Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate

Ebraheim, Nabil A.; Buchanan, Grant; Liu, Xiaochen; Cooper, Maxwell E.; Peters, Nicholas; Hessey, Jacob A.; Liu, Jiayong

doi:10.1111/os.12257

Cited by 25 publications

(13 citation statements)

References 26 publications

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“…Temporary immobilization and surgical fixation are considered as the treatment choice for most fractures 5 . Unfortunately, many patients refused to undergo invasive operation due to the risk of non-union and delayed union 6 . There is a critical need to develop alternative strategies to promote fracture healing and repair.…”

Section: Introductionmentioning

confidence: 99%

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

Wang¹,

Ying²,

Luo³

et al. 2017

Int. J. Biol. Sci.

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Osthole is a bioactive coumarin derivative and has been reported to be able to enhance bone formation and improve fracture healing. However, the molecular mechanism of Osthole in bone fracture healing has not been fully defined. In this study we determined if Osthole enhances bone fracture healing through activation of BMP2 signaling in mice. We performed unilateral open transverse tibial fracture procedure in 10-week-old C57BL/6 mice which were treated with or without Osthole. Our previous studies demonstrated that chondrocyte BMP signaling is required for bone fracture healing, in this study we also performed tibial fracture procedure in Cre-negative and Col2-Cre;Bmp2flox/flox conditional knockout (KO) mice (Bmp2Col2Cre) to determine if Osthole enhances fracture healing in a BMP2-dependent manner. Fracture callus tissues were collected and analyzed by X-ray, micro-CT (μCT), histology, histomorphometry, immunohistochemistry (IHC), biomechanical testing and quantitative gene expression analysis. In addition, mouse chondrogenic ATDC5 cells were cultured with or without Osthole and the expression levels of chondrogenic marker genes were examined. The results demonstrated that Osthole promotes bone fracture healing in wild-type (WT) or Cre- control mice. In contrast, Osthole failed to promote bone fracture healing in Bmp2Col2Creconditional KO mice. In the mice receiving Osthole treatment, expression of cartilage marker genes was significantly increased. We conclude that Osthole could promote bone strength and enhance fracture healing by activation of BMP2 signaling. Osthole may be used as an alternative approach in the orthopaedic clinic for the treatment of fracture healing.

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Section: Introductionmentioning

confidence: 99%

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

Wang¹,

Ying²,

Luo³

et al. 2017

Int. J. Biol. Sci.

View full text Add to dashboard Cite

show abstract

“…5,6,[9][10][11][14][15][16] Non implant related clinical complications, infection has the highest rate of occurrences, because surgical sites were usually more prone to infection which can either be a deep infection or superficial infection. 4,10,11,14,15 In our study neither of the patients were affected with either of the types of infection, proper sterilization of implants was done before surgery as well as patients were on very high vigilance during the period of hospitalization with the sterilized environment conditions.…”

Section: Discussionmentioning

confidence: 84%

“…13 Locking plates have picked up support since they are less intrusive, less problematic and give the normal state of stability. 4 The femoral system i.e., locking plates have transformed into an essential strategy for treating breaks of the femur bone. They are favoured for giving an especially enduring form that requires unimportant periosteal stripping.…”

Section: Discussionmentioning

confidence: 99%

A prospective study for the treatment of femur bone fracture following femur plate fixation with a screws to achieve initial stability and early mobilization

Rawat¹,

Kumar²,

Luthra³

2019

Int J Res Orthop

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Background: Fractures of the femur are relatively common, most often is caused by high-energy trauma in young and low-energy trauma in older persons. Femur fractures were classified according to Arbeitsgemeinschaft für Osteosynthesefragen system which included proximal, diaphyseal and distal.Methods: 30 patients prospective data was collected with a year of follow up. Clinical and radiological follow-ups were conducted at four weeks, twenty-four week, and forty-eight week after the discharge to check the bone union and implant-related complications. Three different plates were used for the treatment of fracture as per the fracture type (4.5/5.0 mm wise-lock distal femur plate, 4.5/5.0 mm wise-lock proximal femoral plate, 4.5/5.0 mm wise-lock proximal lateral femur plate (type II), 4.5/5.0mm wise-lock osteotomy medial distal femur plate). The patient's health status was evaluated by American Society of Anesthesiologists grade and the visual analog score (VSA) was also obtained.Results: The gradual decrease of the VSA score showed the results of the good significance related to pain management. The continued Physiotherapy under the supervisor of physiotherapists in all patients after discharge helps in good recovery and earlier mobilization. In the series of our 30 patients, no biomechanical complication was observed related to implant plate and screw-like loosening, bend, corrosion, etc.Conclusions: Femoral system (Auxein Medical Private Limited, India) is effective as a treatment for femur bone union. Definitive treatment of femur bone fracture fixation with Femoral System have good rate of success of mobilization and bone union in this study.

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“…Complications in this study, including superficial infection and re‐nonunion, had a great negative influence on the fracture healing and increased hospital costs. Plate fixation was generally associated with low infection rates in some studies due to the gradual improvement of biotechnology. Of course, the choice of methods also needs to be determined according to the actual situation.…”

Section: Discussionmentioning

confidence: 99%

Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta‐analysis

Yao

Shen

et al. 2020

Orthopaedic Surgery

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Objective The aim of this meta‐analysis was to systematically evaluate the efficacy of augmentative plating (AP) and exchange nailing (EN) in the treatment of nonunion of femoral shaft fracture. Methods For the present meta‐analysis, PubMed, EMBASE, and the Cochrane Library were searched to identify relevant articles up to April 2019. Two investigators independently evaluated the quality of original publications following the guidelines proposed by the Cochrane Handbook. Data were extracted from the studies and analyzed using Review Manager 5.3. Results Five studies were included in this meta‐analysis, with a total of 506 patients. There were 232 patients in the AP group and 276 patients in the EN group. The AP group was associated with higher union rate (OR, 11.66; 95% CI, 4.31–31.50; P < 0.01), shorter union time (SMD, −1.10; 95% CI, −2.09 to −0.11; P = 0.03), shorter operation time (SMD, −0.55; 95% CI, −0.88 to −0.21; P < 0.01), less blood loss (SMD, −1.72; 95% CI, −3.33 to −0.11; P < 0.01), and fewer complications (OR, −0.11; 95% CI, −0.16 to −0.07; P < 0.01) than the EN group. Conclusion The results of the meta‐analysis showed that AP is found to be superior for nonunion of femoral shaft fractures in both intraoperatively (ie, shorter operation time and less blood loss) and postoperatively (ie, higher union rate, shorter union time, and lower complication rate). Overall, AP was superior to EN in the treatment of nonunion of femoral shaft fractures after intramedullary nailing (IMN).

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Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate

Abstract: Definitive treatment of distal femur nonunion after initial treatment with a locking plate had a low rate of success in this study, suggesting that this procedure is ineffective as a definitive treatment for distal femur nonunion.

Cited by 25 publications

References 26 publications

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

A prospective study for the treatment of femur bone fracture following femur plate fixation with a screws to achieve initial stability and early mobilization

Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta‐analysis

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