Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds.
One of the applications for circular external fixators is the treatment of large-bone defects which may be difficult to manage with conventional methods. Successful results have been reported with the use of circular external fixators, particularly in the treatment of infected tibial pseudoarthroses and those with bone loss. In this study, a total of 43 cases with tibial bone defects (18 infected) as a result of high-velocity gun-shot injuries were treated with circular external fixators between January 1, 1988 and December 31, 1995. The mean follow-up period was 50 months (range: 28-98 months) after the removal of the Ilizarov device. Satisfactory union was obtained in 40 cases without any major complication or additional surgical intervention, in spite of the large and in some cases infected defects. We conclude that this is a safe method for the treatment of infected or noninfected tibial bone defects. (+info)
Open reduction and internal fixation of acetabular fractures.
Between 1982 and 1995, 84 patients with displaced acetabular fractures underwent open reduction and internal fixation in our institution. The mean follow-up was 5.5 years with a minimum of 2 years. There were 33 simple and 51 complex fractures according to the classification of Judet and Letournels. Reduction after operation was anatomical in 49% of the patients, satisfactory in 24%, and unsatisfactory in 27%. Using Merle d'Aubigne's scale, the clinical results were excellent in 39% of the patients, good in 29%, fair in 8%, and poor in 24%. Factors of statistical significance associated with a poor clinical outcome were T-shaped fractures, unsatisfactory reduction (> 3 mm residual displacement), age > 40 years and development of avascular necrosis. Acetabular surgery is demanding, and a high rate of complications can be expected. Trauma centres should designate a group of surgeons who will consistently treat these fractures in order to obtain more experience and better results. (+info)
Results of the Bosworth method for unstable fractures of the distal clavicle.
Eleven consecutive Neer's type II unstable fractures of the distal third of the clavicle were treated by open reduction and internal fixation, using a temporary Bosworth-type screw. In all cases, fracture healing occurred within 10 weeks. Shoulder function was restored to the pre-injury level. A Bosworth-type screw fixation is a relatively easy and safe technique of open reduction and internal fixation of type II fractures of the distal third of the clavicle. (+info)
Growth factors in bone.
Bone contains several growth factors, including bone morphogenetic proteins (BMPs), transforming growth factor beta (TGF-beta), insulin-like growth factors I and II (IGF-I and IGF-II), platelet derived growth factor (PDGF) and basic and acidic fibroblast growth factor (bFGF and aFGF). Spatial and temporal variations in the expression and secretion of the various growth factors have been demonstrated in osteoblastic cultures and in various experimental and clinical in vivo models, including fracture healing in humans. Local application of various growth factors influences proliferation, differentiation and protein synthesis in osteoblastic cultures and bone formation in different animal models, including experimental fractures and skeletal defects. The BMPs are the only growth factors known to provoke bone formation heterotopically by making undifferentiated mesenchymal cells differentiate into osteoblasts (osteoinduction). BMPs and other growth factors, soon to become commercially available for clinical use, need a delivery system for their sustained release, as the factors are otherwise rapidly absorbed. Some existing systems inhibit bone formation by inducing chronic inflammation or physically by unresorbed carrier obstructing bone formation. New delivery systems are being investigated. (+info)
Intra-articular displaced fractures of the calcaneus. Operative vs non-operative treatment.
Twenty-eight patients with displaced intra-articular fractures of the calcaneus treated by open reduction and fixation were compared with 30 patients with similar fractures treated conservatively. Judged by the clinical and radiographic criteria results were more satisfactory in the surgical group than in the nonoperative group, although high rates of poor results were encountered in both groups. (+info)
Case report. Post-traumatic tibial recurvatum: resolution with growth.
The outcome of proximal tibial fractures in children is often complicated by the development of malalignment. Progressive valgus deformity is frequently seen, but is known to correct spontaneously in a high proportion of cases; however, recurvatum of the tibia usually requires surgical intervention. We present a child with a proximal tibial metaphyseal fracture who developed increasing tibial recurvatum which corrected spontaneously. (+info)
New concepts and advances of immobilization of long bones.
OBJECTIVE: To present some new concepts in the treatment of fractures and bone defects of long bones with internal fixation. METHODS: Animal experiments, mechanical tests and clinical analyses were done. RESULTS AND CONCLUSIONS: Reduction of fracture should be perfect, bone defect can be reconstructed by intramedullary and extramedullary bone graft. Relatively rigid fixation at the early stage and elastic fixation at the later stage are beneficial not only for fracture healing, but also for bone remodeling. In order to avoid complications including non-union, immobilization syndrome of the bone and joint, and implant failure, radiographs should be taken periodically; if there is any bone resorption, weight-bearing should be restricted. (+info)
Percutaneous autologous bone marrow grafting on the site of tibial delayed union.
Six months after injury, 150 mL of autogenous bone marrow was applied percutaneously at the site of delayed union to stimulate the healing of a tibial delayed union fracture in a 44 year-old man. Five months following the procedure, the fracture gaps and bone defects were completely filled with callus, the external fixator was removed, and the patient started using normal leg loading. (+info)