Stability of union after tibial shaft fracture. Analysis by a non-invasive technique

Hammer, Richard; Edholm, Paul; Lindholm, Bernt

doi:10.1302/0301-620x.66b4.6746687

Cited by 20 publications

(6 citation statements)

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“…This has been used for the early detection of pseudarthrosis and also to decide the best time to dynamise the fixator and then to remove it. Other authors have established the level of 15 Nm/°as the minimal stiffness which will allow safe removal of the external fixator in human tibial fractures, and 20 Nm/°in femoral fractures [12,14,15,20]. Nevertheless, the value of stiffness is not the only criteria to allow fixator removal.…”

Section: Discussionmentioning

confidence: 99%

Mechanical analysis of the healing of different osteotomies fixed externally

Mora

Forriol

2000

International Orthopaedics

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Under standard conditions the left tibia was osteotomised in nine sheep. The osteotomy was transverse in six, and oblique in three. The osteotomies were fixated using a strain-gauge-monitored unilateral external fixator. The fixation was rigid in three sheep with a transverse osteotomy (group 1) and also in three sheep with an oblique osteotomy (group 2). The fixation was dynamic in three sheep with a transverse osteotomy (group 3) using a roller-bearing mechanism allowing 1 mm of axial displacement. The bone callus stiffness increased progressively with time. One month after osteotomy the load force through the fixator in groups 1 and 2 was more than 20%, whereas the equivalent load force in group 3 was only about 5%.Résumé Avec un fixateur monolatéral instrumenté avec des jauges extensiométriques (strain gauges) on a étudié l'évolution des forces qui passent par le fixateur et la rigidité du cal de fracture chez neuf agneaux ayant trois types d'ostéotomies du tibia et des fixations différentes (I: ostéotomie transversale avec fixation rigide; II: osté-otomie oblique avec fixation rigide; III: ostéotomie transversale avec fixation dynamique. La rigidité du cal de fracture augmente progressivement dans les trois groupes alors que les forces qui passent par le fixateur diminuent. Après un mois, chez tous les animaux ayant un traitement rigide (groupe I et II) les forces qui passent par le fixateur sont supérieures à 20%, alors que dans le groupe III, à la même période, les forces moment sont approximativement de 5%.

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Section: Discussionmentioning

confidence: 99%

Mechanical analysis of the healing of different osteotomies fixed externally

Mora

Forriol

2000

International Orthopaedics

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“…A lthough increased age has been a known risk factor for a decreased rate of fracture healing for >30 yr, little progress has been made toward understanding the mechanisms involved.

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The rate of bone repair is progressively reduced with aging from the pediatric population to the elderly.

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Delayed healing results in an increased duration of immobilization, increases the risk of joint stiffness, and is associated with increased morbidity.

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Delayed healing also increases the risk of inadequate fracture alignment.

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However, the most significant clinical problem is the development of nonunion. Several studies have established that aging results in an overall reduction in union in numerous fractures.

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This population not only has an increased risk of fracture caused by reduced BMD but also has reduced fracture healing potential. Thus, for any given fracture, the morbidity is greater for the aging population.…”

Section: Introductionmentioning

confidence: 99%

Reduced COX-2 Expression in Aged Mice Is Associated With Impaired Fracture Healing

Naik

Xie

Zuscik

et al. 2009

Journal of Bone and Mineral Research

144

121

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The cellular and molecular events responsible for reduced fracture healing with aging are unknown. Cyclooxygenase 2 (COX-2), the inducible regulator of prostaglandin E2 (PGE2) synthesis, is critical for normal bone repair. A femoral fracture repair model was used in mice at either 7–9 or 52–56 wk of age, and healing was evaluated by imaging, histology, and gene expression studies. Aging was associated with a decreased rate of chondrogenesis, decreased bone formation, reduced callus vascularization, delayed remodeling, and altered expression of genes involved in repair and remodeling. COX-2 expression in young mice peaked at 5 days, coinciding with the transition of mesenchymal progenitors to cartilage and the onset of expression of early cartilage markers. In situ hybridization and immunohistochemistry showed that COX-2 is expressed primarily in early cartilage precursors that co-express col-2. COX-2 expression was reduced by 75% and 65% in fractures from aged mice compared with young mice on days 5 and 7, respectively. Local administration of an EP4 agonist to the fracture repair site in aged mice enhanced the rate of chondrogenesis and bone formation to levels observed in young mice, suggesting that the expression of COX-2 during the early inflammatory phase of repair regulates critical subsequent events including chondrogenesis, bone formation, and remodeling. The findings suggest that COX-2/EP4 agonists may compensate for deficient molecular signals that result in the reduced fracture healing associated with aging.

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“…The 22 late referrals presented a more complex situation. 12 fractures were grossly unstable, whereas nonunion in 7 cases was diagnosed by shift comparison (Hammer et al 1984). An average of 6 (2-13) unsuccessful surgical procedures had been done prior to referral.…”

Section: Methodsmentioning

confidence: 99%

“…Joint exercises were started in all patients as soon as soft-tissue conditions were stable. The stage and progress of fracture healing were followed by the technique described by Hammer et al (1984) and Hammer (1985).…”

Section: Methodsmentioning

confidence: 99%