Acute peg in hole docking in the management of infected non-union of long bones.
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ABSTRACT:
SUBMITTER: Dhar SA
PROVIDER: S-EPMC2532279 | biostudies-other | 2008 Aug
REPOSITORIES: biostudies-other
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Project description:Objectives: Septic non-union in long-bone fractures represents a challenging clinical entity. Management of lower extremity segmental bone defects, aiming to restore functional anatomy, remains extremely difficult and controversial. Masquelet technique is a reconstruction method for large diaphyseal bone defects, based on the notion of the induced membrane. The principle of the induced membrane is to create a foreign body reaction by placing cement spacer in the bone defect. The purpose of this study was to assess the success rate of induced membrane technique (IMT) in treating lower extremity large bone defects due to septic non-union. Methods:This is a retrospective observational study performed in a single referral center in France, Europe, which is specialized in complex bone and joint infections. All patients operated for septic non-union were identified from a prospectively maintained database. Patients treated with the IMT for septic femoral or tibial non-union between 2013 and 2017 were enrolled in this study. Exclusion criteria were infection of a continuous bone, aseptic non-union, or patients with less than one year of follow-up after antibiotic treatment ending. Results:Twenty-three cases (19 patients) with an average age of 41.3 years were included in the present study. There were 19 tibial and four femoral fractures. The mean bone defect was 65.3 mm. The mean time interval from initial trauma to the first surgical phase was 17 months, while that between the two surgical phases was 77.7 days. After the first surgical phase, samples were positive in 13 cases (68.5%), isolating Staphylococcus (26%) and more than one pathogen in 22% of cases. Bone union was successful in 16 of 23 cases (69.6%, 14 patients). There were seven failures: five amputations due to mechanical and/or infection-related failure and two failed unions. Conclusion:This study found that 69% of cases with septic non-union of tibial or femoral fracture treated with the two-step surgical protocol achieved bone union and infection eradication within about 13.2 months after the second stage of the procedure. The study revealed promising results in patients suffering large-size bone defect; hence, the IMT may prove beneficial in the management of such cases.
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Project description:When considered in two-dimensional space, a cylindrical peg being withdrawn from a clearance-fit hole can exhibit one of four contact states: no contact, one-point contact, two-point contact and line contact. Jamming and wedging can occur during the two-point contact. Effective control of the two-point contact region can significantly reduce resistance in peg-hole disassembly. In this paper, we explore generic peg-hole disassembly processes with compliance and identify the effects of key parameters including the degree of compliance, the location of the compliance centre and initial position errors. A quasi-static analysis of peg-hole disassembly has been performed to obtain the boundary conditions of the two-point contact region. The effects of key variables on the two-point contact region have been simulated. Finally, peg-hole disassemblies with different locations of compliance centre achieved using active compliance have been experimentally investigated. The proposed theoretical model can be implemented to predict the range and position of the two-point contact region from the perspective of peg-hole disassembly.
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Project description:Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
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Project description:Non-union skeletal fractures are characterized by their inability to heal six months after injury. Left untreated, the non-union fracture may cause advanced arthritis or loss of function in the affected limb. Arrays were used to identify the mechanisms that lead to lack of skeletal repair in non-unions. These profiles are the non-union callous samples pooled from five individuals Keywords: other
2003-07-16 | GSE494 | GEO
Project description: Not available
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Project description:Long bone fractures are common and although treatments are highly effective in most cases, it is challenging to achieve successful repair for groups such as open and periprosthetic fractures. Previous biomechanical studies of fracture repair, including computer and experimental models, have simplified the fracture with a flat geometry or a gap, and there is a need for a more accurate fracture representation to mimic the situation in-vivo. The aims of this study were to develop a methodology for generating repeatable transverse fractures in long bones in-vitro and to characterise the fracture surface using non-invasive computer tomography (CT) methods. Ten porcine femora were fractured in a custom-built rig under high-rate loading conditions to generate consistent transverse fractures (angle to femoral axis < 30 degrees). The bones were imaged using high resolution peripheral quantitative CT (HR-pQCT). A method was developed to extract the roughness and form profiles of the fracture surface from the image data using custom code and Guassian filters. The method was tested and validated using artificially generated waveforms. The results revealed that the smoothing algorithm used in the script was robust but the optimum kernel size has to be considered.
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Project description:The different anatomical regions involved in osteogenesis in the chick long bone have been examined for heterogeneities in collagen structure that might relate to the mechanism of ossification. Experimentally induced lathyrism was employed to enhance collagen solubility, and vitamin D deficiency to allow accumulation of osteoid, the precursor of bone matrix. The extractable lathyritic collagens of the cartilaginous and osseous regions of growing long bones from rachitic and non-rachitic chicks were examined for alpha-chain type and amino acid composition. In both groups of animals the growth plate and cartilaginous regions of the epiphysis gave collagen molecules of the constitution [alpha1(II)](3), whereas the ossifying regions contained [alpha1(I)](2) alpha2. The degree of hydroxylation of the lysine moieties was increased by approximately 50% in the alpha1(I)-chain and alpha2-chain of rachitic bone collagen. Since uncalcified osteoid is greatly enriched in rachitic bone, it is concluded that the collagen of osteoid has the configuration [alpha1(I)](2) alpha2, similar to that of bone matrix, but has an elevated hydroxylysine content. The possible relationship of this difference to the mechanism of calcification is discussed.
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Project description:Multifactorial aetiology defines non-unions, with a biological and a mechanical distortion of the timeline of bone healing.Research on new advances to increase osteogenesis and promote non-union healing is strongly directed towards new forms of cell products.Basic science and research on non-union treatments is needed to compile preclinical data on new treatments.Bone marrow concentration and expanded mesenchymal stromal cells still require extensive clinical research to confirm efficacy in non-union treatment.Solid preclinical studies, precise cell product definition and preparation, and appropriate ethical and regulatory approvals are needed to assess new advanced therapy medicinal products. Cite this article: EFORT Open Rev 2020;5:574-583. DOI: 10.1302/2058-5241.5.190062.
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Project description:BackgroundAlthough relatively rare, non-unions and mal-unions of tibial plateau fractures present significant challenges for the orthopedic surgeon. With careful pre-operative planning, tibial plateau mal-union or non-union revision surgery with intra-articular and varus opening osteotomies can provides good functional results when performed early (within 1 year) after primary surgical procedure.Questions/purposesWe present our treatment algorithm for approaching and treating non-union or mal-union of tibial plateau fractures. Our aim is to give surgeons treating these difficult injuries an overview of the pertinent literature as well as describe the challenges and pitfalls we have experienced when treating non-union or mal-union of tibial plateau fractures.MethodsUsing two case examples from our institution, one for mal-union and one for mal-reduction, we describe our treatment algorithm and surgical technique for managing these difficult injuries. We also provide a brief literature review outlining relevant studies and summarizing outcomes for similar injuries. A systematic literature review was conducted with the aim of determining the methods and outcomes commonly reported in the literature regarding revision surgery following tibial plateau non-union or mal-union. Due to the nature of revision surgery, there are no long-term randomized trials dealing with outcomes, but rather several smaller case series exist from which larger conclusions have to be drawn.ResultsTo date, we have successfully treated approximately 35 patients with this technique, and clinical follow-up continues to show good functional outcomes with reduced pain and little radiographic evidence of arthritic changes. Restoring long leg alignment, anatomic reduction of the articular surface, and achieving stable internal fixation are paramount in achieving the best long-term outcome. Due to the shallow soft tissue envelope around the proximal tibia, and the tendency for these fractures to fall into progressive valgus collapse, these problems can seem intimidating and complex. However, with well-planned surgery and meticulous surgical technique, reliable healing can be achieved.ConclusionBy outlining our method, we hope to provide other surgeons with an algorithm to guide clinical and operative decision making. These difficult injuries can be daunting to treat, but if performed before the onset of severe degenerative arthritis, early revision surgery, as we describe, can be a viable alternative to total knee arthroplasty, particularly in younger, more active patients.
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Project description:Fibrin is a widely used biological scaffold in tissue engineering and regenerative medicine. While the polymerization dynamics from its soluble precursor fibrinogen has been studied for decades, few attempts have been made to modulate fibrin network structure through the addition of external agents that actively engage this process. We propose the use of polyethylene glycol (PEG)-based linkers that interact with fibrinogen via knob:hole affinity interactions as a means of controlling thrombin-mediated fibrin polymerization dynamics and resulting network structure. Using bivalent and tetravalent knob-PEG conjugates with sizes ranging from 2 to 20 kDa, we demonstrate that the clotting characteristics of fibrinogen solutions can be altered in a dose-dependent manner, with conjugate size playing a major role in altering fibrin network structure. Interestingly, factor XIIIa-catalyzed fibrin(ogen) crosslinking and plasmin-mediated degradation were not significantly impacted. This work demonstrates the feasibility of modulating fibrin network structure through the addition of knob-PEG conjugates that perturb the polymerization process through non-covalent knob:hole interactions.
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