جستجوی مقالات مرتبط با کلیدواژه « union » در نشریات گروه « پزشکی »

The optimal surgical indications for humeral shaft fractures in the working population remain uncertain.This study investigates the impact of surgical fixation on return to duty, union, and complications in workers’ compensationpatients with humeral shaft fractures. All workers’ compensation patients with humeral shaft fractures managed at a single institution between2007 and 2017 were identified. Manual chart and radiographic review was performed to identify etiology of injury, typeof work, time until return to duty, length of physical therapy, complications, and time to fracture union. There were 39 humeral shaft fractures in workers’ compensation patients managed at our institution (25surgical; 64.1%). There was no difference in the return to light (106.1 versus 60.4 days; P=0.20) or full (140.1 vs.139.9 days; P=0.99) duty for surgical versus nonsurgical treatment, respectively. There was no difference in thelength of physical therapy (132.6 versus 106.3 days; P=0.15) or time to maximum medical improvement (174.3 vs.198.8 days; P=0.25) for surgical versus nonsurgical treatment, respectively. Three patients returned to the operatingroom in the surgical group. Nonunion was observed in two surgical cases (8.0%) and one case (7.1%) of nonsurgicalmanagement. This study did not identify an advantage for faster return to work after surgical management of humeralshaft fractures in workers’ compensation patients. Though one of the perceived advantages of surgical fixation is aquicker return to physical activity, there may be other variables in this patient population that influence the timing ofreturn to work.Level of evidence: III

Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion anddelayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods,there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one methodhas a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibiafractures using biological fixation with bridge plating and rigid fixation with compression plating. This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjectswere divided into two groups based on the fixation method, namely bridge plating and compression plating. Baselinecharacteristics, fracture characteristics, and union status were analyzed and compared in this study. Baseline and fracture characteristics were similar between the groups. Only higher translation in any planeswas noted in the bridge plating group (2.80±3.04 mm; P<0.001). As for union status, the rates of the union during 3months and delayed/no union were similar between the two groups (P=0.18). During a 6-month follow-up, 92% and93.8% of the patients achieved union in the bridge plating and compression plating groups, respectively. Rates of delayed union and nonunion are similar regarding extra-articular distal tibia fractures treatedwith either bridge plating or compression plating.Level of evidence: III

The appropriate monitoring of union following the treatment of scaphoid nonunion is essential. However, there is no consensus regarding the optimal imaging modality for this evaluation. 

Here, we compared the reliability of plain radiographs with computed tomography (CT) scanning in determining the union of scaphoid following the scaphoid nonunion.

In this retrospective study, 25 patients, who underwent the surgical treatment of scaphoid nonunion and had both plain radiographs and CT images, were included. The surgical procedure included open reduction, illiac crest bone graft, and K-wire fixation. Two different observers assessed the healing of scaphoid nonunion by both imaging modalities and graded as healed or non-healed.

The mean±SD age of the patients was 29.1±6.8 years. The mean±SD time interval from the operation to imaging was 6.5±2.5 months. Based on the plain radiographs, all patients achieved the scaphoid union. However, in the CT evaluation, 23(92%) patients showed the scaphoid union. Accordingly, CT images and plain radiographs agreed in 23 cases and disagreed in two cases. This difference was not statistically significant (P=0.5).

In a subset of patients, who underwent the operation for the treatment of scaphoid nonunion, plain radiographs might falsely confirm a scaphoid union. In these patients, a complementary CT evaluation might be helpful in the accurate assessment of scaphoid healing.

The goal of treatment in displaced lateral condylar fracture is to achieve union without residual deformity. However, growth disturbance may occur despite initial anatomic reduction and secure fixation.
The purpose of this study was to evaluate clinical and radiographic results and assess complications associated with the operative treatment of lateral condylar fractures in children.
A total of 73 pediatric patients under the age of 13 years, who were diagnosed with displaced lateral condylar fractures of the humerus and were treated with open reduction and internal fixation, were assessed from March 2011 to September 2015. The mean follow-up duration in these patients was 22 months (8 - 48 months). The clinical results were evaluated using the Hardcare scoring system. Also, anteroposterior and lateral radiographic views were assessed to identify the union process and presence of complications.
The results of evaluation on 48 boys and 25 girls demonstrated that lateral condylar fractures of the humerus were more common in boys, aged 5-8 years (average: 57.1%). There was no significant relationship between complications and sex. However, according to the radiographic evaluation, while fractures in 71 (97.2%) patients were completely united without any complications, 2 (2.8%) patients experienced overgrowth of the lateral humeral condyle. Clinical evaluation demonstrated excellent and good outcomes in 68 and 5 patients, respectively. Also, evaluation of Hardcare scores revealed no significant relationship between complications and clinical outcomes.
The present results were in line with previous research regarding the absence of complications such as non-union, avascular necrosis, fishtail deformity, cubitus varus, cubitus valgus, and pain. The findings demonstrated that the acceptable treatment option for displaced and rotated fractures is open reduction and internal fixation. Furthermore, deformity did not affect the clinical outcomes of fractures.

Accounting for approximately 5% of the bone fractures in the human body, the shaft of the humerus is one of the most common long bone fracture sites. Humerus fracture may be associated with several complications: radial nerve damage, bone infection, and non-union and mal-union of the bone. Autologous bone marrow injections are considered to decrease these complications and accelerate union and healing in non-unions.
The present study investigates the effect of autologous bone marrow injections on the union rate in humerus fractures.
Patients and For this interventional clinical trial, patients with humerus fracture referred to the emergency ward of Baqiyatallah and Imam Hossein hospitals were enrolled in the study. Thirty-six patients with a mean age of 33.97 ± 10.08 years underwent analysis. Demographic information, type of fracture, para-clinical test results, and initial X-ray results were recorded on a predesigned questionnaire. Patients were randomly assigned to either bone marrow injection or cast only (non-surgical) treatment. Patients were followed up one, two, three, four, six, twelve, and sixteen weeks after injection or cast (non-surgical) therapies with lateral and anterior-posterior radiography. Details regarding union time and mal-union or non-union were recorded.
The mean time of union was 8.54 ± 3.41 weeks for the individuals followed in the study. On average, union took 7.04 ± 2.49 weeks for the injection group, while it took 10.41 ± 3.26 weeks for the control group (P = 0.002). In the sixth week, 16 (80%) patients from the injection group and 4 (25%) individuals from the control group had radiographic changes (P = 0.001). Union changes were seen in 19 (95%) patients from the injection group and 12 (75%) individuals from the control group at the end of the twelfth week (P = 0.108). All patients in both groups had complete union 16 weeks after their respective treatments (P = 0.31).
Due to the high risk of non-union and mal-union in humerus shaft fracture, and because applying this simple and inexpensive technique significantly decreased these complications, injecting autologous bone marrow grafts is recommended for accelerating union in cases of humerus fracture.

The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists’ and orthopedic surgeons’ diagnosis and treatment plans for
delayed unions and non-unions.
A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters’ observations was determined in each case by subtracting the two scores of both time points.
All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided.
In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.

To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.
This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.
The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.
Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.

Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of non-unions according to the principles of ‘diamond concept’ and aspects that have to be attended.
Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept.
If an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required.
By using the ‘diamond concept’ as a complex concept, non-unions can be treated in different stages in a targeted manner.

Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-vascularized bone graft. Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes. There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and Cooney wrist scores in the patients. In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes.

Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2–4%), where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection.