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Fu CX, Gao H, Ren J, Wang H, Lu SK, Wang GL, Zhu ZF, Liu YY, Luo W, Zhang Y, Zhang YF. Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis. Chin J Traumatol 2024:S1008-1275(24)00055-5. [PMID: 38762419 DOI: 10.1016/j.cjtee.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Indexed: 05/20/2024] Open
Abstract
PURPOSE To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity. METHODS PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3. RESULTS This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 - 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95 % CI: -1.79 - -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95 % CI: -0.93 - -0.19, p = 0.003), less bleeding (SMD: -1.5, 95 % CI: -2.81 - -0.18), p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95 % CI: -0.27 - -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95 % CI: -3.28 - -0.61, p < 0.001; isthmal SMD: -1.08, 95 % CI: -1.64 - -0.52, p = 0.002). CONCLUSION In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.
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Affiliation(s)
| | - Hao Gao
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Jun Ren
- Air Force Medical University, Xi'an, 700032, China
| | - Hu Wang
- Xi'an Medical University, Xi'an, 710021, China
| | - Shuai-Kun Lu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Guo-Liang Wang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Zhen-Feng Zhu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Yun-Yan Liu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, 700032, China
| | - Yong Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
| | - Yun-Fei Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China.
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Khandaker M, Lane R, Yeakley S, Alizereej H, Nikfarjam S, Ait Moussa A, Vaughan MB, Haleem AM. Evaluation of a Bioabsorbable Scaffold and Interlocked Nail System for Segmental Bone Defect. J Funct Biomater 2023; 14:jfb14040183. [PMID: 37103273 PMCID: PMC10141685 DOI: 10.3390/jfb14040183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In the current study, we designed and manufactured a scaffold and fixation system for the reconstruction of long-bone segmental defects in a rabbit tibia model. We used biocompatible and biodegradable materials, polycaprolactone (PCL) and PCL soaked with sodium alginate (PCL-Alg) to manufacture the scaffold, interlocking nail and screws using a phase separation casing method. Degradation and mechanical tests on the PCL and PCL-Alg scaffolds indicated that both were suitable for faster degradation and early weight-bearing capacity. PCL scaffold surface porosity facilitated the infiltration of alginate hydrogel through the scaffold. Cell viability results showed that the number of cells increased on Day 7 and decreased marginally by Day 14. For accurate placement of the scaffold and fixation system, a surgical jig was designed and 3D-printed using biocompatible resin in a stereolithography (SLA) 3D printer, then cured with UV light for increased strength. Our cadaver tests using New Zealand White rabbit confirmed our novel jigs’ potential for accurate placement of the bone scaffold, intramedullary nail and the alignment of the fixation screws in future reconstructive surgeries on rabbit long-bone segmental defects. Additionally, the cadaver tests confirmed that our designed nails and screws were strong enough to carry the surgical insertion force. Therefore, our designed prototype has the potential for further clinical translational study using the rabbit tibia model.
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Affiliation(s)
- Morshed Khandaker
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034, USA
- Correspondence: ; Tel.: +1-405-974-5935; Fax: +1-405-974-3812
| | - Reuben Lane
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Shannon Yeakley
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Hussein Alizereej
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Sadegh Nikfarjam
- Department of Biology, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Abdellah Ait Moussa
- School of Engineering, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Melville B. Vaughan
- Department of Biology, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Amgad M. Haleem
- Department of Orthopedics, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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Perisano C, Cianni L, Polichetti C, Cannella A, Mosca M, Caravelli S, Maccauro G, Greco T. Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review. Bioengineering (Basel) 2022; 9:560. [PMID: 36290528 PMCID: PMC9598798 DOI: 10.3390/bioengineering9100560] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Femoral shaft fractures (FSFs) are a frequent injury in traumatology for which intramedullary nailing (IMN) is considered the gold standard treatment. Nonunion (NU) is one of the most frequent complications in FSF treated with IMN, with a percentage from 1.1% to 14%. Plate augmentation (PA), the addition of a compression plate and screws, with or without bone graft has been described as an effective option for the treatment of NU, improving the biomechanical conditions at the fracture site. The aim of this review was to analyze the literature relating to the use of PA in NU after IMN in FSFs to assess the efficacy of the technique. METHODS An electronic search on PubMed, Google Scholar, and Web of Science was conducted to search for all studies concerning PA of femoral shaft NUs after IMN. RESULTS Twenty-four studies were included in the review comprising a total of 502 patients with a mean age of 39.5 years. Of these, 200 hundred patients had atrophic pseudoarthrosis and 123 had hypertrophic pseudoarthrosis, while in 179, the type of pseudoarthrosis was not reported. The most frequently used plate for PA was the dynamic compression plate (DCP); in 87.1% of the cases, the authors added a bone graft to the plate fixation. In 98.0% of the patients, a complete bone union was achieved in a mean time of 5.8 ± 2.12 months. CONCLUSION The patients treated with PA included in this review showed a good rate of consolidation in the femoral shaft NUs, with good functional recovery and a low incidence of complications.
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Affiliation(s)
- Carlo Perisano
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Luigi Cianni
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Chiara Polichetti
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Adriano Cannella
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Massimiliano Mosca
- IRCCS Istituto Ortopedico Rizzoli—U.O.C. II Clinic of Orthopaedics and Traumatology, 40136 Bologna, Italy
| | - Silvio Caravelli
- IRCCS Istituto Ortopedico Rizzoli—U.O.C. II Clinic of Orthopaedics and Traumatology, 40136 Bologna, Italy
| | - Giulio Maccauro
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Greco
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Flunixin Meglumine Enhanced Bone Fracture Healing in Rabbits Associated with Activation of Early Collagen Deposition and Enhancement of Vascular Endothelial Growth Factor Expression. Animals (Basel) 2021; 11:ani11102834. [PMID: 34679855 PMCID: PMC8532723 DOI: 10.3390/ani11102834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used postoperative analgesics, antipyretics, and anti-inflammatories, and they help prevent blood clotting. However, most NSAIDs delay bone healing. This study was aimed to investigate bone healing in a rabbit animal model by assessing the ability of flunixin meglumine (FM) and ketoprofen to induce fracture healing by examining histology, radiological changes, and vascular endothelial growth factor (VEGF) immunostaining during bone healing. For this purpose, 24 New Zealand rabbits were assigned to three groups: the control group, the FM group, and the ketoprofen group. Our results revealed that there were no intraoperative complications, and all surviving rabbits achieved full-weight bearing. Significant periosteal reaction and callus formation were confirmed at 2 postoperative weeks. Interestingly, FM enhanced callus formation, bone union, and remodeling in the FM group compared to the control and ketoprofen groups. FM enhanced bone healing through early collagen deposition and marked angiogenesis process activation by increasing the expression of VEGF. Our findings demonstrated, for the first time, the potential imperative action of FM in the bone healing process rather than other NSAIDs in animals.
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Wane M, Naqvi WM, Vaidya L, Kumar K. Kinesiophobia in a Patient With Postoperative Midshaft Fracture: A Case Report of Its Impact on Rehabilitation in a 16-Year-Old Girl. Cureus 2020; 12:e11333. [PMID: 33304670 PMCID: PMC7719470 DOI: 10.7759/cureus.11333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Kinesiophobia is an irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. According to the concept of avoidance of fear, pain is interpreted as threatening, which can trigger pain-related fears and anxiety leading to avoidance behavior. Avoidance action involves a process/period characterized by a person stepping back from undertaking daily tasks like exercise, socializing, and work, which increases the intensity of the painful experience. In hospital settings, kinesiophobia needs to be resolved to ensure a positive result in rehabilitation interventions. The femur is the lower extremity's primary weight-bearing bone. Early fracture fixation in the shaft of the femur allows for early mobilization, thereby reducing the risk of hip and knee stiffness as well as quadriceps and hamstring wasting. In this report, we present the case of a 16-year-old girl with an alleged history of fall who was admitted to Acharya Vinobha Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Deemed To Be University (DU), Wardha, India, with primary complaints of pain and swelling over the left thigh. She was diagnosed with a left midshaft femur fracture. An open reduction internal fixation (ORIF) femur interlock nailing was performed to stabilize the fracture, and she was referred to physiotherapy after surgery for further management. The comprehensive rehabilitation program was helpful in alleviating the severe kinesiophobia in the patient, and she was able to resume her activities of daily living (ADLs) independently.
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Affiliation(s)
- Madhuri Wane
- Occupational Therapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Waqar M Naqvi
- Community Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Laukik Vaidya
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Kiran Kumar
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Jia Z, Wang S, Xiao T, Jiang W, Zhou T, Liu Q, Li G, Hu X. The design of an "H" joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique. J Orthop Surg Res 2020; 15:357. [PMID: 32847603 PMCID: PMC7449011 DOI: 10.1186/s13018-020-01898-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022] Open
Abstract
Background Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopedic traction table. However, lateral displacement and angulation persist. Methods In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation, and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, non-union, malunion, and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Shijin Wang
- Department of Orthopaedics, Taian City Central Hospital, Taian City, 271000, Shan dong Province, China
| | - Tinghui Xiao
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Wei Jiang
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Tianjian Zhou
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Qisong Liu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China.,Institute for Regenerative Medicine, Texas A&M Health Science Center College of Medicine, Temple, TX, 76502, USA
| | - Guangheng Li
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China
| | - Xinjia Hu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong Province, China.
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Sabater González M, Calvo Carrasco D. Advances in Exotic Animal Osteosynthesis. Vet Clin North Am Exot Anim Pract 2019; 22:441-450. [PMID: 31395324 DOI: 10.1016/j.cvex.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Exotic animal orthopedics has not incorporated the most recent progress made in small animal surgery or human medicine. Although minimally invasive osteosynthesis has been incorporated as a routinely used alternative in small animals, its use in exotic animals is still in its infancy. This article compliments the reviews of orthopedics in small mammals, birds, and reptiles in the previous issue. It reviews relevant recent studies performed in laboratory animals about new orthopedic materials and techniques showing potential to become incorporated into the routine orthopedic treatment of exotic animals in the coming years.
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Brady J, Hardy BM, Yoshino O, Buxton A, Quail A, Balogh ZJ. The effect of haemorrhagic shock and resuscitation on fracture healing in a rabbit model: an animal study. Bone Joint J 2018; 100-B:1234-1240. [PMID: 30168758 PMCID: PMC6333172 DOI: 10.1302/0301-620x.100b9.bjj-2017-1531.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims Little is known about the effect of haemorrhagic shock and resuscitation
on fracture healing. This study used a rabbit model with a femoral
osteotomy and fixation to examine this relationship. Materials and Methods A total of 18 male New Zealand white rabbits underwent femoral
osteotomy with intramedullary fixation with ‘shock’ (n = 9) and
control (n = 9) groups. Shock was induced in the study group by
removal of 35% of the total blood volume 45 minutes before resuscitation
with blood and crystalloid. Fracture healing was monitored for eight weeks
using serum markers of healing and radiographs. Results Four animals were excluded due to postoperative complications.
The serum concentration of osteocalcin was significantly elevated
in the shock group postoperatively (p < 0.0001). There were otherwise
no differences with regard to serum markers of bone healing. The
callus index was consistently increased in the shock group on anteroposterior
(p = 0.0069) and lateral (p = 0.0165) radiographs from three weeks
postoperatively. The control group showed an earlier decrease of
callus index. Radiographic scores were significantly greater in
the control group (p = 0.0025). Conclusion In a rabbit femoral osteotomy model with intramedullary fixation,
haemorrhagic shock and resuscitation produced larger callus but
with evidence of delayed remodelling. Cite this article: Bone Joint J 2018;100-B:1234–40.
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Affiliation(s)
- J Brady
- Lismore Base Hospital, Lismore, Australia
| | - B M Hardy
- John Hunter Hospital, New Lambton Heights, Australia
| | - O Yoshino
- Austin Hospital, Melbourne, Australia
| | - A Buxton
- University of Newcastle, Newcastle, Australia
| | - A Quail
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Z J Balogh
- University of Newcastle, Newcastle, Australia and Orthopaedic Surgeon, John Hunter Hospital, New Lambton Heights, Australia
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