RESUMEN
Fracture healing is a complex biological process that can be delayed or impaired in certain situations. Bone morphogenetic proteins (BMPs) have emerged as a promising therapeutic strategy to promote bone formation and accelerate fracture healing. This editorial talks about the current understanding of BMPs, their mechanisms of action in fracture healing, and their potential applications in orthopedic trauma management. We also discuss the ongoing challenges and future directions for research on BMPs in fracture healing.
RESUMEN
A significant amount of all paediatric fractures are forearm fractures involving the radius, ulnar shaft, or both. As surgical stabilisation lowers the likelihood of re-displacement, surgical intervention is currently recommended over conservative treatment of such fractures involving significant displacement and angulation. Open reduction and plating can better anatomically repair the majority of fractures. Bracing is necessary for the first six to eight weeks after nailing since nailing does not give a rigid fixation. External bracing is generally not necessary for plating. In our facility, paediatric diaphyseal forearm fractures are typically treated using titanium elastic nail system (TENS) nailing. However, there are occasional instances where the primary fracture site refractures after surgery, particularly in diaphyseal forearm fractures involving both bones. Our patient was a 12-year-old boy who had come to our facility with a left forearm radius shaft fracture and ulna shaft plastic deformation. The radius shaft fracture was fixed with TENS nailing, and the ulna shaft plastic deformation was corrected by the three-point bending method. Three months later, the patient came back with a refracture of the radius shaft. TENS nail removal, open reduction, and internal fixation of the radius shaft refracture were done with a plate and screws. Anatomic reduction of forearm fractures, open reduction, and the use of plate fixation enable a more thorough correction of malrotation and restoration of the radial bow, allowing for an early range of motion. Since the TENS nail is not a locking device, there is always some amount of mobility at the fracture site, causing loss of reduction, chances of implant failure, and non-union. So primary plating, especially in cases of forearm fractures, appears to be a better option compared to primary TENS nailing in juvenile patients.
RESUMEN
The chronic and incapacitating condition of infected non-union of the long bones continues to be a challenging issue for surgeons in terms of efficient and economical treatment. A number of variables, such as open fractures, soft tissue or bone loss, infection following internal fixation, persistent osteomyelitis with pathologic fractures, and surgical debridement of infected bone, can result in infected non-unions. An infected non-union is typically treated in two stages. To transform an infected non-union into an aseptic non-union, the initial step involves debridement, either with or without the insertion of antibiotic cement beads and systemic antibiotics. In order to ensure stability, external or internal fixation - with or without bone grafting - is carried out in the second stage. There is a wealth of literature supporting the use of antibiotic-impregnated cement-coated intramedullary (IM) nailing for infected non-union of tibia and femur fractures. In contrast to cement beads, the cement nail offers stability throughout the fracture site, and osseous stability is crucial for the treatment of an infected non-union. When using antibiotics for this purpose, they should possess unique qualities, including low allergenicity, heat stability, and a broad spectrum of activity. The most commonly utilised medication has been gentamicin, which is followed by vancomycin. Furthermore, it has been discovered that solid nails are more resistant to local infection than cannulated IM nails. In this case study, the patient was treated with a solid IM nail that had a specially designed slot on its exterior surface for the application of cement impregnated with antibiotics. In conclusion, an easy, affordable, and successful treatment for infected non-union of the tibia is antibiotic cement-impregnated nailing. It has strong patient compliance and removes the problems associated with external fixators, which makes it superior to them. A few benefits of this approach are early weight-bearing, stabilisation of the fracture, local antibiotic treatment, and the potential for accelerated rehabilitation. Additionally, lowering the requirement for continuous antibiotic medication may lessen the chance that antibiotic resistance may arise.
RESUMEN
Clavicle fractures at the medial end are very rare. Even in cases where there is severe displacement, such fractures have usually been managed nonoperatively. Yet, there are many patients who remain symptomatic over a year following injury, and the non-union rate is also high. Operative intervention for displaced clavicle fractures of the medial end has been more common in the past decade. The possibility of iatrogenic injury due to the near proximity of critical vascular structures continues to be a concern. This case report describes the management of a rare displaced medial end clavicle fracture in a young male. The patient is a 28-year-old male who came with a week-old displaced medial end left clavicle fracture. On examination, tenting of skin was seen over the medial end clavicle region. CT angiography of the left upper limb was performed to check the vascular structures in relation to the fracture, as there remain concerns about the close proximity of underlying vascular structures and the potential for iatrogenic damage. A vascular surgeon was kept on standby during the surgery. The patient was taken up for surgery after a pre-anesthetic checkup and open reduction and internal fixation was done with a 2.4-mm system mini fragment locking compression plate over the anterior surface of the clavicle. The surgery was uneventful, and the patient had a good clinical and radiological outcome postoperatively.
