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1.
BMC Musculoskelet Disord ; 25(1): 353, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724941

RESUMO

BACKGROUND: External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method's feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators. METHODS: A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon's diagnosis based on the clinical and radiological assessment (bone union achieved). RESULTS: No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05). CONCLUSION: The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice.


Assuntos
Remoção de Dispositivo , Fixadores Externos , Fixação de Fratura , Consolidação da Fratura , Fraturas da Tíbia , Humanos , Feminino , Fraturas da Tíbia/cirurgia , Masculino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Remoção de Dispositivo/métodos , Suporte de Carga , Adulto Jovem , Idoso , Estudos de Viabilidade , Desenho de Equipamento
2.
Medicine (Baltimore) ; 103(18): e37979, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701293

RESUMO

Older children over 8 years old are at higher risk of elbow joint stiffness after treatment of supracondylar humeral fractures. The objective of this study was to improve the Slongo's external fixation system for treating supracondylar humeral fractures in older children. This would be achieved by increasing fixation strength and providing a theoretical basis through finite element analysis and mechanical testing. A 13-year-old female patient with a history of previous fracture was selected for CT data processing to create a three-dimensional model of the distal humerus fracture. Two internal fixation models were established, using the Slongo's external fixation method with Kirschner wire (Group A) and modifying the Slongo's external fixation (Kirschner wire tail fixation) (Group B). The fracture models were then subjected to mechanical loading analysis using Finite Element Analysis Abaqus 6.14 software to simulate separation, internal rotation, and torsion loads. A PVC humeral bone model was used to create a supracondylar fracture model, and the A and B internal fixation methods were applied separately. The anterior-posterior and torsional stresses were measured using the Bose Electroforce3510 testing system, followed by a comparative analysis. The finite element simulation results showed that under the same tensile, torsion, and inversion forces, the osteotomy model fixed with Kirschner wire at the distal end in Group B exhibited smaller tensile stress and deformation compared to the unfixed osteotomy model in Group A. This indicated that the fixation strength of Group B was superior to that of Group A. According to the test results of the Bose Electroforce3510 testing system, a simple linear regression analysis was conducted using SPSS software. The K values of rotation angle-torque tests and front and rear displacement-stress tests were calculated for Groups A and B, with Group B showing higher values than Group A. The results of this study supported the significantly enhanced biomechanical reliability and stability of fracture fixation in Group B, which utilized the modified Slongo's external fixation (Kirschner wire tail fixation). This optimized method provides a new choice for the clinical treatment of supracondylar humeral fractures in older children, backed by both clinical evidence and theoretical basis.


Assuntos
Fixadores Externos , Análise de Elementos Finitos , Fixação de Fratura , Fraturas do Úmero , Humanos , Fraturas do Úmero/cirurgia , Feminino , Adolescente , Fixação de Fratura/métodos , Fios Ortopédicos , Fenômenos Biomecânicos , Tomografia Computadorizada por Raios X
3.
BMC Musculoskelet Disord ; 25(1): 284, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38609889

RESUMO

BACKGROUND: The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection. METHODS: Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification. RESULTS: A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B. CONCLUSIONS: Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.


Assuntos
Fixadores Externos , Osteopatia , Humanos , Estudos Retrospectivos , Fixação de Fratura , Fixadores Internos
6.
Sci Rep ; 14(1): 9544, 2024 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664538

RESUMO

To compare the biomechanical properties of several anterior pelvic ring external fixators with two new configurations in the treatment of Tile C pelvic fractures, in order to evaluate the effectiveness of the new configurations and provide a reference for their clinical application. A finite element model of a Tile C pelvic ring injury (unilateral longitudinal sacral fracture and ipsilateral pubic fracture) was constructed. The pelvis was fixed with iliac crest external fixator (IC), anterior inferior iliac spine external fixator (AIIS), combination of IC and AIIS, combination of anterior superior iliac spine external fixator (ASIS) and AIIS, and S1 sacroiliac screw in 5 types of models. The stability indices of the anterior and posterior pelvic rings under vertical longitudinal load, left-right compression load and anterior-posterior shear load were quantified and compared. In the simulated bipedal standing position, the results of the vertical displacement of the midpoint on the upper surface of the sacrum are consistent with the displacement of the posterior rotation angle, and the order from largest to smallest is IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. The longitudinal displacement of IC is greater than that of the other models. The displacements of ASIS + AIIS and IC + AIIS are similar and the latter is smaller. In the simulated semi-recumbent position, the vertical displacement and posterior rotation angle displacement of the midpoint on the upper surface of the sacrum are also consistent, ranking from large to small: IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. Under the simulated left-right compression load state, the lateral displacements of the highest point of the lateral sacral fracture end are consistent with the highest point of the lateral pubic fracture end, and the order from large to small is S1 screw, IC, AIIS, ASIS + AIIS and IC + AIIS, among which the displacements of S1 screw and IC are larger, and the displacements of ASIS + AIIS and IC + AIIS are similar and smaller than those of other models. The displacements of IC + AIIS are smaller than those of ASIS + AIIS. Under the simulated anterior-posterior shear load condition, the posterior displacements of the highest point of the lateral sacral fracture end and the highest point of the lateral pubic fracture end are also consistent, ranking from large to small: IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. Among them, the displacements of IC and AIIS are larger. The displacements of ASIS + AIIS and IC + AIIS are similar and the latter are smaller. For the unstable pelvic injury represented by Tile C pelvic fracture, the biomechanical various stabilities of the combination of IC and AIIS are superior to those of the external fixators of conventional configurations. The biomechanical stabilities of the combination of ASIS and AIIS are also better than those of the external fixators of conventional configurations, and slightly worse than those of the combination of IC and AIIS. Compared with sacroiliac screw and conventional external fixators, the lateral stabilities of IC + AIIS and ASIS + AIIS are particularly prominent.


Assuntos
Fixadores Externos , Fraturas Ósseas , Ossos Pélvicos , Humanos , Fenômenos Biomecânicos , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Fraturas Ósseas/cirurgia , Fixação de Fratura/métodos , Fixação de Fratura/instrumentação , Análise de Elementos Finitos , Sacro/lesões , Sacro/cirurgia , Parafusos Ósseos
7.
Proc Inst Mech Eng H ; 238(4): 403-411, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38602217

RESUMO

External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient's risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound (n = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent (p < 0.05) and (p < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample (p < 0.05) and (p < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis.


Assuntos
Fixadores Externos , Fixação de Fratura , Humanos , Fixação de Fratura/métodos , Infecção da Ferida Cirúrgica/terapia , Interleucina-8 , Pinos Ortopédicos , Cicatrização/fisiologia
8.
Sci Rep ; 14(1): 7724, 2024 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-38565922

RESUMO

Transarticular external skeletal fixation (TESF) is repeatedly used for temporary stabilisation of tarsal joint in cats. Hence, this study aimed to evaluate the use of temporary modified type II TESF for management of talocrural instability (TCI) in cats without joint arthrodesis and to rate short-term outcomes and complications. Medical records of all cats treated for TCI between January 2012 and December 2021 were reviewed. Information was collected including signalment, degree of lameness, type of TCI, accompanying soft tissue and bone injuries, and post-operative follow-up assessment including time of frame removal, complications, degree of lameness, range of joint motion and ankylosis. Surgical management didn't involve debridement of the articular cartilage. Eighty-five percent of cats had satisfactory joint stability at the time of frame removal. Eighteen cats exhibited minor complications, six cats had major complications, and 8 cats showed persistent lameness. All cats showed reduction of joint motion range by 20°-30° directly after frame removal while returned to normal in 79% of cats 4 weeks later. Variable degrees of joint ankylosis were reported. In conclusion, this study supports the use of temporary modified type II TESF for management of TCI in cats without joint involvement as an excellent alternative to tarsal arthrodesis.


Assuntos
Anquilose , Luxações Articulares , Gatos , Animais , Fixadores Externos/veterinária , Coxeadura Animal , Fixação de Fratura , Luxações Articulares/cirurgia , Anquilose/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
9.
J Pak Med Assoc ; 74(3): 440-444, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38591274

RESUMO

Objective: To determine the combined column tibial plateau fracture treated with a hybrid external fixator in terms of knee functionality, union outcome and complications. METHODS: The quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore, Pakistan, from July 5, 2019, to December 31, 2021, and comprised patients of either gender aged 20-50 years who presented with 2-column or 3-column fractures of proximal tibia classified according to the 3-column classification system after being diagnosed using radiographs and three-dimensional computed tomography scan. Knee function, union and complications, like neural, vascular, infection, delayed union, nonunion, malunion and implant failure, were evaluated. The Knee Society Score was used to assess knee function, and modified Rasmussen score for the union, while complications were assessed clinically on the 2nd, 6th, 12th, 16th, 24th, 36th weeks and one year post-operatively. Data was analysed using SPSS 26. RESULTS: Of the 113 patients, 91(80.53%) were males and 22(19.47%) were females. The overall mean age was 35.56±9.00 years. From the 12th week to the 24th week 45(39.83%) patients had good and 59(52.21%) patients had excellent functional outcomes. Union outcome in the 16th and 24th week was good in 57(50.44%) patients and excellent in 47(41.59%) patients. No neurovascular injury was observed. Superficial pin tract infection was observed in 21(18.6%) cases that healed with wound debridement and antibiotics. No delayed union, malunion and implant failure was observed. CONCLUSIONS: Good to excellent functional and union outcomes with minimum complications were observed with the hybrid external fixator.


Assuntos
Fraturas da Tíbia , Fraturas do Planalto Tibial , Masculino , Feminino , Humanos , Adulto , Resultado do Tratamento , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Fixadores Externos , Fixação de Fratura/métodos , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos
10.
J Orthop Surg Res ; 19(1): 231, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38589910

RESUMO

BACKGROUND: Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS: We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS: The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION: Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.


Assuntos
Fraturas Ósseas , Distúrbios do Início e da Manutenção do Sono , Humanos , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/etiologia , Fixadores Externos , Estudos Retrospectivos , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fenômenos Físicos
11.
J Back Musculoskelet Rehabil ; 37(3): 611-616, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38517767

RESUMO

BACKGROUND: The clavicle is recognized as the bone most vulnerable to fractures. Moreover, approximately 80% of fractures occur in the middle third of the clavicle. Conservative treatment is associated with a higher rate of nonunion, while surgical treatment of fracture via internal fixation may have a variety of postoperative complications. Therefore, to improve patient satisfaction and reduce the complications related to internal fixation techniques, we modified the surgical approach to external fixation. OBJECTIVE: The purpose of this study was to assess the modified intervention's prospects for clinical application. METHODS: A total of 36 patients with middle clavicle fractures were treated with screw-rod external fixation between April 2015 and October 2019. We observed the operative time, intraoperative blood loss, length of hospital stay, and fracture healing time. The patients were followed up regularly, and the clinical efficacy of the modified intervention was evaluated. Finally, the patients' shoulder function was assessed based on the disabilities of the arm, shoulder, and hand (DASH) score. RESULTS: For the screw-rod external fixation, the mean operative time was found to be 48.6 ± 6.8 min, the intraoperative blood loss was 30.6 ± 17.2 mL, the length of hospital stay was 4.5 ± 1.5 days, and the fracture healing time was 2.8 ± 0.4 months. Eventually, all the patients healed well, with the combined "excellent" and "good" rate of shoulder function being assessed to be as high as 94.44%. Furthermore, the DASH scores were all less than 10, with the average score being 4.65 ± 3.34. CONCLUSIONS: The screw-rod external fixation technique offers the advantages of convenience, reliability, and good aesthetics, suggesting that it could be used as an alternative treatment method for fractures of the middle third of the clavicle.


Assuntos
Clavícula , Fraturas Ósseas , Humanos , Clavícula/lesões , Clavícula/cirurgia , Feminino , Masculino , Adulto , Fraturas Ósseas/cirurgia , Pessoa de Meia-Idade , Fixação de Fratura/métodos , Consolidação da Fratura/fisiologia , Duração da Cirurgia , Tempo de Internação , Resultado do Tratamento , Parafusos Ósseos , Fixação Interna de Fraturas/métodos
12.
Foot Ankle Int ; 45(5): 446-455, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38501715

RESUMO

BACKGROUND: For the temporary treatment of ankle fracture dislocations (AFDs), previous studies indicate higher rates of secondary loss of reduction (LOR) with splint immobilization, prompting consideration for expanding indications for external fixation (ExFix). However, these studies did not investigate the influence of fracture morphology to further improve patient selection. The aim of this study was to investigate the influence of Lauge-Hansen injury type on the LOR rate in bimalleolar or trimalleolar AFDs for temporary cast vs ExFix immobilization. METHODS: In this retrospective cohort study, patients with isolated AFD cases treated at our institution from 2011 to 2020 were reviewed. Inclusion criteria required radiographs depicting initial dislocation and appropriate reduction after Cast or ExFix immobilization. Exclusion criteria encompassed concomitant injuries, open fractures, conservative management as well as surgery performed within 48 hours or at a different facility. Patients were grouped by temporary treatment (Cast or ExFix). The primary endpoint was LOR prior to definitive surgery across various Lauge-Hansen types. RESULTS: The LOR rate was significantly higher in the cast group (40/152, 26.3%) compared to the ExFix group (5/191, 2.6%; P < .0001). In the cast group, LOR was associated with an increase in time to definitive surgery by a mean of 3 days (P < .002). During cast treatment, LOR was significantly more likely for pronation abduction (P = .001) and supination external rotation injuries (P < .0001), whereas no significant differences were observed for pronation external rotation (P = .006), supination adduction (P > .99), and fractures not classifiable (P > .99). CONCLUSION: In cases of AFDs resulting from supination external rotation or pronation abduction trauma according to the Lauge-Hansen classification, especially in the setting of an additional posterior malleolar fracture, primary application of external fixation should be considered to reduce the risk for secondary loss of reduction. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Fraturas do Tornozelo , Moldes Cirúrgicos , Fratura-Luxação , Humanos , Fraturas do Tornozelo/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Fratura-Luxação/cirurgia , Fixação de Fratura/métodos , Idoso , Estudos de Coortes
14.
Acta Biomater ; 179: 354-370, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38490481

RESUMO

Fracture fixation in an ageing population is challenging and fixation failure increases mortality and societal costs. We report a novel fracture fixation treatment by applying a hydroxyapatite (HA) based biomaterial at the bone-implant interface and biologically activating the biomaterial by systemic administration of a bisphosphonate (zoledronic acid, ZA). We first used an animal model of implant integration and applied a calcium sulphate (CaS)/HA biomaterial around a metallic screw in the tibia of osteoporotic rats. Using systemic ZA administration at 2-weeks post-surgery, we demonstrated that the implant surrounded by HA particles showed significantly higher peri­implant bone formation compared to the unaugmented implants at 6-weeks. We then evaluated the optimal timing (day 1, 3, 7 and 14) of ZA administration to achieve a robust effect on peri­implant bone formation. Using fluorescent ZA, we demonstrated that the uptake of ZA in the CaS/HA material was the highest at 3- and 7-days post-implantation and the uptake kinetics had a profound effect on the eventual peri­implant bone formation. We furthered our concept in a feasibility study on trochanteric fracture patients randomized to either CaS/HA augmentation or no augmentation followed by systemic ZA treatment. Radiographically, the CaS/HA group showed signs of increased peri­implant bone formation compared with the controls. Finally, apart from HA, we demonstrated that the concept of biologically activating a ceramic material by ZA could also be applied to ß-tricalcium phosphate. This novel approach for fracture treatment that enhances immediate and long-term fracture fixation in osteoporotic bone could potentially reduce reoperations, morbidity and mortality. STATEMENT OF SIGNIFICANCE: • Fracture fixation in an ageing population is challenging. Biomaterial-based augmentation of fracture fixation devices has been attempted but lack of satisfactory biological response limits their widespread use. • We report the biological activation of locally implanted microparticulate hydroxyapatite (HA) particles placed around an implant by systemic administration of the bisphosphonate zoledronic acid (ZA). The biological activation of HA by ZA enhances peri­implant bone formation. •Timing of ZA administration after HA implantation is critical for optimal ZA uptake and consequently determines the extent of peri­implant bone formation. • We translate the developed concept from small animal models of implant integration to a proof-of-concept clinical study on osteoporotic trochanteric fracture patients. • ZA based biological activation can also be applied to other calcium phosphate biomaterials.


Assuntos
Durapatita , Osteogênese , Ácido Zoledrônico , Animais , Ácido Zoledrônico/farmacologia , Durapatita/química , Durapatita/farmacologia , Feminino , Humanos , Osteogênese/efeitos dos fármacos , Medicina Regenerativa/métodos , Ratos , Ratos Sprague-Dawley , Fixação de Fratura , Idoso , Difosfonatos/farmacologia , Difosfonatos/química , Idoso de 80 Anos ou mais , Masculino
15.
Artigo em Inglês | MEDLINE | ID: mdl-38537115

RESUMO

INTRODUCTION: External fixation of unstable ankle injuries is commonly done by orthopaedic surgeons. An improper technique can negate the benefits of the procedure and necessitate revision. This study sought to determine the risk factors for revision of external fixation of unstable ankle injuries. METHODS: Retrospective cohort at a level I academic trauma center of 120 consecutive patients underwent external fixation of an unstable ankle injury. Exclusion criteria included external fixation for reason other than fracture, inadequate intraoperative imaging, skeletal immaturity, and follow-up less than 30 days. Primary outcome measurement was revision of external fixation within 30 days. RESULTS: Ninety-seven patients met inclusion criteria. Eighteen (18.6%) underwent revision within 30 days of whom 5 (28%, P < 0.001) had a poor reduction intraoperatively. No patients with a good reduction required revision. Revised patients had a significantly higher talar tilt (P < 0.001) and were more likely to lack a first metatarsal pin (P = 0.018). Multivariate analysis revealed talar tilt >0.5° (odds ratio, 22.62; 95% confidence interval, 6.52 to 50.63) as an independent risk factor for revision. DISCUSSION: For external fixation of unstable ankle injuries, poor reduction quality is a risk factor for need for revision surgery. Orthopaedic surgeons should be critical of their final intraoperative assessment to prevent revision.


Assuntos
Traumatismos do Tornozelo , Fixação de Fratura , Humanos , Estudos Retrospectivos , Fixação de Fratura/métodos , Fixadores Externos , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Fatores de Risco
16.
J Mech Behav Biomed Mater ; 153: 106488, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38437754

RESUMO

INTRODUCTION: This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs. METHODS: A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials. RESULTS: Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques. DISCUSSION AND CONCLUSION: An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Humanos , Fenômenos Biomecânicos , Fixadores Externos , Fixação de Fratura/métodos , Ossos Pélvicos/cirurgia
17.
Med Sci Monit ; 30: e944136, 2024 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-38549240

RESUMO

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.


Assuntos
Disfunções Sexuais Fisiológicas , Fraturas da Tíbia , Adulto , Humanos , Feminino , Estudos Retrospectivos , Fixadores Externos , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Resultado do Tratamento
18.
J Plast Reconstr Aesthet Surg ; 91: 276-283, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38432085

RESUMO

BACKGROUND: The study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. METHODS: The study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. RESULTS: BoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. CONCLUSION: BoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.


Assuntos
Fraturas Cranianas , Fraturas Zigomáticas , Animais , Coelhos , Fraturas Zigomáticas/diagnóstico por imagem , Fraturas Zigomáticas/cirurgia , Fixadores Internos , Fixação Interna de Fraturas/métodos , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/cirurgia , Fixação de Fratura , Placas Ósseas
20.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484095

RESUMO

CASE: A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large osseous defect of the right thumb metacarpal. The patient was successfully treated with metacarpophalangeal joint arthrodesis and metacarpal reconstruction using definitive external fixation, an intramedullary Kirschner wire, and use of the Masquelet bone grafting technique. CONCLUSION: The authors' treatment approach for a mangled thumb injury with definitive external fixation and utilization of the Masquelet technique resulted in restoration of a large osseous defect, avoidance of infection, and limited loss of mobility.


Assuntos
Traumatismos da Mão , Procedimentos de Cirurgia Plástica , Ferimentos por Arma de Fogo , Humanos , Masculino , Adulto Jovem , Fixadores Externos , Fixação de Fratura/métodos , Traumatismos da Mão/cirurgia , Polegar/cirurgia , Ferimentos por Arma de Fogo/cirurgia
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