Cefazolin-sodium has no adverse effect on fracture healing in an experimental rabbit model.

OBJECTIVES: This study aims to investigate whether cefazolin-sodium has any adverse effect on fracture healing in an experimental rabbit model. MATERIALS AND METHODS: The study was performed on 50 male New-Zealand white rabbits. Under general anesthesia, closed double fracture of middle one-third of the tibia-fibula of the left lower extremity of the subjects was produced by manual compression followed by closed reduction of fracture and long leg circular cast was applied. Subjects were divided randomly into five groups including 10 rabbits in each group. The first and second group were administered ciprofloxacin 50 mg/kg SC bid and cefazolin-sodium 50 mg/kg IM on the seventh day of fracture. The third group was applied a single high-dose of vitamin D (50.000 IU/kg) IM following fracture. The fourth group was applied daily vitamin E (alpha tocopherol) 20 mg/kg IM for five days from one hour before the production of fracture. Control group did not receive any treatment before and after fracture. Initial and control X-ray examinations were performed immediately and four weeks after production of fracture, respectively. At the end of the fourth week, animals were sacrificed and a histological examination of the fracture site was performed. RESULTS: Histological evaluation showed that the histological grade of the fracture healing was significantly lower in the ciprofloxacin group, while it was significantly higher in the cefazolin-sodium, vitamin D and vitamin E groups, compared to control group (p<0.005). CONCLUSION: Significantly improved histological grade of the fracture healing in subjects treated with cefazolin-sodium than controls suggest that it may be reasonable to choose cefazolin-sodium as an antibiotic therapy for the treatment of infection in patients with bone fractures.

A complex injury of the distal ulnar physis: a case report and brief review of the literature.

Physeal fractures of the distal forearm are common injuries in children and adolescents. However, Salter-Harris type III and type IV fractures of the distal ulnar epiphysis are often high-energy injuries that require open reduction for restoration of anatomical alignment. These injuries are uncommon and there are few descriptions of them in the contemporary literature. Here we report the case of a 13-year-old boy with a type IV distal ulna fracture not diagnosed with standard radiography. After closed manipulation, an incompletely reduced physis was suspected on the basis of fluoroscopic imaging and comparison radiographs of the contralateral wrist. Computed tomography showed a large, displaced physeal fragment. The patient underwent open reduction and internal fixation. Thorough radiographic assessment should be conducted when there is a high suspicion for these fracture patterns. Appropriate diagnosis can lead to expedient reduction and expectant management of sequelae associated with these injuries.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Manipulation of nasal fractures under local anaesthetic: a convenient method for the Emergency Department and ENT clinic.

BACKGROUND: Nasal fractures are the commonest facial fracture. They can cause morbidity in terms of nasal obstruction and cosmesis. They can be treated by simple external digital manipulation, provided they are seen and assessed in a timely fashion. This manipulation is commonly done under general anaesthetic (GA), which utilises precious resources and may cause delays in treatment. SUMMARY OF EVIDENCE FOR PROPOSED METHOD: A recent comprehensive systematic review has shown local anaesthetic (LA) to be comparable to GA in terms of cosmesis, airway patency and patient acceptability. The experience for the patient is akin to that of a dental filling, and can be made more painless with the use of topical anaesthesia. PROPOSED METHOD: In the current age of evidence-based medicine and drive for cost-effective management decisions, it is thought that LA manipulation may offer a superior option to GA. A simple method for manipulation under LA is presented that can be done in the Emergency Department.

Pharmacokinetics of cefuroxime in traumatic wound secretion and antibacterial activity under vacuum therapy.

The objective of this study was to investigate the pharmacokinetics of cefuroxime in wound secretion and the antibacterial activity of the traumatic wound secretion in patients receiving cefuroxime and in those not receiving antibiotics. Included in the present controlled, prospective, non-randomized study were 12 patients with an open fracture who needed vacuum therapy (group A) and 12 patients with a closed fracture, who, due to soft tissue damage, also underwent treatment with vacuum therapy (group B). Wound secretion was obtained on the first, third and fifth postoperative days and exposed to the test bacteria, Staphylococcus aureus and Staphylococcus epidermidis. Patients in group A underwent systemic antibiotic treatment with cefuroxime administered intravenously at a dose of 1.5 g every 8 hours. Patients in group B did not receive antibiotics. Cefuroxime concentrations were determined using high-performance liquid chromatography (HPLC). Antibacterial activity was determined using the inhibition test. Maximum cefuroxime concentrations in wound secretion were measured at 4-5 hours following intravenous administration and, with a mean concentration of 10 mg/l, remained consistently above the minimum inhibitory concentration (MIC) for the test bacteria at all points during the measurement period. As expected, the antibacterial activity of the wound secretion in patients in group A (cefuroxime) was higher than that in group B (no antibiotics). In group A, antibacterial activity against S. aureus was 94.6% and 100% against S. epidermidis. In group B, antibacterial activity against S. aureus was 61% and 81% against S. epidermidis. Cefuroxime reaches the highest level in wound secretion after 4 hours. The high antibacterial activity of the wound secretion in traumatic closed fractures is elevated by cefuroxime. in addition, our findings show that vacuum therapy of wounds is suitable as a non-invasive method for studying the pharmacokinetics of antibiotics.

Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques.

UNLABELLED: The aim of the current study of nasal bone fracture reduction carried out under topical, local, and general anesthesia was to suggest a proper treatment of patients with nose fractures. METHOD: The patient candidates for close nasal bone reduction (CNR) were divided into 3 groups: topical anesthesia (TA), local anesthesia (LA), and general anesthesia (GA), and CNR was performed. After reduction, pain scores and satisfaction and failure rates after 2 and 30 days were noted. All the patients were followed up for at least 1 month. RESULTS: The mean pain scores (TA = 2.35, LA = 2.47, and GA = 1.9) showed no significant difference among these 3 groups (P > 0.05). The percentages of the patients' satisfaction in the groups were as follows: TA = 84.6%, LA = 83.8%, and GA = 91.7%. These values had no statistical difference (P > 0.05). There was no significant difference among the failure rates on the second day and after 1 month of follow-up (after 2 d, TA = 10%, LA = 18%, and GA = 14%, and after 1 month, TA = 2%, LA = 7%, and GA = 5%). CONCLUSIONS: If the selection of patients is done properly, CNR under TA/LA will have considerable success in comparison with GA. Topical anesthesia is suggested in simple nasal fracture with unilateral depression or minimal displacement.

[Therapeutic effects of multi-stage manipulative reduction and splint fixation in 22 patients with tibia shaft fracture].

OBJECTIVE: To study the method and effects of multi-stage manipulative reduction and homemade splint fixation in the treatment of tibia shaft fractures. METHODS: Twenty-two patients (16 male and 6 female) were involved the retrospective study. The average age was 33 years (from 6 to 54 years). Single tibia shaft fracture was in 15 cases and tibiofibular fracture in 7 cases. Fracture site: 3 cases were in the upper part of the tibia, 4 in the middle part and 15 in the lower part. Fracture pattern: oblique fracture was in 8 cases, spiral fracture in 5 cases, comminuted fracture in 4 cases and transverse fracture in 5 cases. All the patients were treated with multi-stage manipulative reduction and homemade splint fixation. RESULTS: All the patients were followed up from 3 to 15 months (mean 6 on months). There were malunion of fracture in 1 case, delayed union in 1 case and nonunion in 1 case. The results were excellent in 18 cases, good in 3 cases and poor in 1 case according to WANG Xu-dong assessment criteria. CONCLUSION: On the base of traditional manipulative reduction and splint fixation, multi-stage manual correction could stabilize the broken part and prevent displacement. It had the characteristics of easy operation, reliable fixation, rapid union of fracture, few complications and influences on joint function. Multi-stage manipulative reduction and homemade splint fixation is one of the most reliable methods for closed tibia fracture.

The practice of traditional bonesetting: training algorithm.

Traditional bonesetters (TBS) have been in Nigeria for centuries. Up to 85% of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Nigeria. We attempted to document the current practice of TBS in Ibadan and their methods of fracture treatment with a view to training and improving the services offered by them. We carried out a literature search to review all previous studies on traditional bonesetters' practice and visited a few of them to document their current practice. The only change in the management of fractures by the TBS over the past 28 years was the use of spiritual methods of healing to treat open comminuted fractures; a technique for which no scientific basis was readily discernible. There is a need to educate and train the TBS in effective management of both open and closed fractures. Such training should be provided by orthodox orthopedic surgeons with a view to minimizing mismanagement of fractures. To this end, we propose a training algorithm.

[Manipulative reduction and splint fixation for the treatment of middle and lower segment fracture of ulnar and radius].

OBJECTIVE: To investigate the outcome of manipulative reduction and splint fixation for treatment of middle and lower fractures of ulnar and radius. METHODS: Sixty-eight patients with lower segment fractures of ulnar and radius included 46 male and 22 female, aged from 1 to 26 years. The course was from 10 min to 1 week. There were 39 cases in right and 29 in left; 45 in inferior segment and 23 in middle segment. All cases were closed fractures. According to fracture displacement, different methods of manipulation and splint or plaster splint fixation were used to reduction and fixation. RESULTS: Sixty-eight patient were followed-up for 0.5 to 1 year (mean 8 months), the fractures were all healing. According to the effective evaluation criteria, the results were excellent in 57 cases, good in 11. X-ray film showed anatomic reduction in 38 cases, similar to anatomic reduction in 20, functional reduction in 10. CONCLUSIONS: Manipulative reduction and splint fixation for the treatment of the ulnar and radial bone fractures is a method of simple, minimally invasive, effective and functional advantages of quick recovery.

The role of the traditional bonesetter in primary fracture care in Nigeria.

BACKGROUND: In view of the growing interest in the management of fracture worldwide, the traditional bonesetter (TBS) practice in Nigeria was documented. OBJECTIVE: To highlight the role of the TBS in primary fracture care in Nigeria. SETTING: Rural. STUDY DESIGN: Over a 5-year period a qualitative study of the TBS settings and knowledge, diagnostic techniques and principles of fracture treatment in four TBS centres in Nigeria was carried out by active participation, on the spot assessment, interactive dialogues and oral interviews. RESULTS: It was found that TBS services are well preserved as a family practice, and training is by apprenticeship. Records are kept by oral tradition. There is no prescribed fee and the patronage is high. Fracture diagnosis is based on physical assessment and experience. The TBS relies solely on the conservative method of fracture treatment, and all fractures are reduced by the closed method and stabilised with an external traditional splint and a protracted period of immobilisation. The outcome of TBS treatment is good for closed fractures of the shaft of the humerus, ulna, radius and tibia, but poor for peri-articular and open fractures. Non-union, malunion, traumatic osteomyelitis and limb gangrene were the common major complications of TBS treatment. CONCLUSION: Despite criticisms and antagonism from orthodox medical practitioners TBS practice is well patronised by Nigerians. In order to guarantee safety and efficiency of the TBS practice in primary fracture care service delivery in Nigeria, there is therefore a need both to educate the community and to train the TBS.

Initial management of closed fracture-dislocations of the ankle.

BACKGROUND: Immediate management of closed fracture-dislocations of the ankle requires urgent reduction and immobilisation of the ankle prior to definitive surgery. METHODS: The management of 23 patients attending the accident and emergency department of a district general hospital with this type of injury were reviewed retrospectively. RESULTS: Paramedic reduction was attempted in 1 of the 22 patients brought by ambulance. Triage categorisation was inappropriate in 14 patients. Unnecessary pre-reduction radiographs were obtained in 8 patients. Reduction was initially inadequate in 2 patients, and no post-reduction splintage was applied in a further 2 patients. Recording of skin and neurovascular status was inadequate in the majority of the patient's notes. CONCLUSIONS: The necessary urgent reduction and splintage is being delayed in some cases because of inadequate injury recognition, inappropriate triage categorisation and unnecessary radiographs.

Extracto de Aloe barbadensis inyectable en fracturas experimentales / Injectable extract of Aloe barbadensis in experimental fractures

El Aloe barbadensis inyectable (A. barbadensis), es un producto farmacéutico que tiene la propiedad de estimular la cicatrización de heridas. Basado en ello, a un modelo de fractura cerrada de tibia se le administró 3 dosis diferentes de A. barbadensis por vía subcutánea para estudiar su acción sobre el callo óseo. Las dosis de 0,03; 0,1 y 0,18 mg/kg estimularon la cicatrización ósea de forma significativa (p < 0,05). También fue observada una elevación de los valores de hemoglobina además de un descenso de calcio y fósforo sanguíneos en los animales tratados(AU)

Electrical and ultrasound stimulation for scaphoid fractures.

The standard treatment for delayed union or nonunion of the scaphoid is operative management. Electrical stimulation has been employed in these clinical situations in patients unable or unwilling to undergo surgical intervention. Recent interest has also focused on the use of low-intensity ultrasound as an adjunct to healing in distal radius and tibial fractures. Results with the use of ultrasound for scaphoid fractures is encouraging. A review of the mechanisms of action, clinical results, and possible indications is presented for these two nonoperative modalities.

Hypnosis for pediatric fracture reduction.

Hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures. While hypnosis has been used for millennia and was demonstrated to be of use in clinical medicine more than a century ago, modern physicians have been reluctant to adopt this technique in clinical practice. This article describes four children with angulated forearm fractures who had no possible access to other forms of analgesia during reduction, and in whom hypnosis was used successfully. A simple method for hypnotic induction is described.

The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures.

Fracture manipulation in the emergency department often requires some method of anesthesia. This study evaluates the efficacy and safety of the hematoma block in patients with closed, isolated fractures requiring manipulative reduction. Sixty-one patients treated with a hematoma block (HB group) prior to fracture manipulation were compared with 53 patients treated with either intravenous sedation or "conscious sedation" (NHB group). Using a pain analog scale, patients rated their pain from 1 (no pain) to 10 (severe pain) both prior to and during fracture manipulation. A pain differential score was calculated for each group. Results demonstrated pain differential scores of 2.7 and 0.8 for the HB and NHB groups, respectively. There were no complications associated with any of the procedures. Based on these results, we conclude that the hematoma block is an effective and safe method of providing anesthesia for fracture reduction in select patients.

Hematoma block for ankle fractures: a safe and efficacious technique for manipulations.

The purpose of this study was to examine the safety and efficacy of the hematoma block technique for closed ankle fracture manipulation. Twenty-three patients received a hematoma block with or without supplemental analgesia and/or sedation for the manipulative reduction of an ankle fracture, and 37 patients received parenteral agents alone. At an average of 12 months post-reduction, patients were administered a questionnaire concerning their level of discomfort surrounding the manipulation of their acute injury. Their experienced level of pain was recorded on a pain analog scale at the time of injury, at the time of reduction, and at the time of the questionnaire. Other queries were made regarding their recall of other aspects of their acute care treatment. The hematoma block group noted their pain differential to be 3.4 less during reduction compared with the time of injury. In the 17% subgroup of hematoma block patients who received no supplemental parenteral analgesia, the pain differential was noted to be 4.5 less during reduction. This was in contrast to the non-hematoma block group, which rated their pain differential to be 0.6 between injury and reduction. In addition, the hematoma block procedure resulted in no associated complications. The results of this study led us to conclude that the hematoma block with or without supplemental analgesia for the manipulation of ankle fractures was safe and effective and is a useful technique. This is particularly true in those patients in whom an adequate dosage of parenteral medication is contraindicated or unsafe.

The use of electricity in bone healing.

The history of electrical bone healing and the vast amount of laboratory and clinical data that support its efficacy are reviewed. The paper presents guidelines for the proper use of electrical stimulation and a description of the various systems available. The use of electrical stimulation to treat scaphoid fractures is covered in detail. Contraindications to the use of electrical stimulation are also addressed.