The benefits of various minerals and vitamins on fracture healing have been demonstrated in animal models. Vitamin C is an essential substance in fracture healing but has not been studied previously on an experimental basis. Sixteen rats were grouped randomly into control and vitamin C-supplemented groups. The right tibias of all rats were fractured by digital manipulation. One group received single high dose of vitamin C intramuscularly. On the 5th, 10th, 15th, and 20th days, two rats from each group were killed and the tibias examined under light microscopy. It was seen that the vitamin C-supplemented group went through the stages of fracture healing faster compared with the control group.
Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.
PurposeThe aim of this study was to compare the results of intramedullary fixation with those of plate-screw fixation for peritrochanteric femoral fracture patients older than 60 years old.MethodsThis article reports on a retrospective review of patients who had peritrochanteric femoral fractures and were treated with a 95° fixed-angle screw plate (DCS) or an intramedullary nailing system (PFNA). Patients with 79 fractures were enrolled in the study; 47 of them were treated with the PFNA system and 37 with the DCS. Followed for at least 1 year, the treatment groups were compared by taking into consideration all demographic and trauma variables.ResultsNo significant differences were discovered between the two groups with regard to side of injury, mechanism of trauma, associated comorbidities, AO fracture classification, average follow-up duration, mortality, and fracture reduction quality at the 1-year follow-up. The average surgical time was significantly lower in the PFNA group (57 min.) compared to the DCS group (87 min.). Longer operative time was needed in the DCS group, and thus, greater blood loss occurred compared to the PFNA group. The functional results of the PFNA group were found to be significantly better than those of the DCS group.ConclusionsOwing to some advantages, such as minimal exposure, reduced operative blood loss, and the achievement of biological fixation, PFNA is a better choice for the treatment for unstable peritrochanteric fractures.
From January 1992 to May 1997, 46 distal humeral fractures were treated by open reduction and internal fixation. Among these, 30 were intra-articular, which were managed by the transolecranal approach, routine ulnar nerve transposition, 3.5-mm dual-plate fixation and early active mobilisation. We encountered 2% non-union, 2.2% fixation failure, 11.1% nerve complications, 28.2% overall heterotopic ossification and 11.1% poor range-of-motion rates.
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