ABSTRACT
OBJECTIVE: Dynamization has already been described as a secondary intervention for delay unions of tibial shaft fractures treated with intramedullary nailing. Although it's a common procedure, it is not widely supported in the literature. The purpose of this study was to determine the union rate of nail dynamization in cases of delayed union of diaphyseal tibial fractures, and assess the effect of fracture morphology on union rates. MATERIALS AND METHODS: We retrospectively analyzed a series of 199 consecutive tibial shaft fractures. We recorded the dynamization rate, period from nailing to dynamization, nailing to the union, the fracture pattern (according to AO/ASIF and whether it was closed or open), the callus diameter before dynamization (fracture healing index; FHI) and union/failure rates. RESULTS: Out of a total of 199 fractures treated during the study period, 41 (20.6%) were dynamized. After applying inclusion and exclusion criteria, 39 patients with 39 fractures were included in the study. The mean time from nailing to dynamization was 18.4 ± 7.2 weeks. The union rate was 92.3% (n = 36) over a mean time of 14.1 ± 5.6 weeks as from dynamization. The overall failure rate was 6.7% (n = 3). There was no significant association between failure and AO/ASIF classification (p > 0.05) or fracture exposure (X 2 = 0.19; p = 0.66). The pre-dynamization FHI of ≥ 1.17 was significantly associated with consolidation (p < 0.05). CONCLUSION: In cases of delayed union of tibial fractures, dynamization offered a high union rate associated with pre-dynamization FHI, while fracture morphology did not affect the failure rate.
ABSTRACT
Nonunion fractures occur frequently in humans, with profound implications (medical and non-medical). Although there are numerous animal models to study pathogenesis and treatment of nonunion fractures, there is apparently the lack of a definitive model for atrophic nonunion fracture. Therefore, the objective was to develop a low-cost rat model of nonunion fracture with a vascular deficit that enabled standardized quantitative analysis of bone growth and regeneration. The model was developed with two surgeries, performed apart. The first involved osteotomy of the femur diaphysis, removal of periosteum and endosteum, isolation of the fracture site using a latex artefact (Penrose drain tube), and reduction of the fracture using an intramedullary pin, whereas the second surgery was to remove the latex artefact. Based on radiographic imaging, micro-CT and histological analyses done 125 days after the fracture was induced, there was clear evidence of atrophic nonunion fracture, without pin migration or specimen loss. Perceived advantages of this model included low cost, ease of reproducibility, lack of specimen loss, and, finally, the potential to assess bone growth and regeneration under poor vascular conditions.
Subject(s)
Femoral Fractures/pathology , Fracture Fixation , Fractures, Malunited/pathology , Microradiography , Osteotomy/methods , Animals , Atrophy , Biomechanical Phenomena , Disease Models, Animal , Fracture Healing , Rats , Reproducibility of ResultsABSTRACT
A doença da fratura caracteriza-se por alterações ósseas e musculares decorrentes de falhas entre o contatoósseo, complicações causadas pelo acesso cirúrgico e contaminação no foco de fratura. Tais alteraçõessão importantes, pois afetam diretamente no tempo de cicatrização óssea além de interferir no sucesso cirúrgico.Este trabalho tem como objetivo realizar uma breve revisão de literatura sobre a patogenia destasprincipais alterações ósseas em pequenos animais,bem como as suas formas de tratamento e profilaxia.AU
The fracture disease is characterized by bone and muscle changes resulting from failures between contact bone,complications caused by surgical access and contamination in the fracture. These changes are important becausethey affect directly the time of fracture healing and surgical success. This paper aims to show a short reviewabout the pathogenesis of these bony changes in small animals and main forms of treatment and prophylaxis.AU
Subject(s)
Animals , Fractures, Bone/veterinary , Quadriceps MuscleABSTRACT
A doença da fratura caracteriza-se por alterações ósseas e musculares decorrentes de falhas entre o contatoósseo, complicações causadas pelo acesso cirúrgico e contaminação no foco de fratura. Tais alteraçõessão importantes, pois afetam diretamente no tempo de cicatrização óssea além de interferir no sucesso cirúrgico.Este trabalho tem como objetivo realizar uma breve revisão de literatura sobre a patogenia destasprincipais alterações ósseas em pequenos animais,bem como as suas formas de tratamento e profilaxia.
The fracture disease is characterized by bone and muscle changes resulting from failures between contact bone,complications caused by surgical access and contamination in the fracture. These changes are important becausethey affect directly the time of fracture healing and surgical success. This paper aims to show a short reviewabout the pathogenesis of these bony changes in small animals and main forms of treatment and prophylaxis.