Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study.

BACKGROUND: It's difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs. METHODS: A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit. RESULTS: There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05). CONCLUSION: In terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.

Application and Effect Evaluation of Needle Tract Nursing after External Fixation with 2% Chlorhexanol Gluconate Gauze.

In the medical domain, needle-track nursing especially after 2 percent chlorhexidine gluconate gauze pressure bandaging is a challenging issue and needs a timely response from the research community. In this research paper, a total of 213 patients who met the inclusion and exclusion criteria after external fixation with 2% chlorhexidine gluconate gauze pressure bandaging in the second orthopaedic ward from March 2018 to December 2017 were selected and randomly divided into three groups, each with 71 cases. For needle tract care, various intervention strategies are used. Gauze pressure bandage with 2% chlorhexidine gluconate is in Group A. In group B, BID was cleaned with a sterile cotton swab containing 2 percent chlorohexanol gluconate. BID uses a 75 percent alcohol sterile cotton swab wipe for basic needle maintenance. The intervention measures suggested by each group were provided to the three groups. Finally, the effects and differences of the intervention measures used by the three groups on the infection rate of the needle tract after external fixation and patient pain scores were examined. It is worth noting that chlorhexidine disinfectant has not only evident and quick germicidal effects but also long-term bacteriostatic efficiency against germs that are difficult to develop drug resistance to. The nursing technique of chlorhexidine pressure bandaging the needle tract minimises the risk of infection, particularly severe needle tract infection. The compression bandage group had a considerably lower rate of needle tract infection than the other two groups (P0.05), according to the statistics. The pain score in the pressure bandaging group was significantly lower than the other two groups after intervention (P0.05), notably in the typical alcohol disinfection group. The use of 2 percent chlorhexidine gluconate alcohol gauze pressure dressing nursing measures can minimise the rate of needle tract infection following external fixator surgery, as well as the pain and satisfaction of patients. The needle tract nursing technique offers clinical and promotional value.

Utility of technetium-99m-methylene diphosphonate single-photon emission computed tomography/computed tomography fusion in detecting post-traumatic chronic-infected nonunion in the lower limb.

BACKGROUND: This study aimed to evaluate fused images of single-photon emission computed tomography/computed tomography (SPECT/CT), stand-alone whole-body scintigraphy (WBS) and stand-alone CT in the diagnosis of post-traumatic chronic-infected nonunion osteomyelitis (OST) of the lower limb. PATIENTS AND METHODS: The imaging data from 144 patients with known/suspected chronic-infected fracture nonunion in the lower limbs following internal/external fixation between June 2015 and December 2017 were reviewed retrospectively. Technetium-99m-methylene diphosphonate SPECT/CT scans were performed on the patients. For each patient, the diagnosis on the basis of each imaging approach was classified as yes (OST), no (no OST), or equivocal by experienced nuclear medicine physicians and radiologists. An intraoperative bacterial culture experiment was conducted as our gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, κ coefficient, significance level, and agreement level were analyzed. RESULTS: The diagnosis on the basis of SPECT/CT fused images showed a sensitivity of 91.3%, a specificity of 84.6%, and accuracy of 88.9% compared to that based on WBS, with a sensitivity of 52.2%, a specificity of 15.4%, accuracy of 38.9%, and CT, with a sensitivity of 65.2%, a specificity of 23.1%, accuracy of 50.0%. The fused images can show the precise sites of post-traumatic chronic-infected OST. Considerable agreement (κ 0.679) was found between the SPECT/CT diagnosis and an intraoperative bacterial culture test (WBS, κ 0.218; CT, κ = 0.184). CONCLUSION: Technetium-99m-methylene diphosphonate SPECT/CT imaging fusion can improve diagnostic confidence for post-traumatic patients with chronic nonunion OST. This imaging approach can achieve an accurate diagnosis by revealing the precise location and scope of OST with high sensitivity and specificity, which has important implications for surgical guidance by providing the precise location of OST.

[CLINICAL OBSERVATION OF Othofix PERTROCHANTERIC FIXATOR FOR FIXATION OF INTERTROCHANTERIC FRACTURE].

OBJECTIVE: To evaluate the effectiveness of Othofix pertrochanteric fixator for fixation of intertrochanteric fracture. METHODS: A retrospective analysis was made on the clinical data from 36 cases of intertrochanteric fracture treated with Othofix pertrochanteric fixator (OPF group) and 47 cases treated with Gamma nail (Gamma group) between October 2012 and March 2015. There was no significant difference in gender, age, cause of injury, side, AO fracture classification, combined medical disease, and injury to operation time between 2 groups (P > 0.05). The operation time, intraoperative blood loss, hospitalization time, fracture union time, and complication rate were recorded and compared between 2 groups. Hip function was evaluated with Sanders post-trauma criteria. RESULTS: The operation time, intraoperative blood loss, and hospitalization time of the OPF group were significantly less than those of the Gamma group (P<0.05). All the cases were followed up 6-12 months (mean, 8.8 months) in 2 groups. Healing of incision by first intention was obtained. Bone union was achieved in 2 groups, and the fracture union time of the OPF group was significantly shorter than that of the Gamma group (t = 14.780, P = 0.000). There was no deep wound or pin track infection in 2 groups. Superficial skin reactions developed around the screw and the pins in 14 cases (38.9%) of the OPF group, but no incision infection in the Gamma group, showing significant difference (χ² = 22.010, P = 0.001). Mild varus of the hip and pin cutting-out occurred in 3 cases (8.3%) and 2 cases (5.6%) of the OPF group, and in 4 cases (8.5%) and 3 cases (6.4%) of Gamma group, showing no significant difference (χ² = 0.001, P = 0.960; χ² = 0.025, P = 0.830). According to Sanders post-trauma criteria, the results were excellent in 16 cases, good in 15 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.1% in the OPF group; the results were excellent in 22 cases, good in 20 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 89.4% in the Gamma group; and there was no significant difference (χ² = 0.200, P = 0.610). CONCLUSION: The Othofix pertrochanteric fixator has good effectiveness in the treatment of intertrochanteric fracture, which has the advantages of simple operation, less operation time, little bleeding, and early functional recovery.

[CLINICAL FEATURES AND SURGICAL EFFECTIVENESS OF ANKLE FRACTURES INVOLVING Tillaux-Chaput IN ADULTS].

OBJECTIVE: To investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. METHODS: Between May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years (range, 19-45 years). The causes included sport injury (8 cases), traffic accident injury (5 cases), and falling injury from height (2 cases). The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures (Gustilo type I) and 13 close fractures. Five patients had single Tillaux-Chaput fractures. The mean time between injury and surgery was 8.5 days (range, 3 hours to 15 days). According to the Lauge-Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. RESULTS: Primary healing of incisions was obtained in 13 patients without infection and neurovascular injury; 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average (range, 13-36 months). X-ray films showed complete fracture healing at 10-16 weeks postoperatively (mean, 13 weeks) in all cases. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 87 (range, 78-99), with an excellent and good rate of 80% (excellent in 9 cases, good in 3 cases, and fair in 3 cases). CONCLUSION: Open reduction and internal fixation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.

A new choice for the treatment of segmental tibial bone defects: intramedullary nail internal fixation combined adipose-derived stem cells technique.

The repair of various segmental tibial bone defects continues to be a challenging part of many reconstructive procedures. Many methods have been tried to repair the defects, followed by many complications and the results may be unsatisfied. Since 2001 Zuk et al. established human adipose-derived stem cells (hASCs) as a multipotent stem cell population with the ability to assume osteogenic phenotypes through chemically induced differentiation, hASCs represent a valuable tool for pharmacological and biological studies of osteoblast differentiation in vitro and bone development in vivo, and have been proved to be a useful source of stem cells in bone repair. Recently, hASCs have been found to repair both animals and human calvarial defects. In this paper, we hypothesize that hASCs cultured on custom scaffolds can be used to repair of tibial segmental bone defects with intramedullary nail internal fixed. Unlike current treatment modalities, it would promote the regeneration of tibial defects, provide structural support and allow for weight bearing and bony substitution over time.

Expression of nerve growth factor and its receptor in distracted tibial nerve after limb lengthening.

Despite many experimental and clinical studies conducted on distraction osteogenesis (DO) in the past decade, changes in the surrounding tissues that occur after the procedure remains poorly understood. To study the biochemical changes of recovery in nerve tissues upon DO-induced nerve injury, we prepared a rabbit model of tibia lengthening to observe the expression pattern of nerve growth factor (NGF) and low-affinity NGF receptor (p75NGFR) in the distracted tibial nerve. The distracted tibial nerve was harvested at various time points during the consolidation period of new bone formation and immunohistochemical staining was performed to detect the expression of NGF and p75NGFR. The expression levels of NGF and p75NGFR were found to be different at various times after DO. The changes in expression of these two cellular factors show similar tendencies with significantly elevated expression in Schwann cells at 7 and 14 days after distraction, but low or undetectable levels of expression at 0, 28, and 56 days. These results suggest that NGF and p75NGFR may play important roles in the adaptive process of the distracted nerve. NGF and p75NGFR are autocrine growth factors present in the distracted nerve during the early consolidation period. NGF interacts with p75NGFR to promote damage repair and reconstruction of nerves. Together, this study furthers the understanding of the relative mechanisms of nerve repair, as well as provides a further basis for the clinical application of neurotrophins.

Treatment of posttraumatic equinus deformity and concomitant soft tissue defects of the heel.

BACKGROUND: To evaluate the operative method and clinical outcome for the treatment of posttraumatic equinus deformity and concomitant soft tissue defect of the heel. METHODS: Between June 2006 and May 2010, seven cases of posttraumatic equinus deformity and concomitant unstable scar or ulcer of the heels were treated by using a hinged Ilizarov apparatus and reversed sural fasciocutaneous island flap transfer. Achilles tendon lengthening was also done in all patients. The average duration of follow-up was 21 months. The sizes of sural flaps were from 7 cm × 6 cm to 10 cm × 9 cm. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus position of the foot. RESULTS: Results were evaluated by using the following criteria: (1) the degree of active dorsiflexion of the ankle, (2) the total active range of motion of the ankle, and (3) walking ability and flap durability. For active dorsiflexion of the ankle, the results were good in three patients and fair in four patients. For range of active motion of the ankle, the results were good in five patients and fair in two patients. For walking ability and flap durability, the results were good in six patients and fair in one patient. CONCLUSION: This study showed that posttraumatic equinus deformity accompanied by soft tissue defect of the heel can be treated effectively with Achilles tendon lengthening, reversed sural fasciocutaneous island flap transfer, and a hinged Ilizarov technique.

[Preliminary study on effect of surgical delay on anti-infection ability of reverse fascio-cutaneous flap].

OBJECTIVE: To improve the success rate of the reverse fascio-cutaneous flap in repairing the infected wound, to observe the effect of surgical delay on the anti-infection ability of the reverse fascio-cutaneous flap by establishing an oryctolagus cuniculus model of reverse fascio-cutaneous flap based on sural nerve on the lateral side of left later limb. METHODS: Sixteen 5-month-old Japanese white rabbits weighing 2.0-2.5 kg (mean, 2.3 kg) were randomly divided into experimental group (n = 8) and control group (n = 8). The reverse fascio-cutaneous flap of 4 cm x 2 cm was designed, based on 1 cm above the lateral malleolar as pedicle in sural nerve region in the lateral left later limb. In the experimental group, the full-thickness of the flap distal end half was harvested according to the design; and after 10 days delay, the full-thickness flap was obtained according to the design, and 0.5 mL Staphylococcus aureus solution was implanted at a density of 3.8 x 10(6)/mL in 2 groups. The general observation was performed postoperatively; the venous blood of the marginal ear vein was collected to observe white blood cell (WBC) count before implantation of staphylococcus aureus solution and after 1, 3, 5, 7, 10, and 14 days of implantation. The flap survival rate and the colony counting of necrosis flap tissue were calculated after 10 days of implantation; the blood vessel caliber and the peak value of peroneal artery blood flow of flap proximal end were measured after 14 days of implantation. RESULTS: All animals survived to the end of the experiment, and all incisions healed primarily. Inflammatory reaction with different degrees was observed after implantation in 2 groups, and it was obvious at 3-5 days. Inflammatory reaction in the experimental group was slighter than that in the control group. Except for no significant difference before implantation and after 14 days of implantation between 2 groups (P > 0.05), there were significant differences in WBC count at other time points between 2 groups (P < 0.05). The flap survival rate of the experimental group (93.20% +/- 4.62%) was significant higher than that of the control group (72.65% +/- 7.80%) after 10 days of implantation (P < 0.05). The colony counting of necrosis flap tissue in the experimental group [(20.63 +/- 5.76) x 10(3) colony/g] was significantly lower than that in the control group [(32.38 +/- 6.14) x 10(3) colony/g] after 10 days of implantation (P < 0.05). The blood vessel caliber of the experimental group and the control group were (1.03 +/- 0.10) mm and (0.75 +/- 0.09) mm, respectively, and the peak value of peroneal artery blood flow in the experimental group and the control group were (20.73 +/- 2.46) cm/s and (13.83 +/- 1.51) cm/s, respectively, after 14 days of implantation; showing significant differences between 2 groups (P < 0.05). CONCLUSION: Surgical delay has the ability of enhancing survival and anti-infection of the rabbit reverse fascio-cutaneous flap.

A biomechanical comparison of micromotion after ankle fusion using 2 fixation techniques: intramedullary arthrodesis nail or Ilizarov external fixator.

BACKGROUND: In difficult ankle arthrodesis situations, intramedullary (IM) arthrodesis nails and external fixation are often considered in lieu of standard fusion techniques. The purpose of this study was to compare the amount of micromotion measured across an ankle fusion site stabilized with either an IM nail or with the Ilizarov external fixator. MATERIALS AND METHODS: The relative bone mineral density of 8 pairs of human cadaveric lower legs was measured by DEXA scanning. One specimen from each pair was randomly assigned to be stabilized with a new generation IM nail and the other with an Ilizarov external fixator. Specimens were tested in compression, rotation, and dorsiflexion. Optical motion capture was used to measure the direct motion occurring at the fusion site. RESULTS: No significant difference was found between the axial displacements (p = 0.94), torsional displacement (p = 0.07), or the dorsiflexion angular displacement (p = 0.28) for the IM rod group and the external fixation group. A weak correlation was found between BMD and displacement. CONCLUSION: Both the new generation IM nail and the Ilizarov external fixator imparted excellent stability to the fusion site despite a wide range of bone mineral densities. Medialization of the talus, the ability to compress the nail, and the addition of a posterior-to-anterior locking screw were thought to improve the performance of the nail. CLINICAL RELEVANCE: Both IM nail and Ilizarov external fixation provided excellent fusion site stability. The decision of which implant to use for complex arthrodesis should be dictated by the clinical needs.