-
Journal of Orthopaedic Surgery (Hong... 2018Pin tract infection is a common problem in orthopedic and traumatology surgery. The aim of this study was to investigate the efficacy of an implant coated with...
BACKGROUND
Pin tract infection is a common problem in orthopedic and traumatology surgery. The aim of this study was to investigate the efficacy of an implant coated with carboxymethyl chitosan-zinc (CMC-Zn) in prevention of pin tract infection.
MATERIALS AND METHODS
Twenty-four male New Zealand White rabbits were randomized into two equal groups ( n = 12, uncoated and CMC-Zn). The implants were colonized with 1 × 10 colony forming units of Staphylococcus aureus and inserted into the lateral right proximal tibia in each rabbit. In each group, at 2 and 4 weeks post-surgery, five and seven rabbits were killed, respectively, to harvest the soft tissues around the implant as well as the hard tissue for histological analysis. The bone cross-sectional view, X-ray, and micro-computed tomography (μCT) were performed.
RESULTS
The surgical sites in each animal were evaluated individually at both time points. No evident signs of infections were found in the CMC-Zn group, while a high rate of infection was observed in the uncoated group where minor infections were 85.71% ( n = 12) and major infections 14.29% ( n = 12). The radiography, μCT, and histological analysis showed no evident signs of infection in both groups at 2 weeks post-surgery. However, at 4 weeks, signs of infection were found in all the animals in the uncoated group, whereas in the CMC-Zn group, no infections were observed. The difference between the two groups was highly significant ( p = 0.00).
CONCLUSIONS
Our study showed that CMC-Zn-coated implants were effective in preventing pin tract infection.
Topics: Animals; Bone Nails; Chitosan; Coated Materials, Biocompatible; Cross-Sectional Studies; Disease Models, Animal; Fracture Fixation, Internal; Male; Prostheses and Implants; Prosthesis-Related Infections; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Tibia; Tibial Fractures; X-Ray Microtomography; Zinc
PubMed: 29343155
DOI: 10.1177/2309499017749981 -
BMC Musculoskeletal Disorders Aug 2020To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate...
BACKGROUND
To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate whether excellent tip-apex distance (TAD) can be obtained by changing the entry point via axial rotation of the main intramedullary nail.
METHODS
Fifty patients with intertrochanteric femoral fractures (IFFs) undergoing internal fixation with intramedullary nails under 2D fluoroscopy were retrospectively enrolled. Both of the PSA at the anteroposterior film and anteversion angle at the lateral film before and after adjustment of the guide pin were collected. Pearson correlation analysis was performed to investigate their correlation. Intraoperative and postoperative outcomes were recorded. Furthermore, the software of Mimics 10.0 and Pro/E were used to establish the 3D models of the proximal femur and main intramedullary nail/guide pin, respectively. Surgery was simulated on the Pro/E software platform and solid geometry analysis was conducted to calculate the correlation between the PSA and the anteversion angle.
RESULTS
Pearson correlation analysis indicated there was a positive correlation between PSA and anteversion angle, with the correlation coefficient of 0.902 (p < 0.01). By altering the PSA and anteversion angle, TAD was adjusted to be less than 25 mm in all patients. The mean operative time, fluoroscopy time and length of hospital stay were 65.82 ± 11.16 min, 2.03 ± 0.79 min and 6.66 ± 2.49 d. Thirty-one patients received blood transfusions (3.55 ± 1.95 U). Fracture reduction was considered to be good or acceptable in all patients. Complications occurred only in 6 patients (12.00%). At a 3-month follow-up, the mean Timed Up and Go was 31.54 ± 20.95 s and Harris Hip Score was 72.88 ± 8.79. The 3D surgery model also showed when the main intramedullary nail was externally rotated or internally rotated of 20° at the standard location, the PSA of guide pin at the anteroposterior position and anteversion angle of the guide pin at the lateral position were simultaneously increased or decreased.
CONCLUSION
Our findings suggest altering the PSA and anteversion angle may be beneficial for obtaining excellent TAD and achieving superior outcomes.
Topics: Bone Nails; Femoral Fractures; Femur Neck; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Retrospective Studies; Treatment Outcome
PubMed: 32738886
DOI: 10.1186/s12891-020-03518-5 -
Journal of the American Veterinary... Sep 2021To describe a modified technique for reinforced, free-form external skeletal fixation (rFF-ESF) of appendicular fractures in cats and identify factors associated with...
OBJECTIVE
To describe a modified technique for reinforced, free-form external skeletal fixation (rFF-ESF) of appendicular fractures in cats and identify factors associated with development of complications.
ANIMALS
46 cats with fractures repaired with rFF-ESF at Angell Animal Medical Center between 2010 and 2019.
PROCEDURES
Medical records were reviewed for information on signalment, affected bone, fracture location and orientation, degree of comminution, severity (open vs closed), fixator type, number of fixation pins, use of an intramedullary pin (yes vs no), surgeon experience (staff surgeon vs surgical resident), anesthesia time, surgery time, perioperative antimicrobial administration, concurrent surgical procedures, intraoperative complications, postoperative alignment, whether fixator destabilization was performed, and time to complete fixator removal. Postoperative complications were recorded.
RESULTS
43 of the 46 (93%) cats had a successful outcome, with a median time to complete fixator removal of 8 weeks (range, 3 to 61 weeks). Twelve of the 46 (26%) cats had major (n = 3) or minor (9) complications. In univariable analyses, 4 factors were significantly associated with development of postoperative complications: body weight (OR for each 1-kg increase in weight, 1.8), tibial fracture (vs fracture of any other long bone; OR, 16), use of a type 2 fixator (vs a type 1 fixator; OR, 11), and use of destabilization (vs no destabilization; 7).
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that rFF-ESF can be successfully used to stabilize a variety of appendicular fractures in cats. Further studies are required to compare rFF-ESF with other fracture fixation methods.
Topics: Animals; Bone Nails; Cat Diseases; Cats; External Fixators; Fracture Fixation; Retrospective Studies; Tibial Fractures; Treatment Outcome
PubMed: 34388012
DOI: 10.2460/javma.259.5.510 -
Annals of African Medicine 2023Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular...
INTRODUCTION
Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants.
MATERIALS AND METHODS
Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases.
RESULTS
Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters.
CONCLUSION
Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.
Topics: Humans; Male; Female; Anti-Bacterial Agents; Bone Cements; Tibial Fractures; Bone Nails; Osteomyelitis; Treatment Outcome
PubMed: 38358142
DOI: 10.4103/aam.aam_185_22 -
Acta Ortopedica Mexicana 2007Tibial shaft fractures are common since they account for 9% of all fractures. Intramedullary nailing is described in the literature as the gold standard for their... (Review)
Review
INTRODUCTION
Tibial shaft fractures are common since they account for 9% of all fractures. Intramedullary nailing is described in the literature as the gold standard for their treatment and the most recent research emphasizes minimum exposure.
OBJECTIVE
To present the clinical and radiological course of closed, unreamed intramedullary fixation for tibial shaft fractures in a group of patients seen at Medica Sur Hospital.
MATERIAL AND METHODS
Twenty-two male patients with a diagnosis of tibial shaft fracture were analyzed retrospectively; mean age was 28 years. In all of them the Orthofix nail was inserted through the patellar tendon, with a closed approach and without reaming the medullary cavity.
RESULTS
Twenty patients had closed fractures (90.90%) and 2 patients had open fractures (9.09%). The mean time to starting ambulation with protected weight bearing was two weeks in 18 patients (81.81%); with full weight bearing, six weeks in 13 patients (91%). The mean time to full weight bearing without crutches was 10 weeks in 21 patients (95.45%). Mean radiographic grade III-IV healing time was 16 weeks. Complications were: delayed union in two patients (9.09%), compartmental syndrome, in one patient (4.45%).
CONCLUSION
The Orthofix interlocking intramedullary nail placed with a closed approach provides immediate stability due to the proximal and distal locking. Patient rehabilitation is quicker, with total mobility, providing an early stimulation for callus formation and the added benefit of sparing the endosteal blood supply.
Topics: Accidents; Adult; Athletic Injuries; Bone Nails; Equipment Design; Female; Follow-Up Studies; Fracture Fixation, Intramedullary; Humans; Male; Mexico; Middle Aged; Postoperative Complications; Retrospective Studies; Tibial Fractures
PubMed: 17970562
DOI: No ID Found -
BMC Musculoskeletal Disorders Jan 2021Locked titanium nails are considered the reference treatment for metastatic bone lesions of the humerus in patients with aggressive histotypes, high risk of fracture or...
The IlluminOss® photodynamic bone stabilization system for pathological osteolyses and fractures of the humerus: indications, advantages and limits in a series of 12 patients at 24 months of minimum follow-up.
BACKGROUND
Locked titanium nails are considered the reference treatment for metastatic bone lesions of the humerus in patients with aggressive histotypes, high risk of fracture or when estimated survival is lower than 6 months.Nevertheless, they are responsible for CT and MRI artifacts which interfere with postoperative radiotherapy and follow-up.The IlluminOss® is an intramedullary stabilization system which is introduced inside the humeral canal in a deflated state, and is then distended with a monomer which hardens after exposure to blue light,stabilizing the segment; it does not cause artifacts, allowing easier and more effective radiotherapy and follow-up. The aim of this study is to report our experience, indications, possible advantages and limitations of this stabilization system at 24 months of minimum follow-up in a series of 12 patients affected by pathological fractures or impending fractures of the humerus.
METHODS
This is a retrospective case-series that included all patients who underwent surgery with the IlluminOss® Photodynamic Bone Stabilization System for pathological osteolyses and fractures of the humerus. Intraoperative and postoperative complications were valued.
RESULTS
12 patients and 13 procedures were included in the study. All surgeries were performed without intraoperative complications. No early postoperative complications were noted. The wounds healed in all cases and stitches were removed at two weeks from surgery, so the patients were able to perform chemotherapy after three weeks. All patients except one had a painless active range of motion which reached 90°.The VAS score was 7 preoperatively and 2.6 at one month from surgery. Pain relief was also associated to radiotherapy and chemotherapy. Unfortunately, two nail ruptures were reported at 4 and 12 months of follow-up. No artifacts were noted in the postoperative CT scans so the radiotherapy plans were easily performed without the need of dose compensation.
CONCLUSIONS
The IlluminOss® intramedullary stabilization system can provide primary stability in humeral fractures and impending fractures;the surgical technique is easy and minimally invasive.Moreover,it does not present artifacts at postoperative imaging,probably giving a better chance to perform prompt radiotherapy and chemotherapy.However, randomized clinical studies are necessary to verify its potential strength and if precocious adjuvant radio- and chemotherapy are associated to a reduction of the local progression rate.
Topics: Bone Nails; Follow-Up Studies; Fracture Fixation, Intramedullary; Humans; Humeral Fractures; Humerus; Osteolysis; Retrospective Studies; Treatment Outcome
PubMed: 33430839
DOI: 10.1186/s12891-020-03927-6 -
BMC Veterinary Research Oct 2017The physis is the weakest component of immature long bones, and physeal fractures constitute about 30% of fractures in growing dogs. Fractures of the proximal humeral... (Comparative Study)
Comparative Study
BACKGROUND
The physis is the weakest component of immature long bones, and physeal fractures constitute about 30% of fractures in growing dogs. Fractures of the proximal humeral physis typically have a Salter Harris type I or II configuration. These fractures require accurate reduction and adequate stabilization to allow for any potential continued longitudinal bone growth, in conjunction with physeal fracture healing. Conventional internal fixation of these fractures involves insertion of two parallel Kirschner wires, although other methods described include tension band wiring, Rush pinning, and lag screws. However these recommendations are based on anecdotal evidence, and information about the biomechanical stability of physeal fracture repair is sparse. The unique anatomical structure of the epiphyseal-metaphyseal complex makes the gripping of the epiphysis for ex vivo biomechanical testing of physeal fracture repair very challenging. The objective of our study was to biomechanically assess the optimal number (three, two or one) of implanted Kirschner wires in a porcine Salter Harris I proximal humeral physeal fracture model, using motion analysis tracking of peri-fragmental retro-reflective markers while constructs were subjected to a constant axial compression and a sinusoidal torque of +/- 2 Nm at 0.5 Hz for 250 cycles.
RESULTS
There were significant differences between the three constructs (three, two or one Kirschner wire repair) for gross angular displacement (p < 0.001). The difference between three pins and two pins on toggle was not significant (p = 0.053), but both three-pin and two-pin fixation significantly reduced rotational toggle compared to one-pin fixation. Construct stiffness was not significantly different between any of the pin groups (p > 0.33).
CONCLUSIONS
Motion analysis tracking using peri-fragmental markers in this porcine model of physeal fracture repair found that the stability at the fracture site of one-pin fixation was significantly less than two-pin and three-pin fixation. Whether there was increased stabilization of these fractures with three-pin fixation compared to two-pin fixation was not conclusive in this porcine model.
Topics: Animals; Biomechanical Phenomena; Bone Nails; Bone Wires; Fracture Fixation, Internal; Humeral Fractures; Humerus; Swine
PubMed: 29070026
DOI: 10.1186/s12917-017-1225-y -
Clinical Orthopaedics and Related... Mar 2015
Review
Topics: Adult; Bone Nails; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Treatment Outcome
PubMed: 25560962
DOI: 10.1007/s11999-014-4123-7 -
Medicina (Kaunas, Lithuania) Jun 2019: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open...
: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. : A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3-14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn's criteria. : The mean time to union was 10.85 ± 3.39 (range of 6-20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures ( < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. : Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.
Topics: Adolescent; Bone Nails; Child; Child, Preschool; Female; Humans; Male; Orthopedic Procedures; Radiography; Retrospective Studies; Tibia; Tibial Fractures; Titanium; Treatment Outcome
PubMed: 31185694
DOI: 10.3390/medicina55060266 -
Orthopaedics & Traumatology, Surgery &... Dec 2021This paper describes two different techniques for removal of broken Precice Stryde intramedullary bone lengthening nails, which unlike trauma nails are solid containing...
This paper describes two different techniques for removal of broken Precice Stryde intramedullary bone lengthening nails, which unlike trauma nails are solid containing mechanical components. Consequently, surgeons face unique challenges when these implants brake within medullary canal. Here, we present our surgical approach for removal of three broken implants. In one patient (46kg) both Ø10mm femoral Stryde implants (max. weight allowance 68kg) broke through the proximal locking screw hole preoperatively on the right side and intraoperatively on the left side (413 and 504 days after index surgery respectively). The third Ø11.5 femoral nail broke through the area containing the magnet (55kg patient, 325 days after index surgery). LEVEL OF EVIDENCE: IV.
Topics: Bone Lengthening; Bone Nails; Femur; Fracture Fixation, Intramedullary; Humans; Retrospective Studies
PubMed: 33965599
DOI: 10.1016/j.otsr.2021.102958