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Torres-Izquierdo B, Tippabhatla A, Pereira DE, Cummings JL, Rivera AE, Meyer ZI, Hosseinzadeh P. Patient-reported outcomes of adolescents with tibia shaft fractures: comparison of closed reduction and casting vs. elastic stable intramedullary nailing. J Pediatr Orthop B 2024; 33:462-467. [PMID: 37916465 DOI: 10.1097/bpb.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Tibial shaft fractures are the third most common pediatric long bone fractures. Closed reduction and casting (CRC) is considered initial treatment in this population, however, surgical management using elastic stable intramedullary nailing (ESIN) is also used in adolescents. This study compared patient-reported outcomes in a cohort of adolescents with tibia fractures treated with ESIN or CRC. This single-center retrospective study gathered adolescent patients 10-18 years of age with closed tibia shaft fractures between the years 2015 and 2021 treated by either CRC or ESIN. Measured outcomes include patient demographics, overall casting time, time to full weight bearing, time to full healing, radiographic healing, complications (loss of reduction, malunion >5° and >10°) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. A total of 141 patients (68% male) were included, with 31 receiving ESIN and 110 having CRC. Patient demographics were similar across groups. At follow-up, CRC had a significant shorter time to healing (11 vs. 15 weeks), but an increased casting duration (7 vs. 4 weeks). Finally, the ESIN group had significantly greater pre-intervention angulation, displacement, and shortening. In both interventions, mobility and pain interference scores showed significant improvements from baseline (2 weeks post-op) at 12, 16, and 24 weeks. No statistically significant differences were noted between CRC and ESIN groups across PROMIS domains of pain interference and mobility. CRC and ESIN are effective in improving pain and mobility in adolescent diaphyseal tibia fractures, but neither intervention is superior based on PROMIS scores at 12, 16 and 24+ weeks. From a patient standpoint, we demonstrate that neither treatment is superior in achieving better-perceived mobility or decreasing pain sooner. Level of Evidence: Level III.
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Affiliation(s)
- Beltran Torres-Izquierdo
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri, USA
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Allan AY, Berner JE, Chan JK, Gardiner MD, Nanchahal J, Jain A. International Lower Limb Collaborative Paediatric subpopulation analysis (INTELLECT-P) study: multicentre, international, retrospective audit of paediatric open fractures. BJS Open 2024; 8:zrae082. [PMID: 39066677 PMCID: PMC11282435 DOI: 10.1093/bjsopen/zrae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Anna Y Allan
- Plastic Surgery Department, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Juan E Berner
- Kellogg College, University of Oxford, Oxford, UK
- Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James K Chan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Plastic Surgery Department, Stoke Mandeville Hospital, Aylesbury, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Plastic Surgery Department, Wexham Park Hospital, Slough, UK
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Plastic Surgery Department, Imperial College Healthcare NHS Trust, London, UK
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Bowers KM, Anderson DE. Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review. Bioengineering (Basel) 2024; 11:525. [PMID: 38927761 PMCID: PMC11201148 DOI: 10.3390/bioengineering11060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.
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Affiliation(s)
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996-4550, USA;
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Chakraborty S, Salama K, Lee LH. Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital. Cureus 2023; 15:e36462. [PMID: 37090408 PMCID: PMC10117001 DOI: 10.7759/cureus.36462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Tibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. Methods A retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. Results The study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. Conclusion The treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.
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Affiliation(s)
| | - Karim Salama
- Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, GBR
| | - Ling Hong Lee
- Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, GBR
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Khan H, Monsell F, Duffy S, Trompeter A, Bridgens A, Gelfer Y. Paediatric tibial shaft fractures: an instructional review for the FRCS exam. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03484-3. [PMID: 36788165 DOI: 10.1007/s00590-023-03484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
This instructional review presents the literature and guidelines relevant to the classification, management and prognosis of paediatric tibial shaft fractures at a level appropriate for the FRCS exit examination in Trauma and Orthopaedic surgery.
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Affiliation(s)
- H Khan
- Trauma and Orthopaedic Department, Kingston Hospital, London, UK.
| | - F Monsell
- Bristol Royal Hospital for Children, Bristol, UK
| | - S Duffy
- Trauma and Orthopaedic Department, Bristol Royal Infirmary, Bristol, UK
| | - A Trompeter
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
| | - A Bridgens
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
| | - Y Gelfer
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
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Tveit M, Quan T, Kraft D, Malyavko A, Recarey M, Pizzarro J, Nguyen C, Das A, Ramamurti P, Tabaie S. Asthma and Its Impact on Pediatric Patients Undergoing Surgical Management of Tibial Shaft Fractures. Cureus 2022; 14:e31369. [DOI: 10.7759/cureus.31369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
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Nonoperative Management of Closed Displaced Tibia Shaft Fractures in Patients Under 18 Years of Age: Low Failure Rate. J Pediatr Orthop 2022; 42:421-426. [PMID: 35793788 DOI: 10.1097/bpo.0000000000002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibial shaft fractures are the third most common pediatric long bone fracture pattern. Historically, these fractures have been initially treated with closed reduction and casting (CRC). Recently, there has been an increasing trend toward surgical intervention as an initial treatment for these injuries. In an effort to better understand whether this trend is warranted, this study seeks to characterize the clinical and radiographic outcomes of a large number of children who underwent nonoperative treatment with CRC as their initial treatment for pediatric tibial shaft fractures at a single tertiary care center. METHODS Outcomes measured included final alignment, other procedures performed, length of time to full radiographic healing, and length of time in each method of immobilization before progressing to full weight-bearing status. Patients were separated by ages into the following cohorts during statistical analysis: 4 to 8 years, 9 to 12 years, and 13+ years. Differences between continuous variables were analyzed with independent-samples t tests. χ 2 tests were used to analyze differences in categorical variables. An α<0.05 was considered statistically significant. RESULTS A total of 137 patients met our inclusion criteria. The median age was 10.19 years (4.03 to 17.43). The average initial displacement among all age groups was 27.42% (±15.05%). After the initial intervention with CRC, all age groups demonstrated an average of <5 degrees of residual angulation and <20% of residual displacement. Complete radiographic healing was seen in 127 (92.7%) patients by 3 months. Loss of reduction requiring additional clinical intervention was seen in 30 (21.9%) patients with only 5% requiring surgical intervention, whereas malunion was seen in a total of 16 (11.7%) patients at the final visit. There were no cases of compartment syndrome or deep wound infection. Male and initial angulation were the only factors predictive of loss of reduction. CONCLUSION Initial intervention with CRC is a safe and effective treatment for the majority of children in all age groups presenting with tibial shaft fractures demonstrating minimal angulation and displacement with surgical intervention being required in only 5% of patients. Further studies are warranted to elucidate the characteristics of patients who may benefit most from initial surgical intervention. LEVEL OF EVIDENCE Level III-retrospective study.
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Li D, Zhang D, Yuan Q, Liu L, Li H, Xiong L, Guo X, Yan Y, Yu K, Dai Y, Xiao T, Li Y, Wen C. In vitro and in vivo assessment of the effect of biodegradable magnesium alloys on osteogenesis. Acta Biomater 2022; 141:454-465. [PMID: 34971787 DOI: 10.1016/j.actbio.2021.12.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 12/17/2022]
Abstract
Magnesium (Mg) and some of its alloys are considered promising biodegradable metallic biomaterials for bone implant applications. The osteogenesis effect of Mg alloys is widely reported; however, the underlying mechanisms are still not clear. In this study, pure Mg, Mg-3Zn, and Mg-2Zn-1Mn were prepared, and their degradation behavior, biocompatibility, and osteogenesis effect were systematically assessed both in vitro and in vivo. Primary rat bone marrow-derived mesenchymal stem cells (BMSCs) were used to evaluate the biocompatibility of the prepared Mg alloys, and a rat femur fracture model was used to assess the stimulating effect of these alloys on bone-tissue formation. Mg-2Zn-1Mn showed higher corrosion resistance and more stable degradation behavior than pure Mg and Mg-3Zn. Extracts of the three materials showed significant stimulating effects on osteogenic differentiation of BMSCs along with non-cytotoxicity. Implantation of Mg-2Zn-1Mn wires into the femur of rats demonstrated superior histocompatibility, stable degradation, and notable promotion of osteogenesis without systemic toxicity. Moreover, the results of both in vitro and in vivo assessments demonstrated that bone morphogenetic proteins and fibroblast growth factor receptors are involved in the stimulating effect of Mg alloys. STATEMENT OF SIGNIFICANCE: This work reports the degradation behavior, biocompatibility, and osteogenic effect of pure Mg and Mg-3Zn and Mg-2Zn-1Mn alloys in both in vitro and in vivo conditions. Mg-2Zn-1Mn showed higher corrosion resistance and more stable degradation behavior than pure Mg and Mg-3Zn. The extracts of the three materials showed a significant stimulating effect on osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells (BMSCs) along with non-cytotoxicity. Mg-2Zn-1Mn wires implanted into the femur of rats showed good histocompatibility, stable degradation, and notable promotion of osteogenesis without systemic toxicity. The results of the present study suggest that bone morphogenetic proteins (BMPs) and fibroblast growth factor receptors (FGFRs) are involved in the stimulating effect of Mg alloys on osteogenesis.
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Affiliation(s)
- Ding Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China
| | - Dechuang Zhang
- School of Materials Science and Engineering, Xiangtan University, Xiangtan, Hunan 411105, China.
| | - Qi Yuan
- Department of Hepatopathy, The Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410002, China
| | - Lihong Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China
| | - Hui Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China
| | - Liang Xiong
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China
| | - Xiaoning Guo
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China
| | - Yang Yan
- School of Materials Science and Engineering, Central South University, Changsha 410083, China
| | - Kun Yu
- School of Materials Science and Engineering, Central South University, Changsha 410083, China
| | - Yilong Dai
- School of Materials Science and Engineering, Central South University, Changsha 410083, China.
| | - Tao Xiao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 410011, China; Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha 410011, China.
| | - Yuncang Li
- School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia
| | - Cuie Wen
- School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia.
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Trompeter A. Orthopaedic education: a COVID-driven evolution. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:803-806. [PMID: 34117919 PMCID: PMC8196277 DOI: 10.1007/s00590-021-03009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Alex Trompeter
- Department of Trauma and Orthopaedics, St George's University Hospital, London, London, UK. .,St George's University of London, London, UK. .,EJOST, Paris, France.
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