Bone callus formation is highly disrupted by dietary restriction in growing rats sustaining a femoral fracture

Abstract Purpose: To evaluate the effects of food restriction on fracture healing in growing rats. Methods: Sixty-eight male Wistar rats were assigned to two groups: (1) Control and (2) Dietary restriction. After weaning the dietary restricted animals were fed ad libitum for 42 days with 50% of the standard chow ingested by the control group. Subsequently, the animals underwent bone fracture at the diaphysis of the right femur, followed by surgical stabilization of bone fragments. On days 14 and 28 post-fracture, the rats were euthanized, and the fractured femurs were dissected, the callus was analyzed by dual-energy X-ray absorptiometry, micro-computed tomography, histomorphometry, mechanical tests, and gene expression. Results: Dietary restriction decreased body mass gain and resulted in several phenotypic changes at the bone callus (a delay in cell proliferation and differentiation, lower rate of newly formed bone and collagen deposition, reductions in bone callus density and size, decrease in tridimensional callus volume, deterioration in microstructure, and reduction in bone callus strength), together with the downregulated expression of osteoblast-related genes. Conclusion: Dietary restriction had detrimental effects on osseous healing, with a healing delay and a lower quality of bone callus formation.

Manejo de fractura en hueso patológico en la infancia: picnodisostosis / Management of fractures in pathological bone in childhood: pycnodysostosis

La picnodisostosis es una enfermedad poco común que pertenece a las displasias esqueléticas que presentan fragilidad ósea y fracturas frecuentes. Radiológicamente se caracteriza por incremento de la densidad y fragilidad óseas. OBJETIVO: Presentar el caso de un escolar con displasia esquelética con fracturas en hueso patológico y manejo quirúrgico. CASO CLÍNICO: Escolar de sexo femenino, con antecedente de picnodisostosis detectado en etapa preescolar. Consulta posterior a caída de bicicleta con fractura de ambos fémures que se manejan quirúrgicamente con placa de compresión bloqueada.

Pycnodysostosis is a rare condition within skeletal dysplasias presenting with brittle bones and frequent fractures. Radiologically, it is characterised by increased bone density and fragility. OBJECTIVE: To present the case of a primary schoolchild with skeletal dysplasia with pathological bone fractures and their surgical management. CASE REPORT: A female primary schoolchild with a history of pycnodysostosis detected during the pre-school period. She was seen after bicycle fall that resulted in the fracture of both femurs, that were surgically managed with a locking compression plate.

Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

Férula de acrílico y alambres circunmandibulares para el tratamiento de una fractura de mandíbula / Splint made from acrylic and circummandibular wires for treatment of mandible fracture

Se presenta el caso de una niña que sufrió una caída desde una altura de varios metros y presentó una fractura en el fémur izquierdo y en el cuerpo mandibular del lado izquierdo. Como tratamiento se empleó una férula de acrílico y alambres circunmandibulares para reducir y estabilizar la fractura de la mandíbula; la fractura del fémur fue reducida por método abierto con placa y tornillos. La férula se retiró a las semanas de la fractura. Se le realizó un seguimiento clínico y radiográfico durante 3 meses, y se constató una excelente evolución, con excelente consolidación ósea y oclusión. Los resultados demostraron la utilidad de este medio de fijación de fracturas, sobre todo porque es poco agresivo para los niños y con él se evitan muchas complicaciones(AU)

This is the case of a girl fell from some meters height and had a fracture of left femur and in the left side of mandibular body. As treatment we used an acrylic and circummandibular wires to reduce the mandible fracture; the femur's fracture was reduced by open method using plates and screws. A few weeks later splint was removed. A clinical and radiographic follow-up was made over three months, confirming an excellent course, bone consolidation and occlusion. Results showed the usefulness of this method of fracture's fixation mainly because it is not much aggressive for children avoiding in this way many complications(AU)

Surgical Management of Ipsilateral Fracture of the Femur and Tibia in Adults (the Floating Knee): Postoperative Clinical, Radiological, and Functional Outcomes

BACKGROUND: This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults. METHODS: Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years). RESULTS: The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1. CONCLUSIONS: The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.

Comparison of caulking gun and standard cement gun using for femoral cementation.

BACKGROUND: Currently the standard femoral cementing technique requires cement injection gun to deliver bone cement into the femoral canal. The standard cement gun is expensive and must be imported. There is no previous study about the use of a household caulking gun for femoral cementation. OBJECTIVE: To compare the radiographic quality of cementing technique in proximal femur between using standard cement gun and caulking gun. MATERIAL AND METHOD: Experimental study was performed on ten pairs of adult bovine femora. After the proximal femoral canal was prepared for cementation, each pair of bovine femora was randomly selected to be injected with bone cement with a standard cement gun in one side. The other side was injected with a caulking gun and the authors' invented kit. The prosthesis was inserted and radiographs were taken. Radiographic quality of cement interdigitation was evaluated by the modified Barrack's cement grading score. Cement distribution was categorized into 14 zones of Gruen. The data was statistically analyzed by Wilcoxon matched pairs signed-rank test. The inter-observer and intra-observer agreement was analyzed by Kappa analysis. RESULTS: Radiographic quality score of femoral cementation in the group using the caulking gun was not statistically different from in the group using the standard gun in all 14 Gruen zones (p > 0.05). Intra-observer and inter-observer agreement were moderate (Kappa = 0.71 and 0.59 respectively). CONCLUSION: The radiographic quality of femoral cementation using the caulking gun was not significantly different from the standard cement gun. The caulking gun and invented kit could be applied in clinical use and save the operative cost.

New implant and technique for valgus osteotomy with dynamic osteotomy plate

With the increased rate of orthopedic trauma especially proximal femur, neck femur fractures, non-union, malunion and hip osteoarthritis; and the increased production of instrumentation, we designed a new implant for valgus osteotomy with dynamic osteotomy plate. This implant overcomes a lot disadvantages occurred with the other implants. The aim of this work is to present this implant and its results in treating union problems [nonunion and malunion] in proximal femur and neck femur fractures. 30 patients with different hip problems were included in this study. From April 2000 to May 2005. 12 females and 18 males. Their age ranged from 21 to 68 years old. All patients submitted to a period of follow up [x-rays and clinical evaluation]. This study reported a significant results in early union, correction of the deformity and good hip range of movement with the use of the valgus osteotomy dynamic plate. In conclusion there is a marvelous results and better outcomes with use of this implant. This paper had been presented in: The 1st SGH group international orthopedic conference Riyadh, KSA in sept. 2002. The annual international congress of the EOA in nov. 2001 Heliopolis Sheraton Cairo Egypt. And the author was awarded

Biological fixation of complex fractures of tibia and femur with the use of standard plates and specially designed plates

Tibial and femoral fractures of high velocity injuries are managed in our department following principles of internal fixator with high rate of union, good surgical outcome regarding alignment, reduction and function with specially constructed plate making the reconstructive interlocking system of little interest. The radiological follow up shows earlier union with callus formation. The technique is simple and percutaneous under x-ray control. In late follow up there is preservation of the anatomy and respect of subtrochantric region. The number of cases is increasing now almost over a period of time of 5 years including different types of femoral and tibial fractures fresh and old and as we gained more experience we had extended the indications of biological fixation to include cases with mal and non-union. This paper had been presented,discussed and accepted in: The annual international congress of the EOA in december 2003 Mena House, Cairo, Egypt. And the author was awarded

Intertrochanteric fractures of the femur: results of treatment with 95 degrees Condylar Blade Plate.

The aim of the present study was to analyze patients treated with 95 degrees Condylar Blade Plate and to describe the technique that can prevent complications. 69 patients with closed intertrochanteric femoral fractures were treated by one surgeon using the 95 degrees Condylar Blade Plate, and it was found that 56 of them met the minimum 10 months follow up requirement. 53 patients (94%) healed after the procedure. There were 4 patients (7%) requiring surgical intervention. One patient required bipolar arthroplasty because of the cutting through of the implant, two patients needed repeated open reduction and internal fixation (ORIF) with bone graft due to delayed union and broken implant, and one patient had an infection which was resolved after debridement and a course of antibiotics. The surgical time averaged 45 minutes and blood loss averaged 150 ml. It appeared that open reduction and internal fixation using the 95 degrees Condylar Blade Plate was effective in treating patients with intertrochanteric femoral fractures. The surgical time and blood loss were minimized. Early patient rehabilitation was initiated, and the complications were decreased.

Results of surgical management of hypophosphatemic vitamin [D] resistant state

Hypophosphatemic rickets is the most common form of rickets seen in the developed communities. Intensive investigations recently had described several clinical forms of the disease in various age groups. This article presented the management results of six patients with hypophosphatemic vitamin D resistant rickets and osteomalacia. Two adolescents presented with bilateral lower limb deformities were treated with corrective osteotomies. Four adults presented with various pathological femoral fractures were managed by open reduction and internal fixation. The diagnosis was largely based on the typical biochemical profile which consistently showed hypophosphatemia with hypophosphatemia and reduced tubular re-absorption of phosphate. Other investigations were necessary to exclude similar forms of metabolic bone disease. Radiologically, non-specific ricketic changes in adolescents with looser zones in adults denoting metabolic nature of the disorder were seen in all cases. Increased bone density in axial skeleton with coarse widely spaced bone trabeculae in the pelvis were noted in adult males. All cases were started on combined regimen of vitamin D and oral phosphate supplement once the diagnosis was established. Apart from one incidence of delayed union in a pathologically fractured femur, all cases proceeded to union uneventfully

Endoscopic bone graft for delayed union and nonunion

We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.

A study of the role of osteotomy in unstable intertrochanteric fractures.

Osteotomy has been used in treatment of unstable intertrochanteric hip fractures in an attempt to increase the stability of the fracture fragments. We have assessed this stability in a randomised prospective study on 138 patients, all having been fixed by dynamic hip screen, comparing anatomical reduction with medialisation osteotomy. The groups were similar in terms of age, gender and fracture configuration. There was no difference in final results in both groups except that operation time was longer in osteotomy group and the blood loss was more. We found no clear benefit from osteotomy and therefore recommend anatomical reduction and fixation by a sliding hip screw in most cases. Rarely, a fracture configuration which does not allow anatomical reduction may benefit from an osteotomy.

Closed intramedullary nailing for femoral shaft fracture in Ratchaburi Hospital.

Forty-four patients with 44 femoral shaft fractures were treated by AO interlocking nail technique at Ratchaburi Hospital. All cases were comminuted, segmental or rotational unstable fractures caused by traffic accidents. All patients had more than 90 degrees flexion of the knee within 2 weeks and resumed full range of motion of the knee within 2 months post-operatively. There were no serious complications found in the period of 29 months follow-up. We conclude that the closed interlocking nail is one of the treatments of choice for comminuted, segmental or rotational unstable femoral shaft fractures.

Ipsilateral simultaneous femoral shaft and femoral neck fracture: valuable diagnostic signs

When fractures of both shaft and neck occur in the same femur the neck fracture is often missed; this may lead to complications such as avascular necrosis and non-union. Management of this fracture combination can be successful provided the diagnosis is made early. This paper is presented to demonstrate valuable diagnostic signs to avoid missing the femoral neck fracture; it is based on a clinical and radiological study of 8 patients with this fracture combination. The presence of an associated femoral neck fracture should be suspected if there is fullness and tenderness in the groin or over the greater trochanter of the affected limb. Radiologically, medial displacement of the proximal fragment of a transverse fracture of the shaft is almost always diagnostic of the associated hip injury