Clinical Orthobiologic Approach to Failure or Delay in Bone Healing (original) (raw)
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International Journal of Environmental Research and Public Health
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 an...
Journal of orthopaedic trauma, 2015
To determine factors associated with developing nonunion or delayed healing after open fracture. Prospective cohort between 2001 and 2009. Three Level One Canadian trauma centres. 736 (791 fractures) subjects were enrolled. 689 (94%) subjects (739 fractures) provided adequate outcome data. Subjects were followed until fracture(s) healed; phone interviews and chart reviews were conducted one year post-fracture. Patient, fracture and injury information, and time to surgery / antibiotics were recorded during hospitalization. Nonunion defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing at 1 year and delayed healing defined as 2 consecutive clinical assessments showing no radiographic progression or incomplete radiographic healing between 6 months and 1 year. There were 413 (52%) tibia/fibular, 285 (36%) upper extremity (UE) and 93 (13%) femoral fractures. Nonunion developed in 124 (17%) and delayed healing in 63 (8%) fractures. Th...
Nonoperative Fracture Treatment in the Modern Era
Journal of Trauma-injury Infection and Critical Care, 2010
Background: Nonoperative fracture treatment has been used for millennia, but there has been no demographic study of its use for half a century. In the last 50 to 60 years, there has been an increased interest in operative fracture fixation and in many specialized Trauma hospitals nonoperative management is less frequently used. However, these specialized hospitals do not reflect fracture treatment in the whole community, and we have undertaken a study to investigate the current prevalence of nonoperative fracture treatment. Methods: A retrospective analysis of 7,863 consecutive fractures in a defined population was undertaken. The use of nonoperative management in different fractures was assessed as was the influence of fracture severity, mode of injury, multiple fractures and social deprivation in the choice of treatment. A comparison of current treatment with that of the 1940s and 1950s was undertaken. Results: The prevalence of nonoperative treatment was 74.6% with 91.6% of children and 67.6% of adults being treated nonoperatively. There were significant differences in upper and lower limb fractures in both children and adults. The major determinant of nonoperative management was age, although the severity of fracture, mode of injury, and presence of multiple fractures were also important. Social deprivation was not a significant factor except in adult metacarpal fractures. Conclusions: Nonoperative treatment remains the most widely used method of fracture management. Its prevalence decreases with age, particularly in lower limb fractures. In children, there is a bimodal operative treatment distribution and an increasing prevalence of operative treatment. In some adult fractures, the prevalence of surgery is increasing, but in others, we operate no more frequently than in the 1950s, despite improved operative techniques.
Osteoporosis International, 2005
In this population-based, observational study, we document the personal burden of fracture and utilization of community and health services for women during the 12-month period following a fracture. Participants were 598 women (aged 35-92 years) with incident fracture in the years 1994-1996 who were enrolled in the Geelong Osteoporosis Study. Almost all hip fracture cases and 27% of nonhip fracture cases were hospitalized. Homes were modified in 14% of cases, and 32% of the women purchased or hired equipment to assist with activities of daily living. Three-quarters of women with hip, pelvis, or lower limb fractures were confined to the home, had to walk with a walking aid, or could walk only short distances for several weeks. After a year, nearly one-half had not regained prefracture mobility. One-seventh of women with upper-limb fractures did not venture outside the home for at least 6 weeks. Nearly half of all fracture cases needed help with personal care and housework during the first 6 weeks. After 6 months, 3.4% of all patients and 19.6% of hip, 12.8% of humeral, and 4.7% of spine fracture patients required assistance with bathing and showering. After a year, more than half of the hip fracture cases remained restricted regarding housework, gardening, and transport. These findings have important implications for rehabilitation therapy. A fracture, regardless of site, had a major impact on a woman's lifestyle and wellbeing. Most women were restricted in their activities of daily living and suffered loss of confidence and independence. Short-term morbidity was common for all fractures, with varying degrees of prolonged morbidity often extending to at least a year postfracture.
International journal of scientific research, 2018
Background: Fracture of bone is a persistent problem encountered in orthopedic practice globally and its management depends on reduction and immobility at the fracture site. Traditional bone setters are accepting this procedure as a familiar custom to formulate their own methods and practices for the management of fractures. Aim of the Study: The aim of the study is to evaluate and manage the complications occurred during the treatment given by TBS. Methods: One hundred and twenty cases coming to OPD during the period of Aug.2014 to Nov.2016 with some kind of prior treatment received from TBS are included in the study. Each case was subjected to detailed clinical and radiological examinations to evaluate the outcomes of the interventions by TBSs. Results: Malunion is the predominant form of presentation with 54 cases (46%) followed by non union in 24 (20%) cases. 33 cases (28%) presented with impending ischemia at initial stages of treatment. 8 cases (6%) presented with chronic osteomylitis and infected nonunion. Eventually 13 cases ended with gangrene and amputation. Cost of surgery emerged as the major cause (42%) followed by fear of surgery (23%) to receive treatment from TBS. Conclusion: The results in our study vindicate the fact that TBS play a major role in providing health care to the fracture patients. Multiple factors contribute to the wide spread acceptance of TBS in society. Lack of knowledge about the basic anatomy and referral system by TBS is responsible for complications. So it is required to create public awareness and integrating TBS in the healthcare system through proper training and due legislation is the possible aim to be achieved.
Fracture Healing and its Disturbances. A literature Review
Ortopedia Traumatologia Rehabilitacja, 2015
Go je nie zła mań jest pro ce sem bio lo gicz nym za le żnym od zdol no ści do ak ty wa cji, ku mu la cji w szpa rze prze ło mu oraz pro li fe ra cji i ró żni co wa nia me zen chy mal nych ko mó rek pre kur so ro wych w kie run ku ko mó rek li nii oste obla stycz nej. Je go ce lem jest wy two rze nie kost ni ny i jej re mo de lo wa nie do tkan ki kost nej o bu do wie ana lo gicz nej do tej, któ ra wy stę po wa ła przed ura zem. Jej mi ne ra li za cja wa run ku je przy wró ce nie wła ści wo ści me cha nicz nych za pew nia jąc wa run ki dla speł nia nia funk cji pod po ro wej utra co nej w wy ni ku zła ma nia. Za bu rze nia zro stu kost ne go są re la tyw nie czę stym po wi kła niem, w znacz nym stop niu utrud nia ją cym po stępo wa nie te ra peu tycz ne i pod no szą cym kosz ty le cze nia. Po wo dem ich wy stą pie nia jest brak lub uszko dze nie ko mó rek pre kur so ro wych, za bu rze nia ich re gu la cji hu mo ral nej-za rów no wi kła ją ce ak ty wa cję, jak i na pły wanie do miejsc ura zu, pro li fe ra cję i ró żni co wa nie w kie run ku ko mó rek li nii oste obla stycz nej oraz brak za pewnie nia od po wied nie go śro do wi ska dla opty mal ne go, z punk tu wi dze nia pro ce su go je nia zła ma nia, prze bie gu pro ce sów re pa ra cyj nych. W ni niej szej pra cy przed sta wio no ro lę po szcze gól nych czyn ni ków w pro ce sie zro stu kost ne go oraz me cha ni zmy po wsta wa nia ich za bu rzeń. Słowa kluczowe: złamanie kości, zaburzenia zrostu kostnego, molekularna regulacja gojenia złamań, komórki prekursorowe osteoblastów, czynniki stymulujące zrost kostny SUMMARY The healing of a bone fracture is a biological process depending on the activation of mesenchymal progenitors, their accumulation in the fracture gap, proliferation and differentiation into the osteoblastic cell lineage. Its aim is to form a callus in the fracture gap which is later remodelled into mature bone, restoring the mechanical properties lost in consequence of the fracture. Disturbances in fracture repair occur relatively often, causing therapeutic problems and increasing costs of treatment. They are caused by the lack of or damage to progenitor cells, disturbances in molecular regulation of their activation, homing, proliferation and differentiation into the osteoblastic cell lineage, or lack of appropriate environment for their optimal metabolism for fracture repair. This paper discusses the roles of individual factors crucial for the reparative process as well as the mechanisms responsible for their disturbances.
48 H for Femur Fracture Treatment: Are We Choosing the Wrong Quality Index?
Journal of Orthopaedics and Traumatology, 2019
Background: In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. Materials and methods: All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study. Exclusion criteria were patient age younger than 65 years, death before surgery, and nonsurgical treatment. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index (BMI), type and side of fracture, American Society of Anesthesiologists (ASA) score, date and time of surgery, surgical time, length of hospitalization, death during hospitalization, time from surgery to physiotherapy start, and time from surgery to first walking day. Results: The study sample resulted in 660 patients. Mean age was 82 years, 64 % were female, mean BMI was 24 kg/ m 2 , mean ASA score was 2.7, and 42 % were medial fractures. Mean time from admission to surgery was 95 h; 49.8 % were treated within the first 48 h. Mean time from surgery to physiotherapy start was 2 days, 21 % were not able to walk during hospitalization, time from surgery to first walking day was 5 days, and mean hospitalization time was 15 days. Early surgery was significantly (p = 0.008) associated with the probability of ambulation recovery during hospitalization. No association (p = 0.513) was found between early surgery and time in bed without walking. Conclusions: Early surgery in femur fracture became a priority in the health system. However, according to our data, although 51 % of patients were treated within the first 48 h, time from surgery to physiotherapy start (2 days) was still too long. Furthermore, time from surgery to first walking day was 6 days, longer than in most published papers. These data suggest that the performance index (rate of femur fractures treated within 48 h) may be improved by changing it to rate of femur fractures surgically treated with return to walking in 96 h. Level of evidence: Level 4 (retrospective study).