Warwick hip trauma study : a randomised clinical trial comparing interventions to improve outcomes in internally fixed intracapsular fractures of the proximal femur : protocol for The WHiT Study

Background Controversy exists regarding the optimal treatment for patients with displaced intracapsular fractures of the proximal femur. The recognised treatment alternatives are arthroplasty and internal fixation. The principal criticism of internal fixation is the high rate of non-union; up to 30% of patients will have a failure of the fixation leading to revision surgery. We believe that improved fracture healing may lead to a decreased rate of failure of fixation. We therefore propose to investigate strategies to both accelerate fracture healing and improve fixation that may significantly improve outcomes after internal fixation of intracapsular femoral fractures. We aim to test the clinical effectiveness of the osteoinductive agent platelet rich plasma and conduct a pilot study of a novel fixed-angle fixation system. Design We have planned a three arm, single centre, standard-of-care controlled, double blinded, pragmatic, randomised clinical trial. The trial will include a standard two-way comparison between platelet-rich plasma and standard-of-care fixation versus standard-of-care fixation alone. In addition there will be a subsidiary pilot arm testing a fixed-angle screw and plate fixation system

Application of Far Cortical Locking Technology in Periprosthetic Femoral Fracture Fixation: A Biomechanical Study

© 2016 Elsevier Inc. Background Lack of fracture movement could be a potential cause of periprosthetic femoral fracture (PFF) fixation failures. This study aimed to test whether the use of distal far cortical locking screws reduces the overall stiffness of PFF fixations and allows an increase in fracture movement compared to standard locking screws while retaining the overall strength of the PFF fixations. Methods Twelve laboratory models of Vancouver type B1 PFFs were developed. In all specimens, the proximal screw fixations were similar, whereas in 6 specimens, distal locking screws were used, and in the other six specimens, far cortical locking screws. The overall stiffness, fracture movement, and pattern of strain distribution on the plate were measured in stable and unstable fractures under anatomic 1-legged stance. Specimens with unstable fracture were loaded to failure. Results No statistical difference was found between the stiffness and fracture movement of the two groups in stable fractures. In the unstable fractures, the overall stiffness and fracture movement of the locking group was significantly higher and lower than the far cortical group, respectively. Maximum principal strain on the plate was consistently lower in the far cortical group, and there was no significant difference between the failure loads of the 2 groups. Conclusion The results indicate that far cortical locking screws can reduce the overall effective stiffness of the locking plates and increase the fracture movement while maintaining the overall strength of the PFF fixation construct. However, in unstable fractures, alternative fixation methods, for example, long stem revision might be a better option

Simulasi Pengaruh Jumlah Lubang pada Ring Fiksasi Eksternal untuk Tulang Tibia

External fixation is a device that is placed out of soft tissue. External fixation device is used to heal open fracture. Open fracture is fracture that soft tissue is broken. That device consist of pin, rod, and clamp. We should pay attention of external fixation stiffness. Number of rod can be increased to get this device more stabil. That device should be stabil so fracture position and pin track doesn’t move. External fixation that consist three rod usually   use rin. This research aims to get the effect of external fixation ring holes number to stiffness

An approximate model for cancellous bone screw fixation

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 Taylor & Francis.This paper presents a finite element (FE) model to identify parameters that affect the performance of an improved cancellous bone screw fixation technique, and hence potentially improve fracture treatment. In cancellous bone of low apparent density, it can be difficult to achieve adequate screw fixation and hence provide stable fracture fixation that enables bone healing. Data from predictive FE models indicate that cements can have a significant potential to improve screw holding power in cancellous bone. These FE models are used to demonstrate the key parameters that determine pull-out strength in a variety of screw, bone and cement set-ups, and to compare the effectiveness of different configurations. The paper concludes that significant advantages, up to an order of magnitude, in screw pull-out strength in cancellous bone might be gained by the appropriate use of a currently approved calcium phosphate cement

Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it.</p> <p>Case presentation</p> <p>A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radiographs revealed an inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was on how to position the patient on the fracture table for the surgery. Special attention was needed in positioning the patient and in surgical fixation of the fracture.</p> <p>Conclusion</p> <p>Hip fracture fixation in patients with below-knee amputations poses a special problem in positioning for fracture reduction and fixation. In this case report, we share our experience and suggest techniques to use when encountering this difficult problem.</p

Surgical rib fracture fixation : systematic review of effectiveness, assessment of current UK practice, and development of a core outcome set

AimTo synthesise contemporary evidence for rib fracture fixation, and thereby to fill the gaps in the knowledge required to inform a trial and provide recommendations for future study.MethodA systematic review of systematic reviews and a meta-analysis of primary research were the methods used to examine the effectiveness of rib fracture fixation. Delphi consensus methods were used to survey three international stakeholder groups so as to define a core outcome set and a consensus on indications for and timing of rib fracture fixation. A United Kingdom (UK) survey assessed the provision of rib fracture care and analysis of a UK trauma database assessed the factors that predict rib fixation and the outcomes experienced by rib fracture patients.ResultsThe systematic reviews and meta-analysis suggest that rib fracture fixation shortens the duration of mechanical ventilation, reduces critical care and hospital stay as well as overall mortality. UK clinical data suggests that rib fracture fixation improves these outcomes, and that early intervention confers an advantage over late fixation. With regard to which patients receive an intervention; fracture pattern, pulmonary contusion, admission to a major trauma centre, injury severity and age are all important predictors of undergoing surgery. A core outcome set was derived to include 23 outcomes. Consensus was achieved on 20 indications and 7 timings of surgery. Care of rib fracture patients in England and Wales is delivered in a variety of centres with different care protocols, referral pathways, lead specialties and rehabilitation services.ConclusionFurther evidence is required to assess the effectiveness of rib fracture fixation. A feasibility trial is required to understand more clearly if clinicians have equipoise, patients are willing to be randomised and whether comparative care can be delivered. A trial will need to be stratified for surgical indication and further study is required to define outcome instruments

Development and innovation in the fracture management of animals

In the early 1920's, veterinary orthopedic cases were just managed with the help of external coaptation and external fixation devices. In many places conventionally trained persons and veterinarians carried out this practice. Subsequently after a better understanding of fracture biomechanism many internal fixation techniques, have been adopted in animals, providing good success rate of the fracture repair in veterinary practice.After the formation of AO/ ASIF, fracture repair has branched out into many channels particularly in dogs ,cats ,horses and exotic pets. The availability of implants also facilitated the increasing demands from the animal owner to take these techniques. The topic is discussed from the history of fracture repair, the status of its use in animals, classification of fracture, biomechanism of fracture, factors responsible for bone healing fracture, enhancing factor for fracture healing and different fixation techniques (both external and internal)

Internal Fixation of Femoral Neck Fractures

__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of treatment with internal fixation on health care costs were also described. Part 3 focused on aspects on functional outcome after internal fixation of a femoral neck fracture. In summary, this thesis provides evidence that: • A central, financed trial coordinator to manage all trial related tasks in participating sites is a recommended strategy to improve trial progression (Chapter 2) • Adequate knowledge on the International Conference of Harmonization-Good Clinical Practice (ICH-GCP) guideline is important when conducting an implant trial in orthopedic trauma surgery (Chapter 3) • The current treatment of femoral neck fracture patients is in agreement with the Dutch national guideline in at least 74% of patients (Chapter 4) • The current treatment of non-simultaneous bilateral femoral neck fractures is uniform in 73-88% of patients (Chapter 5) • In and out of hospital cost of internal fixation of femoral neck fracture patients is approximately €16,000 at one year follow-up and €19,000 at two years follow-up (Chapter 6) • Internal fixation of femoral neck fracture patients leads to femoral neck shortening and secondary permanent physical limitations in a majority of patients (Chapter 7) • Salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture (Chapter 8) • Implant removal positively influences function-related quality of life in patients after internal fixation with persisting pain or unsatisfactory functional recovery (Chapter 9) • The physical therapy that femoral neck fracture patients receive after internal fixation generally consists of active movement, functional exercise, and independent practice for less than two times a week, during 20 weeks (Chapter 10

COMBINED MUSCULO-SKELETAL MULTI-BODY DYNAMICS/FINITE ELEMENT ANALYSIS OF SEVERAL ERGONOMICS AND BIO-MECHANICS PROBLEMS

Within this thesis, two ergonomics (i.e. seating comfort and long-distance driving fatigue problems) and two structural bio-mechanics (i.e. femur-fracture fixation and radius-fracture fixation) problems are investigated using musculo-skeletal multi-body dynamics and finite element computational analyses. Within the seating comfort problem analyzed, a complete-body finite element model is constructed and used to assess the effect of seat geometry and seating posture on the feel of comfort experienced by a seated human. Within the long-distance driving fatigue problem, musculo-skeletal analysis is employed to assess the extent of fatigue experienced by a driver through the evaluation of level of activity of his/her various muscles. Within the femur-fracture fixation problem, physiologically realistic loading conditions associated with active daily activities (i.e. cycling) are employed within a finite-element frame work to assess fracture fixation performance and durability of the implant. Within the radius-fracture fixation problem, the analysis developed within the femur-fracture fixation problem is further related to indicate the effects of other types of loadings (associated with additional daily activities) and improved biological and structural material model are employed. For all cases studied in the present work, relevant experimental data are used to validate the computational procedure employed

Biological macro-idea and criterion of osteopathic fracture immobilization in China's traditional mongolian medicine

AbstractObjectiveTo investigate the biological macro-idea and criterion of osteopathic fracture immobilization in China's traditional Mongolian medicine.MethodsBased on biological naturalism regarding the relationship between man and universe (including psychosomatic integration) in osteopathic fracture immobilization in China's traditional Mongolian medicine, we used modern physiopsychological and biomechanical principles and methods to investigate the biological macro-characteristics of humanization, behaviorism, and wholism in “dynamic” fixation of fractures.ResultsOsteopathic fracture immobilization in China's traditional Mongolian medicine is based on the fixation criterion of macro-idea and method as well as on geometry, mechanics, motion, and stress and psychological stability in “non-sheltered fixation” of fractures contained in the life view of nature, regarding the relationship between man and universe (including psychosomatic integration) and on harmony between the limbs and the whole body, between body and function, and between man and nature.ConclusionsOsteopathic fracture immobilization in China's traditional Mongolian medicine is fixation without trauma or shelter. The principle and method of whole, dynamic, and functional fixation of fractures is not only radical, but also represents a new direction for developing the principle and method of fracture immobilization