Orthopaedic surgery

This chapter examines orthopaedic surgery. It begins by detailing the examination of a joint and of the limbs and trunk. The chapter then discusses fracture healing and the reduction and fixation of fractures. Fracture healing occurs as either primary or secondary bone union. Primary bone healing does not produce callus, while secondary bone healing does. Modern fracture reduction and treatment centres around four key principles: fracture reduction and fixation to restore anatomical relationships; stability by fixation or splintage as the personality of the fracture and the injury dictates; preservation of the blood supply to the soft tissue and bone by careful handling and gentle reduction techniques; and early and safe mobilization of the part and patient. Finally, the chapter looks at the skeletal radiograph and considers injuries of the phalanges and metacarpals; wrist injuries; dislocations and fractures of the elbow, shoulders, ribs, pelvis, and neck; spinal injuries; bone tumours; osteoarthrosis (osteoarthritis); Paget’s disease (osteitis deformans); and carpal tunnel syndrome.

Gambaran Penyembuhan Tulang Sekunder pada Fraktur dengan Anatomical Reduction Fixation Tipe Plate and Screw di RSUP Prof. Dr. R. D. Kandou Periode 2019 – 2020

Theoretically, fractures fixed by anatomical reduction fixation will undergo direct bone healing without any callus formation. However, in some cases with anatomical reduction fixation show sceondary bone healing in radiographic examination. This study was aimed to obtain the profile of patients who had secondary bone healing in fractures fixed with anatomical reduction fixation at Prof. Dr. RD Kandou Central General Hospital Manado from 2019 to 2020, distribution of patients based on age, sex, and fracture location, as well as the patient's callus indexes. This was a retrospective and descriptive study using data at the Surgery Section, Radiology Section and the Medical Record Section of Prof. Dr. R. D. Kandou General Hospital Manado. The results showed that the incidence of secondary bone healing in fractures with anatomical reduction fixation was the highest in the 21 - 35 years age group (50%). The number of male patients was greater than of female patients. The location of most fractures was the lower limb. The most frequent callus index was 0.51-0.75, the highest was 0.8, and the lowest was 0.25. In conclusion, secondary bone healing in fractures with anatomical reduction fixation was more common in age group 21-35 years, males, and had callus index of 0.51-0.75.Keywords: fracture, secondary bone healing, callus Abstrak: Secara teori fraktur yang difiksasi secara anatomical reduction fixation akan mengalami penyembuhan tulang secara langsung tanpa pembentukan kalus. Dalam praktik klinis pada beberapa kasus terlihat adanya gambaran kalus pada pemeriskaan radiografi yang menggambarkan adanya penyembuhan tulang sekunder pada fraktur dengan anatomical reduction fixation. Penelitian ini bertujuan untuk mendapatkan profil pasien yang mengalami penyembuhan tulang sekunder pada fraktur dengan anatomical reduction fixation di RSUP Prof. Dr. R. D. Kandou periode 2019 sampai dengan 2020, distribusi pasien berdasarkan usia, jenis kelamin dan lokasi fraktur, serta indeks kalus pasien. Jenis penelitian ialah deskriptif retrospektif menggunakan data di Bagian Bedah, Bagian Radiologi, dan Bagian Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan bahwa angka kejadian penyembuhan tulang sekunder pada fraktur dengan anatomical reduction fixation tertinggi pada kelompok usia 21-35 tahun (50%). Jumlah pasien laki-laki lebih banyak daripada perempuan dan lokasi fraktur tersering ialah ekstremitas bawah. Indeks kalus tertinggi (0,8) dan indeks kalus terendah (0,25), dan yang terbanyak ialah 0,51-0,75. Simpulan penelitian ini ialah penyembuhan tulang sekunder pada fraktur dengan anatomical reduction fixation tertinggi pada kelompok usia 21-35 tahun, jenis kelamin laki-laki, dengan indeks kalus 0,51-075Kata kunci: fraktur, penyembuhan tulang sekunder, kalus

Comparison between new design interlocking nail with plate fixation and intramedullary pin with external skeletal fixation in long bone fracture in the dogs

New design interlocking nail and plate fixation was used in comminuted femur fracture in an old dog that the results showed primary bone healing and she had been quickly weight baring in fifteenth day after surgery, and could be walk in twenty day after operation. Another case was a young dog that showed transverse fracture of both humerus and one transverse fracture of femur that were repaired by intramedullary pin and external skeletal fixation. The results showed secondary bone healing of these three bone fractures and she could be walk after 2 months of operation. An old dog did not show any complication but a young dog showed pin migration in femur healing. This study revealed that the superior result in bone healing was found in rigid fixation by new design interlocking nail and plate fixation greater than intramedullary pin with external skeletal fixation.

Computational modeling of human bone fracture healing affected by different conditions of initial healing stage

Background Bone healing process includes four phases: inflammatory response, soft callus formation, hard callus development, and remodeling. Mechanobiological models have been used to investigate the role of various mechanical and biological factors on bone healing. However, the effects of initial healing phase, which includes the inflammatory stage, the granulation tissue formation, and the initial callus formation during the first few days post-fracture, are generally neglected in such studies. Methods In this study, we developed a finite-element-based model to simulate different levels of diffusion coefficient for mesenchymal stem cell (MSC) migration, Young’s modulus of granulation tissue, callus thickness and interfragmentary gap size to understand the modulatory effects of these initial phase parameters on bone healing. Results The results quantified how faster MSC migration, stiffer granulation tissue, thicker callus, and smaller interfragmentary gap enhanced healing to some extent. However, after a certain threshold, a state of saturation was reached for MSC migration rate, granulation tissue stiffness, and callus thickness. Therefore, a parametric study was performed to verify that the callus formed at the initial phase, in agreement with experimental observations, has an ideal range of geometry and material properties to have the most efficient healing time. Conclusions Findings from this paper quantified the effects of the initial healing phase on healing outcome to better understand the biological and mechanobiological mechanisms and their utilization in the design and optimization of treatment strategies. It is also demonstrated through a simulation that for fractures, where bone segments are in close proximity, callus development is not required. This finding is consistent with the concepts of primary and secondary bone healing.

The Computational Evaluation of a Locking Plate Fixation: Locking Versus Far Cortical Screws

Locking plates have gained increased popularity for the treatment of various types of fractures. However, these constructs can provide high stiffness fixations that can potentially fail. Therefore, several methods have been proposed to reduce the stiffness of these fixations in order to promote secondary bone healing via callus formation. One of the most recent concepts that has been proposed to reduce the stiffness of locking plates is the application of “far cortical screws”. This approach has been experimentally tested in vitro models of the femur and its application in animal models has shown promising results.

Synthesis Pengo System plates for the treatment of long-bone diaphyseal fractures in dogs

SummaryA Brazilian orthopaedic company designed a stainless steel plate called Synthesis Pengo System (S.P.S.), which has one fixed and one changeable extremity. According to the assembly of the changeable extremity, it is possible to obtain dynamization or neutralization of the fracture site. Since the S.P.S. plate was developed for use in human patients, the aim of this study was to evaluate this system in long-bone diaphyseal fractures in dogs. Eight dogs with closed diaphyseal fractures of the femur (n= 1), radius and ulna (n=5), and tibia (n=2) were used. Patients were aged seven months to three years and weighed 18 to 31.2 kg. The S.P.S. plate was assembled with one fixed extremity and one changeable extremity in dynamization mode. The trail bar was positioned for synthesis modules with holes for cortical screws. The modules were positioned close to one another in two fractures and far away from the fracture site in the others. The bone healing occurred by external callus. Since motion at the fracture site determines the amount of callus required, the secondary bone healing that was observed in all of the cases indicated less rigid fixation of this system. A potential benefit of this system was a lesser interface contact with the bone since it was only done by trail bar. The major disadvantage was the prominence of the implant. It was possible to conclude that the S.P.S. plate appears to be a suitable method for the treatment of diaphyseal fractures in dogs.