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Ugeskrift For Laeger Jan 2023Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review... (Review)
Review
Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review describes a broad range of techniques for treatment ranging from immobilization in a cast to open reduction and fixation with K-wires, screws, or flexible intramedullary nails. Premature growth arrest is relatively common following the physeal fractures in proximal or distal tibia. We recommend early consultation with a tertiary care centre for guidance and planning of the best treatment.
Topics: Humans; Child; Leg; Bone Nails; Tibial Fractures; Lower Extremity; Growth Plate
PubMed: 36760152
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Aug 2019To evaluate the effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture (PHF). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture (PHF).
METHODS
China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang database, Chinese Biomedicine Database (CBM), PubMed, EMBASE, Web of Science, and Cochrane Library were searched until July 2018. The eligible references all show that the control group uses locking plates to treat PHF, while the experimental group uses intramedullary nails to do that. Two reviewers independently retrieved and extracted the data. Reviewer Manager 5.3 was used for statistical analysis.
RESULTS
Thirty-eight retrospective studies were referred in this study which involves 2699 patients. Meta-analysis results show that the intramedullary nails in the treatment of proximal humeral fractures are superior to locking plates in terms of intraoperative blood loss, operative time, fracture healing time, postoperative complications, and postoperative infection. But there is no significance in constant, neck angle, VAS, external rotation, antexion, intorsion pronation, abduction, NEER, osteonecrosis, additional surgery, impingement syndrome, delayed union, screw penetration, and screw back-out.
CONCLUSIONS
The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of PHF. Due to the limitations in this meta-analysis, more large-scale, multicenter, and rigorous designed RCTs should be conducted to confirm our findings.
TRIAL REGISTRATION
PROSPERO CRD42019120508.
Topics: Bone Nails; Bone Plates; Fracture Fixation, Intramedullary; Humans; Postoperative Complications; Randomized Controlled Trials as Topic; Retrospective Studies; Shoulder Fractures; Treatment Outcome
PubMed: 31470878
DOI: 10.1186/s13018-019-1345-0 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain... (Review)
Review
Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain their physical capacities and autonomy for a long time, but whose bone solidness is frequently reduced by osteoporosis. Falls increase with age and because of certain medical conditions. Trauma in the geriatric population involves specific risks; thus, the treatment must be adapted not only to the fracture, but to the local conditions and the patient. Ankle injuries are particularly frequent in general traumatology but even more in geriatric traumatology. They can lead to complete loss of autonomy if the treatment is delayed and/or not adapted to the local conditions or the patient. The functional prognosis is brought into play, along with the patient's life due to loss of autonomy and general complications occurring in patients who are bed-ridden. The treatment of bimalleolar ankle fractures in older adults requires rigorous analysis at all points, which starts by evaluating the cutaneous status and viability of the soft tissues upon admission. The benefit-risk balance of the various treatment options will be assessed with the main goal being that patients recover their autonomy. This article will review this topic by answering 7 questions: 1) What are the distinctive features of elderly? Dependence on others, comorbidities, bone and soft tissue fragility are the main ones, explaining these high-risk situations and frequent complications. 2) When should a bimalleolar ankle fracture be treated surgically? The surgery must be done early, preferably within 8hours of the injury occurring, once the comorbidities have been controlled. The local conditions (skin and soft tissue damage) must be evaluated carefully as they determine the treatment. Errors are not allowed in these patients, who are often fragile and in precarious health. Definitive fixation is preferred if the skin status allows it, but one must keep temporary external fixation in mind as an option. 3) Is there still a role for conservative treatment of displaced fractures? This will produce good results when it is well done; however, the indications are rare and must be selected carefully. The main risks are secondary displacement and skin lesions inside the cast, which are sources of infection. 4) Is fixation with anatomical locking plates an advance? This is definitely an advance for these fragility fractures, which are often comminuted, as it allows return to weight bearing in certain conditions. However, the implantation rules must be followed exactly, and it is preferable to use thinner plates. 5) Does transplantar Steinmann pin fixation still have a role? It has few indications, limited to salvage situations (catastrophic local conditions, very poor general condition). External tibiocalcaneal fixation, alone or in combination, is a better option. 6) Is immediate transarticular fixation with a retrograde or antegrade locked nail a reasonable option? Fixation can be done by retrograde nailing or antegrade nailing. It is proposed to patients who are not very autonomous with a poor cutaneous status and/or severe osteoporosis. It is preferable to transplantar nailing. 7) Is immediate protected weight bearing, with or without fixation, possible? This can be considered on a case-by-case basis depending on the extent of the trauma, patient compliance and treatment carried out. LEVEL OF EVIDENCE: V, Expert opinion.
Topics: Aged; Ankle Fractures; Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Osteoporosis; Treatment Outcome
PubMed: 34757182
DOI: 10.1016/j.otsr.2021.103137 -
Journal of Feline Medicine and Surgery Oct 2022External skeletal fixation is an established technique in cats for biological fixation of long bone fractures, stabilisation of the joints, and treatment of shearing...
OBJECTIVES
External skeletal fixation is an established technique in cats for biological fixation of long bone fractures, stabilisation of the joints, and treatment of shearing injuries and angular deformities. As appropriate and accurate pin insertion is imperative for a successful outcome, knowledge of topographic anatomy and areas that are safe (safe corridors) for pin placement is integral to successful surgery. At present, however, safe corridors have not been determined fully in feline orthopaedics, with surgeons having to rely on knowledge based on canine orthopaedics. This study was performed to determine safe corridors for pin placement in feline long bones.
METHODS
The limbs of six feline cadavers were frozen. Only limbs with no history of orthopaedic conditions were used. Transverse sections through the limbs were examined, and anatomical structures were determined in relation to the bone. These structures were compared with those of the contralateral limbs, which were dissected for topographic assessment. Safe corridors were defined as topographic areas where no vital structures, muscles or joints were present.
RESULTS
Examination of the humerus revealed safe corridors at its proximal craniolateral aspect and on the medial and lateral humeral condyles. Safe corridors of the antebrachium were identified on the lateral aspect of the olecranon, the distal two-thirds of the medial antebrachium and the distal third of the lateral antebrachium. Safe corridors in the femur consisted of a small area lateral to and just below the major trochanter, and on the medial and lateral femoral condyles. Evaluation of the tibia revealed safe corridors on the medial aspect of the entire tibia, the cranial aspect of the proximal tibia on the tibial crest and the area just proximal to the lateral malleolus.
CONCLUSIONS AND RELEVANCE
Safe corridors for pin placement during external skeletal fixation in feline limbs differed from those in canine limbs. Knowledge of canine anatomy may be inapplicable to pin placement in feline limbs undergoing external skeletal fixation.
Topics: Animals; Bone Nails; Cats; Dogs; External Fixators; Fracture Fixation; Humerus; Tibia
PubMed: 34870491
DOI: 10.1177/1098612X211057329 -
The Bone & Joint Journal May 2015Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent... (Review)
Review
Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications.
Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Bone Nails; Durapatite; Humans; Nanoparticles; Orthopedic Procedures; Postoperative Complications; Prosthesis Design; Prosthesis-Related Infections; Silver
PubMed: 25922449
DOI: 10.1302/0301-620X.97B5.33336 -
Singapore Medical Journal Jan 2010Fingertip injuries are commonly seen by family and emergency physicians. Many of the cases are simple to treat and do not need specialised treatment by a hand surgeon.... (Review)
Review
Fingertip injuries are commonly seen by family and emergency physicians. Many of the cases are simple to treat and do not need specialised treatment by a hand surgeon. However, there are certain conditions where early intervention by a hand surgeon is warranted for better functional and aesthetic outcomes. Common injuries include mallet finger injury, crush injuries to the fingertip with resultant subungual haematoma, nail bed laceration, partial or complete amputation of the fingertips, pulp amputations and fractures of the distal phalanges.
Topics: Amputation, Traumatic; Bone Nails; Finger Injuries; Fracture Fixation; Fractures, Bone; Hematoma; Humans; Nails; Suture Techniques
PubMed: 20200781
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... 2011
Topics: Anesthesia; Arthroplasty, Replacement, Hip; Bone Nails; Bone Plates; Fracture Fixation; Hip Fractures; Humans
PubMed: 21537692
DOI: 10.1590/s0104-42302011000200003 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2021To review the research progress of intramedullary lengthening nail technology. (Review)
Review
OBJECTIVE
To review the research progress of intramedullary lengthening nail technology.
METHODS
The foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.
RESULTS
The intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.
CONCLUSION
Intramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
Topics: Bone Lengthening; Bone Nails; Femur; Fracture Fixation, Intramedullary; Humans; Leg Length Inequality; Technology; Treatment Outcome
PubMed: 33998220
DOI: 10.7507/1002-1892.202012084 -
Journal of Oral and Maxillofacial... May 1993
Review
Topics: Bone Nails; Bone Plates; Bone Transplantation; Dental Implantation, Endosseous; Humans; Mandible; Osteotomy; Surgery, Oral; Surgical Flaps
PubMed: 8478754
DOI: 10.1016/s0278-2391(10)80501-4 -
Journal of Orthopaedic Surgery and... Mar 2021Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis...
BACKGROUND
Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement.
METHODS
An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position.
RESULTS
Only 4° of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion-extension and internal-external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle.
CONCLUSION
To minimize LL and OS measurement errors in THA, adduction-abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.
Topics: Arthroplasty, Replacement, Hip; Bone Nails; Humans; Leg Bones; Leg Length Inequality; Lower Extremity; Models, Anatomic; Pelvis
PubMed: 33726774
DOI: 10.1186/s13018-021-02347-z