The aim of this study was to review the impact of smoking tobacco on the musculoskeletal system, and on bone fractures in particular. English-language publications of human and animal studies categorizing subjects into smokers and nonsmokers were sourced from MEDLINE, The Cochrane Library, and SCOPUS. This review specifically focused on the risk, surgical treatment, and prevention of fracture complications in smokers.Objectives
Methods
The aims of this study were to quantify health state utility
values (HSUVs) after a tibial fracture, investigate the effect of
complications, to determine the trajectory in HSUVs that result
in these differences and to quantify the quality-adjusted life years
(QALYs) experienced by patients. This is an analysis of 2138 tibial fractures enrolled in the
Fluid Lavage of Open Wounds (FLOW) and Study to Prospectively Evaluate
Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)
trials. Patients returned for follow-up at two and six weeks and
three, six, nine and 12 months. Short-Form Six-Dimension (SF-6D) values
were calculated and used to calculate QALYs.Aims
Patients and Methods
To evaluate interobserver reliability of the Orthopaedic Trauma
Association’s open fracture classification system (OTA-OFC). Patients of any age with a first presentation of an open long
bone fracture were included. Standard radiographs, wound photographs,
and a short clinical description were given to eight orthopaedic
surgeons, who independently evaluated the injury using both the
Gustilo and Anderson (GA) and OTA-OFC classifications. The responses
were compared for variability using Cohen’s kappa.Aims
Patients and Methods
CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (Objectives
Methods
Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral thermal injury to the bone and surrounding tissues. The purpose of this study was to determine the thermal dose, for commonly used metal implants in orthopaedic surgery, at various distances from the heating centre (HC). Commonly used metal orthopaedic implants (hip stem, intramedullary nail, and locking compression plate (LCP)) were heated segmentally using an induction heater. The thermal dose was expressed in cumulative equivalent minutes at 43°C (CEM43) and measured with a thermal camera at several different distances from the HC. A value of 16 CEM43 was used as the threshold for thermal damage in bone.Objectives
Methods
The aim of this study was to describe the technique of distraction
osteogenesis followed by arthrodesis using internal fixation to
manage complex conditions of the ankle, and to present the results
of this technique. Between 2008 and 2014, distraction osteogenesis followed by arthrodesis
using internal fixation was performed in 12 patients with complex
conditions of the ankle due to trauma or infection. There were eight
men and four women: their mean age was 35 years (23 to 51) at the
time of surgery. Bone healing and functional recovery were evaluated
according to the criteria described by Paley. Function was assessed
using the ankle-hindfoot scale of the American Orthopedic Foot and
Ankle Society (AOFAS).Aims
Patients and Methods
The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.Objectives
Methods
This study describes the use of the Masquelet technique to treat
segmental tibial bone loss in 12 patients. This retrospective case series reviewed 12 patients treated between
2010 and 2015 to determine their clinical outcome. Patients were
mostly male with a mean age of 36 years (16 to 62). The outcomes
recorded included union, infection and amputation. The mean follow-up
was 675 days (403 to 952). Aims
Patients and Methods
This is a retrospective study of survivors of
recent conflicts with an open fracture of the femur. We analysed
the records of 48 patients (48 fractures) and assessed the outcome.
The median follow up for 47 patients (98%) was 37 months (interquartile
range 19 to 53); 31 (66%) achieved union; 16 (34%) had a revision
procedure, two of which were transfemoral amputation (4%). The New Injury Severity Score, the method of fixation, infection
and the requirement for soft-tissue cover were not associated with
a poor outcome. The degree of bone loss was strongly associated
with a poor outcome (p = 0.00204). A total of four patients developed
an infection; two with This study shows that, compared with historical experience, outcomes
after open fractures of the femur sustained on the battlefield are
good, with no mortality and low rates of infection and late amputation.
The degree of bone loss is closely associated with a poor outcome. Cite this article:
Infection of implants is a major problem in elective and trauma surgery. Heating is an effective way to reduce the bacterial load in food preparation, and studies on hyperthermia treatment for cancer have shown that it is possible to heat metal objects with pulsed electromagnetic fields selectively (PEMF), also known as induction heating. We therefore set out to answer the following research question: is non-contact induction heating of metallic implants effective in reducing bacterial load Titanium alloy cylinders (Ti6Al4V) were exposed to PEMF from an induction heater with maximum 2000 watts at 27 kHz after being contaminated with five different types of micro-organisms: Objectives
Methods
We compared early post-operative rates of wound
infection in HIV-positive and -negative patients presenting with open
tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV
positive and 56 were HIV negative, were assessed for signs of infection
using the ASEPIS wound score. There were 19 women and 65 men with
a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive The study does not support the hypothesis that HIV significantly
increases the rate of early wound or pin-site infection in open
tibial fractures. We would therefore suggest that a patient’s HIV
status should not alter the management of open tibial fractures
in patients who have a CD4 count >
350 cells/μl. Cite this article:
Ubiquitin E3 ligase-mediated protein degradation regulates osteoblast function. Itch, an E3 ligase, affects numerous cell functions by regulating ubiquitination and proteasomal degradation of related proteins. However, the Itch-related cellular and molecular mechanisms by which osteoblast differentiation and function are elevated during bone fracture repair are as yet unknown. We examined the expression levels of E3 ligases and NF-κB members in callus samples during bone fracture repair by quantitative polymerase chain reaction (qPCR) and the total amount of ubiquitinated proteins by Western blot analysis in wild-type (WT) mice. The expression levels of osteoblast-associated genes in fracture callus from Itch knockout (KO) mice and their WT littermates were examined by qPCR. The effect of NF-κB on Itch expression in C2C12 osteoblast cells was determined by a chromatin immunoprecipitation (ChIP) assay.Objectives
Methods
To review the systemic impact of smoking on bone healing as evidenced
within the orthopaedic literature. A protocol was established and studies were sourced from five
electronic databases. Screening, data abstraction and quality assessment
was conducted by two review authors. Prospective and retrospective
clinical studies were included. The primary outcome measures were
based on clinical and/or radiological indicators of bone healing.
This review specifically focused on non-spinal orthopaedic studies.Objectives
Methods
The continual cycle of bone formation and resorption
is carried out by osteoblasts, osteocytes, and osteoclasts under
the direction of the bone-signaling pathway. In certain situations
the host cycle of bone repair is insufficient and requires the assistance
of bone grafts and their substitutes. The fundamental properties
of a bone graft are osteoconduction, osteoinduction, osteogenesis,
and structural support. Options for bone grafting include autogenous
and allograft bone and the various isolated or combined substitutes
of calcium sulphate, calcium phosphate, tricalcium phosphate, and
coralline hydroxyapatite. Not all bone grafts will have the same
properties. As a result, understanding the requirements of the clinical
situation and specific properties of the various types of bone grafts
is necessary to identify the ideal graft. We present a review of
the bone repair process and properties of bone grafts and their
substitutes to help guide the clinician in the decision making process. Cite this article:
This study explores the relationship between
delay to surgical debridement and deep infection in a series of
364 consecutive patients with 459 open fractures treated at an academic
level one trauma hospital in North America. The mean delay to debridement for all fractures was 10.6 hours
(0.6 to 111.5). There were 46 deep infections (10%). There were
no infections among the 55 Gustilo-Anderson grade I open fractures.
Among the grade II and III injuries, a statistically significant
increase in the rate of deep infection was found for each hour of
delay (OR = 1.033: 95% CI 1.01 to 1.057). This relationship shows
a linear increase of 3% per hour of delay. No distinct time cut-off
points were identified. Deep infection was also associated with
tibial fractures (OR = 2.44: 95% CI 1.26 to 4.73), a higher Gustilo-Anderson
grade (OR = 1.99: 95% CI 1.004 to 3.954), and contamination of the
fracture (OR = 3.12: 95% CI 1.36 to 7.36). These individual effects
are additive, which suggests that delayed debridement will have
a clinically significant detrimental effect on more severe open
fractures. Delayed treatment appeared safe for grade 1 open fractures. However,
when the negative prognostic factors of tibial site, high grade
of fracture and/or contamination are present we recommend more urgent
operative debridement. Cite this article:
