay., Results: The expression of HMGB1 mRNA and protein levels in mice that sustained inflammation due to a closed fracture musculoskeletal injury was significantly decreased in the lidocaine group ( P < 0.00 and P < 0.00 for mRNA and protein, respectively)., Conclusions: Intravenous administration of lidocaine effectively inhibited the inflammatory process in BALB/c mice that underwent closed fracture musculoskeletal injury by suppressing HMGB1 mRNA transcription and HMGB1 protein translation., Competing Interests: There are no conflicts of interest.

Objectives: One commonly used rat fracture model for bone and mineral research is a closed mid-shaft femur fracture as described by Bonnarens in 1984. Initially, this model was believed to create very reproducible fractures. However, there have been frequent reports of comminution and varying rates of complication. Given the importance of precise anticipation of those characteristics in laboratory research, we aimed to precisely estimate the rate of comminution, its importance and its effect on the amount of soft callus created. Furthermore, we aimed to precisely report the rate of complications such as death and infection., Methods: We tested a rat model of femoral fracture on 84 rats based on Bonnarens' original description. We used a proximal approach with trochanterotomy to insert the pin, a drop tower to create the fracture and a high-resolution fluoroscopic imager to detect the comminution. We weighed the soft callus on day seven and compared the soft callus parameters with the comminution status., Results: The mean operating time was 34.8 minutes (sd 9.8). The fracture was usable (transverse, mid-shaft, without significant comminution and with displacement < 1 mm) in 74 animals (88%). Of these 74 usable fractures, slight comminution was detected in 47 (63%). In 50 animals who underwent callus manipulation, slight comminution (n = 32) was statistically correlated to the amount of early callus created (r = 0.35, p = 0.015). Two complications occurred: one death and one deep infection., Conclusions: We propose an accurate description of comminution and complications in order to improve experiments on rat femur fracture model in the field of laboratory research. Cite this article: Bone Joint Res 2013;2:149-54.