Callus formation and the rate of healing of femoral fractures in patients with head injuries

Abstract

Orthopaedic dictum teaches that fractures oflong bones, when associated with head injuries, frequently heal with excessive callus and at a faster rate than normal. The evidence, however, is flimsy and based on small series of patients treated in different ways and never with an adequate control series (Calandriello 1964). The dictum remains unsubstantiated and, indeed, Garland failed to confirm increased callus formation or more rapid healing of fractures of the tibia and femur in patients with head injuries (Garland and Toder 1980;Garland, Rothi and Waters 1982). These series, however, had no controls, nor did they quantify the callus.The conservative treatment of fractures in patients with head injuries is made more difficult for both medical and nursing staff by the fact that patients are often unable to co-operate. Excessive callus in these patients may then be due to lack of control of the limb and excessive movement at the fracture, and only indirectly to the head injury. In order to eliminate these variables, we decided to study fractures ofthe shaft of the femur treated by AO nailing and to measure and compare the extent of callus production and the rate of healing in patients with or without associated head injury. PATIENTS AND METHODSThe series reviewed comprised 22 consecutive patients Requests for reprints should be sent to Mr A P Skirving.©1987British Editorial Societyof Bone and Joint Surgery 0301â€"620X/87/4098 $2.00 severity of the head injury was graded : mild â€" in a coma for less than 3 hours ; moderate â€" a coma lasting 3 hours to 3 days ; or severe â€" a coma lasting more than 3 days. Fourteen of the 22 patients had a severe head injury, the period of coma varying from 3 to 41 days (average 15 days). Twenty-two consecutive patients without head injury but with similar femoral fractures treated with AO intramedullary nails formed the control group (Group II) and 11 of these patients had additional severe orthopae dic injuries.The fractures in both groups were all diaphyseal with displacement of the whole diameter. The degree of comminution was graded : Grade I â€" minor, with one or two small fragments ; Grade II â€" moderate, with three or four small fragments or a large displaced butterfly fragment ; or Grade III â€" with severe comminution.In the majority of patients the AO nailing was performed using a closed technique but in seven ofthe 23 fractures in the head injury group the fracture was openly reduced before fixation ; in Group II only two patients required open reduction. The time lapse from injury to nailing was recorded.An attempt was made to establish the rigidity of fixation in terms of the size of the nail used and the diameter of the medullary cavity at the level of the fracture. In all cases the medullary cavity was reamed to take a large nail at the narrowest part of the medullary cavity but excessive reaming was not performed; therefore, in fractures below the mid-shaft of the femur, the fixation was deemed not to be rigid owing to the poor fit of the nail within the med...

Does accelerated bone healing associated with traumatic brain injury (TBI) occur in open fractures

“…Newman et al reported an increased rate of fracture healing in a small series of 11 patients who had sustained a TBI and an associated long bone fracture, either of the femur or the tibia [1] . His findings were comparable to results reported by Perkins et al in a similar group of head injured patients with an associated femoral shaft fracture [2] . Our study had the useful addition of a control group with similar femoral fractures.…”

“…All these reports are restricted to closed fractures and there is no literature of the effect of TBI in open fractures. Many authors have shown accelerated fracture healing after TBI [1][2][3][12][13][14] . Newman et al reported an increased rate of fracture healing in a small series of 11 patients who had sustained a TBI and an associated long bone fracture, either of the femur or the tibia [1] .…”

“…Fracture healing response in traumatic brain injury (TBI) has been discussed over few decades and many authors have observed accelerated healing of fractures in TBI [1][2][3][4] . All these studies concentrate only on closed fractures.…”

Vascularised osteocutaneous fibular transfer to the tibia

“…After complete excision of the tibia partial weight-bearing was at 5 months and full weight-bearing at 7 months. The patency of the anastomoses was checked by monitoring the colour of the flap whose blood The volumetric h y p e r t r o p h y of the graft was measured [6] and f o u n d to be an average of 9.2 cm 3 at 6 months, 20.6 cm 3 at 12 months and 29.8 cm 3 at 18 months.…”

Alterations in Serum Levels of Receptor Activator of Nuclear Factor-κB Ligand and Osteoprotegerin in Patients with Head Injury and Fracture

“…그리고 중추신경계 손 상 환자에서 이소성 골화가 종종 관찰된다 8, 16,18,24) . 그래서 그 후 수년간에 걸쳐 외상성 뇌손상 환자에서의 골형성 능 력 증가의 원인을 규명하려고 시도하였다 2,3,7,9,14, 19,23,[27][28][29][30] .…”