Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures

Houben, Ignas B; Raaben, Marco; Batenburg, M. van Basten; Blokhuis, Taco J.

doi:10.1007/s00590-018-2190-2

Cited by 32 publications

(28 citation statements)

References 31 publications

(42 reference statements)

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“…This nding may be explained by a relationship between weight bearing and healing outcomes in the reverse direction. That is, bone non-union may cause more pain, resulting in delayed weight bearing, rather than delayed weight bearing causing non-union [37]. Additionally, internal xation failure is often considered as a reason to postpone the initial weight bearing.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Xu¹,

Zhang²,

Dai³

et al. 2020

Preprint

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Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

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Section: Resultsmentioning

confidence: 99%

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Xu¹,

Zhang²,

Dai³

et al. 2020

Preprint

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“…After surgery patients were treated with culture specific antibiotics for 12 weeks (7-14 days intravenous, completed with oral antibiotics) depending on pathogen and clinical evolution. During rehabilitation, permissive weight baring was allowed to improve healing [10] .…”

Section: Treatment Algorithmmentioning

confidence: 99%

“…This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) [ 6 , 7 ]. Open fractures, bone loss, smoking, NSAIDs usage, delay of weight baring and insufficient fixation are important risk factors and can cause a significant risk increase for non-union [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Treatment of infected tibial non-unions using a BMAC and S53P4 BAG combination for reconstruction of segmental bone defects: A clinical case series

Vugt

Geurts

Blokhuis

2021

Injury

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Introduction: Treatment of infected non-unions of the tibia is a challenging problem. The cornerstones of optimal infected non-union treatment consist of extensive debridement, fracture fixation, antimicrobial therapy and creation of an optimal local biological bone healing environment. The combination of S53P4 bioactive glass (BAG), as osteostimulative antibacterial bone graft substitute, and bone marrow aspirate concentrate (BMAC) for the implantation of mesenchymal stem cells and growth factors might be a promising combination. In this paper, preliminary results of a new treatment algorithm for infected non-unions of the tibia is presented.Methods: In this retrospective case series patients with infected non-unions of the tibia are treated according to a new treatment algorithm. Patients are treated with extensive debridement surgery, replacement of the osteosynthesis and implantation of S53P4 BAG and BMAC in a one-stage or two-stage procedure based on non-union severity. Subsequently patients are treated with culture based antibiotic therapy and followed until union and infection eradication.Results: Five patients with an infected non-union were treated, mean age was 55, average NUSS-score was 44 and the average segmental bone defect was 4.6cm. One patient was treated in a one-stage procedure and four patients in a two-stage induced membrane-, or "Masquelet"-procedure. On average, 23 ml S53P4 BAG and 6.2 ml BMAC was implanted. The mean follow-up period was 13.6 months and at the end of follow-up all patients had clinical consolidation with an average RUST-score of 7.8 and complete eradication of infection.Discussion: These early data on the combined implantation of S53P4 BAG and BMAC in treatment of infected non-unions shows promising results. These fracture healing results and eradication rates resulted in promising functional recovery of the patients. To substantiate these results, larger and higher quality studies should be performed.

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“…Generally, clinical data have demonstrated benefit of physical therapy to improve functional outcomes following most musculoskeletal injuries. For instance, early weight bearing is recommended for simple mid-shaft tibia fractures operatively managed with open reduction internal fixation with an intramedullary nail [86]; corresponding with retrospective evidence that delayed initial weight bearing following open and closed tibia diaphyseal fractures associates with increased risk of non-union [87]. As another example, a prospective randomized control trial demonstrated benefit of using an active controlled motion device in addition to a standard physical therapy targeted at early partial weight-bearing for isolated unstable ankle fractures (i. e. Weber type B-or C-Fracture) [88].…”

Section: General Efficacy Of Physical Therapymentioning

confidence: 99%

Musculoskeletal Regeneration, Rehabilitation, and Plasticity Following Traumatic Injury

2020

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AbstractThe musculoskeletal system has an integral role throughout life, including structural support to the body, protection, and allowing a range of fine to complex movements for daily living to elite sporting events. At various times, injuries to the musculoskeletal system occur resulting in varying levels of impact to the person both acutely and chronically. Specifically, there is a spectrum of complexity in orthopedic injuries, with some such as common muscle strains, that while burdensome will have no impact on life-long functional ability, and others that can result in long lasting disability. Focusing on extremity injuries, this review highlights: i)the current impact of orthopedic injuries in sport and daily life; ii) the foundation of bone and skeletal muscle repair and regeneration; and iii) the disruptions in regenerative healing due to traumatic orthopedic injuries. This review seeks to maximize the broad and collective research impact on sport and traumatic orthopedic injuries in search of promoting ongoing innovation for treatment and rehabilitation approaches aimed to improve musculoskeletal health throughout life.

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Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures

Cited by 32 publications

References 31 publications

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Treatment of infected tibial non-unions using a BMAC and S53P4 BAG combination for reconstruction of segmental bone defects: A clinical case series

Musculoskeletal Regeneration, Rehabilitation, and Plasticity Following Traumatic Injury

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