Pulsed electromagnetic fields after intramedullary nailing of tibial fractures: a case control study

Simultaneous reconstruction of tibial osteomyelitis-complicated soft tissue defects using free flap transplantation in conjunction with the masquelet technique: a retrospective study

OBJECTIVE

To investigate the clinical effect of anterolateral femoral free flap combined with Masquelet technique in the treatment of tibial osteomyelitis with wound surface.

METHODS

A retrospective study was conducted to analyze the clinical data of 25 patients with tibial osteomyelitis combined with defected wounds in Xijing Hospital of Fourth Military Medical University from Jun 2017 to Oct 2021. After one-stage treatment with free flap combined with Masquelet technique, the infection index, lower extremity function score (LEFS), and Mazur ankle function score were compared before bone defect repair and at the last follow-up.

RESULTS

The anterolateral femoral free flaps of 25 patients in phase I survived. The healing time of bone fracture after stage II operation was 8-12 months [(7.2 ± 0.9) months]. At the last follow-up, the infection index was significantly lower than that before bone defect repair (P < 0.01). The LEFS and Mazur ankle function scores [(56.2 ± 7.9) and (78.2 ± 16.1)] of the affected limb were significantly higher than those before bone defect repair [(26.0 ± 8.6) and (44.7 ± 18.2)] (P < 0.01). Wounds of all patients' legs healed well, without complications (foot drop, joint dysfunction, or deformity in the affected limbs).

CONCLUSION

The anterolateral femoral free flap combined with Masquelet technique is an effective treatment strategy for tibial osteomyelitis combined with soft tissue defects. This technology can effectively repair limb trauma, inhibit infection, and improve flexion and extension functions of knee and ankle joint.

Clavicle fracture and triathlon performance: a case report

BACKGROUND

Collarbone fracture is a common injury, particularly among athletes involved in contact sports and participating in endurance activities. Conventional treatment requires surgery and postoperative immobilization, resulting in an average return-to-sport timeframe of approximately 13 weeks. This case challenges the established treatment protocols, aiming to expedite recovery and enable a quicker resumption of high-intensity athletic activities.

CASE PRESENTATION

A 24-year-old Caucasian athlete completed a Half-Ironman Triathlon (70.3) merely three weeks post-collarbone fracture. Utilizing Extracorporeal Magneto-Transduction Therapy (EMTT) alongside surgical intervention, the patient achieved accelerated healing and remarkable performance outcomes without encountering any adverse effects.

CONCLUSIONS

The integration of EMTT into the treatment paradigm for bone fractures alters the traditional understanding of recovery timelines and rehabilitation strategies. This case highlights the potential benefits of electromagnetic wave therapy in expediting the healing process and enabling athletes to resume high-level sports activities at an earlier stage.

A novel pulsed electromagnetic field device as an adjunct therapy to surgical treatment of distal radius fractures: a prospective, double-blind, sham-controlled, randomized pilot study

INTRODUCTION

The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures.

METHODS

In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively.

RESULTS

Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12.

CONCLUSION

PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work.

LEVEL OF EVIDENCE

I.

Moderate static magnetic field promotes fracture healing and regulates iron metabolism in mice

BACKGROUND

Fractures are the most common orthopedic diseases. It is known that static magnetic fields (SMFs) can contribute to the maintenance of bone health. However, the effect and mechanism of SMFs on fracture is still unclear. This study is aim to investigate the effect of moderate static magnetic fields (MMFs) on bone structure and metabolism during fracture healing.

METHODS

Eight-week-old male C57BL/6J mice were subjected to a unilateral open transverse tibial fracture, and following treatment under geomagnetic field (GMF) or MMF. The micro-computed tomography (Micro-CT) and three-point bending were employed to evaluate the microarchitecture and mechanical properties. Endochondral ossification and bone remodeling were evaluated by bone histomorphometric and serum biochemical assay. In addition, the atomic absorption spectroscopy and ELISA were utilized to examine the influence of MMF exposure on iron metabolism in mice.

RESULTS

MMF exposure increased bone mineral density (BMD), bone volume per tissue volume (BV/TV), mechanical properties, and proportion of mineralized bone matrix of the callus during fracture healing. MMF exposure reduced the proportion of cartilage in the callus area during fracture healing. Meanwhile, MMF exposure increased the number of osteoblasts in callus on the 14th day, and reduced the number of osteoclasts on the 28th day of fracture healing. Furthermore, MMF exposure increased PINP and OCN levels, and reduced the TRAP-5b and β-CTX levels in serum. It was also observed that MMF exposure reduced the iron content in the liver and callus, as well as serum ferritin levels while elevating the serum hepcidin concentration.

CONCLUSIONS

MMF exposure could accelerate fracture healing via promote the endochondral ossification and bone formation while regulating systemic iron metabolism during fracture healing. This study suggests that MMF may have the potential to become a form of physical therapy for fractures.

NET Formation Was Reduced via Exposure to Extremely Low-Frequency Pulsed Electromagnetic Fields

Fracture-healing is a highly complex and timely orchestrated process. Non-healing fractures are still a major clinical problem and treatment remains difficult. A 16 Hz extremely low-frequency pulsed electromagnetic field (ELF-PEMF) was identified as non-invasive adjunct therapy supporting bone-healing by inducing reactive oxygen species (ROS) and Ca2+-influx. However, ROS and Ca2+-influx may stimulate neutrophils, the first cells arriving at the wounded site, to excessively form neutrophil extracellular traps (NETs), which negatively affects the healing process. Thus, this study aimed to evaluate the effect of this 16 Hz ELF-PEMF on NET formation. Neutrophils were isolated from healthy volunteers and exposed to different NET-stimuli and the 16 Hz ELF-PEMF. NETs were quantified using Sytox Green Assay and immunofluorescence, Ca2+-influx and ROS with fluorescence probes. In contrast to mesenchymal cells, ELF-PEMF exposure did not induce ROS and Ca2+-influx in neutrophils. ELF-PEMF exposure did not result in basal or enhanced PMA-induced NET formation but did reduce the amount of DNA released. Similarly, NET formation induced by LPS and H2O2 was reduced through exposure to ELF-PEMF. As ELF-PEMF exposure did not induce NET release or negatively affect neutrophils, the ELF-PEMF exposure can be started immediately after fracture treatment.

A COMPARATIVE STUDY OF MIPPO AND MDLIN APPLIED TO THE TREATMENT OF DISTAL TIBIAL FRACTURES

Objective: This study aims to analyze the clinical treatment effects of the minimally invasive percutaneous plate osteosynthesis (MIPPO) and multi-directional locking intramedullary nail (MDLIN) techniques in patients with distal tibial fractures. Methods: A total of 124 patients with distal tibial fractures, admitted to the People’s Hospital of Zhongjiang County from February 2019 to January 2020, were selected as the research subjects. They were randomly divided into groups ([Formula: see text]). The control group received MIPPO treatment, the observation group received MDLIN treatment, and the postoperative therapeutic effects and complications in the two groups were compared. Results: The patients in the observation group had shorter operative time and lower intraoperative blood loss than those in the control group ([Formula: see text]). The two groups had no significant differences in fracture healing time, complete weight bearing time, or functional recovery. The postoperative complication rate in the cases of the observation group was significantly lower than that of the control group ([Formula: see text]). Conclusion: Both techniques can achieve sufficient therapeutic effects; however, the MDLIN technique has certain advantages, including significantly fewer complications, lower intraoperative blood loss, and shorter operative durations compared to the MIPPO technique.