Nutrients Applied to Injury_____Rehabilitation and Sports Medicine
Luke R. Bucci in Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Fractures are a break in bone continuity caused by excessive forces applied to bones. Fractures range in severity from small cracks to complete breakage of bone (closed compound) with protrusion from skin (open compound). Cracks may be small and localized, or extensive and spiral-shaped (greenstick). Epiphyseal fractures involve crushing, cracking, or breaking the epiphyseal growth plate in young persons. Fractures usually involve bleeding and are an acute inflammatory event. However, the special dietary needs of bones add other nutrients into the key category, especially during callus formation. Also, with more severe fractures, adverse metabolic consequences may arise. For a more extensive description of bone healing, see Chapter 1. Table 8 lists nutrient protocols for fracture healing.
Injuries of the hip and femur
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Refracture and implant failure Fractures which heal with abundant callus are unlikely to recur. In those treated with absolute stability and internal fixation, bone healing is primary and there is no callus formation. If relative stability and internal fixation is used, bone healing is secondary and there will be callus formation as long as sufficient mechanical stability is achieved and an adequate biological environment maintained. With delayed union or non-union, the integrity of the femur may be almost wholly dependent on the implant, which, if union does not occur, will eventually fail by fatigue failure. If a comminuted fracture is plated, bone grafts should be added and weight-bearing delayed so as to protect the plate from reaching its fatigue limit too soon. Intramedullary nails are less prone to breakage. However, sometimes they do, especially with a slow-healing fracture of the distal third and a static locked nail; the break usually occurs through the screw hole closest to the fracture. Treatment consists of exchange nailing and bone grafting. In resistant cases, the fracture site may need excising (as viability of the bone ends is poor) followed by distraction osteogenesis which simultaneously stabilizes the limb and deals with the leg-length discrepancy (Figure 30.32).
Treatment of a nonunion of a thoracolumbar deformity, not at the site of a three-column osteotomy
Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro in Revision Spine Surgery, 2019
It is imperative to investigate the underlying etiology of the pseudarthrosis prior to attempting a salvage revision. Often, the underlying factors that lead to a nonunion fall into two general categories: metabolic and biomechanical. Metabolic factors that can lead to poor bone healing include smoking, renal disease, steroid use, nonsteroidal anti-inflamatory drug (NSAID) use, infection, and other elements that inhibit bone growth. Biomechanical factors include poor bone quality, inadequate instrumentation, lack of anterior column support, sagittal or coronal malalignment, elevated proximal or distal junctional angle, or a combination of these. By better understanding the underlying factors that may have contributed to the failed fusion, the revision strategy can be optimized for success.
The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant?
Published in Disability and Rehabilitation, 2021
Charlotte M. Lameijer, Henk Jan ten Duis, Charlotte M. S. C. Haag, Mostafa El Moumni, Corry K. van der Sluis
Surprisingly, our results showed that step-off and gap diminished significantly between 6 weeks and follow-up, although these differences were within earlier mentioned magnitude error [10]. Conflicting results regarding reliability of measuring gaps and step-offs following distal radius fractures have been reported. It has been reported that observers, independent of skill level, may measure step-off and gaps accurately to 0.62 ± 53 mm (95% CI 0.59–0.65) [67]. Intraclass correlation coefficient scores showed “substantial” (0.78) to “almost perfect” (0.81) inter- and intraobserver agreement [67]. In contrast, other studies reported low intra- and inter-reliability ICC values [10,18]. Watson et al. showed that measurement error lies within 1–2 mm, indicating that clinicians cannot measure differences ≤1 mm [10]. They therefore questioned the reliability of using these radiographic measurements to guide treatment decisions regarding conservative or operative management. To our knowledge, no literature on the decrease of articular incongruence over time in adult patients is available. Bone healing is a complex event that involves coordination of two complex forces: anabolism or tissue formation and catabolism or remodelling under influence of axial, translational and rotational forces [68,69]. Possibly remodelling processes have diminished the articular incongruence.
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
No patient complained of pain. Bone healing was achieved in all cases, and the mean healing time was 13.6 (range, 11–19) weeks. No rotational or flexion/extension deformities were observed. No postoperative complications, such as infection, CRPS type one, re-displacement of the fractured bone, and implant breakage, were reported. The mean extension lag of the PIP joint was 3° (range, 0°–10°), and an extension lag was observed in two cases, one with 5° and another with 10°. The mean TAM was 237° (range, 210°–260°), mean %TAM was 94% (range, 86–100), and the outcome of all five cases was determined to be excellent based on the ASSH criteria (Table 1). The implants were removed after a mean postoperative period of 29 (range, 22–36) weeks in four of the five patients. The remaining patient did not wish for the implant to be removed and was thus left in place. Tenolysis of extensor tendon was not performed during implant removal in any of these cases, and the TAM before and after implant removal was similar.
Plating System Design Determines Mechanical Environment in Long Bone Mid-shaft Fractures: A Finite Element Analysis
Published in Journal of Investigative Surgery, 2020
Jianzhao Wang, Xiaojuan Zhang, Sheng Li, Bing Yin, Guobin Liu, Xiaodong Cheng, Yingze Zhang
For the bone healing process, the mechanical environment is a crucial factor that is essential for callus formation. However, its importance in the bone healing process has received scant attention in both research literature and clinical practice [9]. Second, bone healing is induced by interfragmentary movement (IFM) in the millimeter range [10] and IFM affects the mechanism and progression of bone healing [11]. It is reported that the stiffness of a fixation construct is a major influential factor of IFM [11]. Plate working length (distance between the first screw at each side of the fracture) [12] has great influence on stiffness. However, both long and short working length of plates could lead to fixation failure [4, 13]. Finding the best compromise between rigidity and flexibility of a plating construct remains challenging and controversial [12].