PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “FRACTURES, UNUNITED”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1993

Beneficial effects of electromagnetic fields.

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.

Animals↗
PubMed1992

Retrieval of a broken intramedullary femoral nail.

A method of retrieval of the distal fragment of a broken intramedullary femoral nail is described. The procedure is simple and requires a steel drill, a standard nail extraction hook and a slotted hammer. The method was successfully used in two patients with ununited fractures of the femoral shaft in which the broken intramedullary nail had jammed in the distal fragment.

Adult↗
PubMed1987

Enhanced responsiveness to parathyroid hormone and induction of functional differentiation of cultured rabbit costal chondrocytes by a pulsed electromagnetic field.

Pulsed electromagnetic fields promote healing of delayed united and ununited fractures by triggering a series of events in fibrocartilage. We examined the effects of a pulsed electromagnetic field (recurrent bursts, 15.4 Hz, of shorter pulses of an average of 2 gauss) on rabbit costal chondrocytes in culture. A pulsed electromagnetic field slightly reduced the intracellular cyclic adenosine 3',5'-monophosphate (cAMP) level in the culture. However, it significantly enhanced cAMP accumulation in response to parathyroid hormone (PTH) to 140% of that induced by PTH in its absence, while it did not affect cAMP accumulation in response to prostaglandin E1 or prostaglandin I2. The effect on cAMP accumulation in response to PTH became evident after exposure of the cultures to the pulsed electromagnetic field for 48 h, and was dependent upon the field strength. cAMP accumulation in response to PTH is followed by induction of ornithine decarboxylase, a good marker of differentiated chondrocytes, after PTH treatment for 4 h. Consistent with the enhanced cAMP accumulation, ornithine decarboxylase activity induced by PTH was also increased by the pulsed electromagnetic field to 170% of that in cells not exposed to a pulsed electromagnetic field. Furthermore, stimulation of glycosaminoglycan synthesis, a differentiated phenotype, in response to PTH was significantly enhanced by a pulsed electromagnetic field. Thus, a pulsed electromagnetic field enhanced a series of events in rabbit costal chondrocytes in response to PTH. These findings show that exposure of chondrocytes to a pulsed electromagnetic field resulted in functional differentiation of the cells.

Alprostadil↗
PubMed1997

Experience with scaphoid grafting.

Over a period of 24 years, the author has used five different methods of bone-grafting for ununited scaphoid fractures. The clinical and radiological results have been reviewed, with a minimum follow-up of 1 year. Radiologically the best results (78% definite union) were obtained with a "wedge" graft and Herbert screw, while the worst results followed the original Russe operation. The clinical result often did not coincide with the radiological outcome. All methods led to a decrease in pain in most cases, but little or no pain was achieved most often by the modified Russe graft. With proximal pole fractures, bony union was only achieved in 54% but the symptoms were always lessened.

Bone Screws↗
PubMed1983

Proximal row carpectomy for posttraumatic disorders of the carpus.

Twenty-four patients (23 men and one woman) from 19 to 65 years old underwent proximal row carpectomy following carpal injuries. The injuries were 10 transscaphoid perilunate dislocations with late subluxation and arthritis, 10 ununited scaphoid fractures with arthritis, three scapholunate dissociations with arthritis, and one acute carpal dislocation. All were followed for from 3 to 10 years. Although the result depended on the original injury, wrist extension was 65% to 70% of normal, flexion was 48% to 65%, ulnar deviation 85 1/2, and radial deviation 17%. Grip strength was equal to that in the opposite hand. There was one failure that was converted to a successful fusion.

Adult↗
PubMedDate not supplied

Prostaglandin E1-induced hyperostosis: clinicopathologic correlations and possible pathogenetic mechanisms.

Prostaglandin E1 (PGE1) causes skeletal hypertrophy, a phenomenon noted when it is administered for several weeks to maintain ductus arteriosus patency in neonates with congenital heart disease. This effect, a dose-dependent and reversible hyperostosis, was described radiologically as bone within bone, but skeletal histopathology was not studied. We compared postmortem gross, radiological, and histological bone findings for untreated controls and term gestation infants after 4, 27, and 56 days of continuous 0.1-0.2 microgram/kg/min PGE1. Bone was not significantly different from controls after 4 days of PGE1. Radiographs were negative after 27 days, but femoral cortex showed early periosteal osteoblast proliferation. At 56 days of PGE1, there was severe, radiologically apparent neocortex formation in tubular, rib, and scapular bones. Corresponding sections of femoral shaft revealed distinctive histopathology with thickened periosteum and fibrocartilage-like tissue covering an exuberant neocortex of closely aligned, gracile, woven bone trabeculae. Paratrabecular stroma contained ectatic capillaries orthogonally oriented to the periosteum, suggesting that a vascular reaction to PGE1 is important in the observed effect. The native cortex was partially resorbed; because it is stress shielded by the neocortex and no inflammation was present, this was interpreted as a secondary effect. We conclude that PGE1-associated paracortical bone hypertrophy is distinct from inflammatory processes and that its early stages may not be apparent radiologically. Moreover, the time course of PGE1-induced osteoblast proliferation and mineralization suggests that experimental use for 4-8 weeks may benefit conditions such as ununited fractures.

Alprostadil↗
PubMed1998

Vertebral pseudarthrosis in the osteoporotic spine.

STUDY DESIGN: Radiologic and operative findings of intravertebral cleft in the osteoporotic spine were investigated and the pathomechanism discussed. OBJECTIVES: To clarify the pathologic features of the intravertebral cleft. SUMMARY OF BACKGROUND DATA: Intravertebral "vacuum" cleft is one of the common radiographic findings in the osteoporotic spine. It is thought that the cleft is a rare lesion of an ununited fracture, or pseudarthrosis. Evidential findings of the disease, however, have never been reported. METHODS: Simple bone grafting was performed in five cases (average age, 76.8 years) of thoracolumbar intravertebral cleft in osteoporotic spine in patients who had been suffering from prolonged pain of the back or leg. Preoperative radiologic evaluation using flexion-extension radiograph and magnetic resonance imaging was performed in all patients. At operation, the cleft and the components of the structure were macroscopically and microscopically observed. The fluid content in the cleft was biochemically analyzed. RESULTS: In all patients, preoperative flexion-extension radiographs showed intravertebral instability at the location of the clefts that indicated gas density in three cases and water density in two cases. Magnetic resonance imaging showed that, for the most part, the cleft was low intensity on the T1-weighted image and high intensity on the T2-weighted scans, regardless of the radiographic findings. At operation, abnormal movement was observed at the cleft of the affected body, which was covered with hypertrophic membrane. The serous fluid within the cleft was aspirated before the excision of soft tissue. The thick membrane was excised and showed that the cleft was lined by smooth fibrocartilaginous tissue and the great degree of motion between the fracture ends that is consistent with the pathologic appearance of pseudarthrosis. CONCLUSIONS: The unstable cleft in the affected vertebral body of the osteoporotic spine with magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a false joint lined by fibrocartilaginous tissue with notable movement consistent with pseudarthrosis.

Aged↗
PubMed1994

ABC of emergency radiology. The ankle.

The os trigonum is a common normal variant of the talus and is due to a separate ossification centre arising from the posterior tubercle. The appearance may resemble an old ununited fracture fragment. However, it is triangular, well corticated, in a classic location, and usually bilateral, which enables it to be distinguished from a fracture. Transverse, sclerotic, linear lines located at the metaphysis of growing long bones are due to short periods of growth arrest and have no clinical importance (fig 5). They may be confused with compression fractures, but again these lines are usually bilateral. Fibrous cortical defects are the most commonly seen benign lesions of long bones and are usually identified incidentally in radiographs taken for another reason. The defect is limited to the cortex, commonly found at the metaphysis, but may be located in the diaphysis as the bone grows. The lesion is well corticated (sclerotic margins) and usually does not produce signs or symptoms.

Ankle Injuries↗
PubMed2004

Posttraumatic radial club hand.

Fifteen adult patients with an unstable ununited fracture of the distal third of the radius and severe radial deviation deformity resembling a radial club hand were retrospectively reviewed at an average of 25 months after operative treatment. There were eight women and seven men with an average age of 57 years (range, 33-79 years). The average duration of nonunion was 56 months (range, 6-252 months). Six patients had a concomitant fracture of the ulna and four had dislocation of the distal radioulnar joint. Three patients were treated with wrist arthrodesis and 12 with plate fixation and autogenous bone grafting. The distal ulna was excised and used for bone graft in eight patients. Correction of deformity was facilitated by z-lengthening of the brachioradialis and flexor carpal radialis in four patients and distraction histogenesis (llizarov) in two patients. One patient failed to heal the fracture and was treated with wrist arthrodesis. Functional alignment and use of the hand was restored in all patients.

Adult↗
PubMed1991

[Evaluation of the results of the treatment of pseudarthroses of the forearm bones based on the analysis of the data of radionuclide studies].

The work is based on the analysis of the results of radionuclide examination and treatment of 14 patients with ununited tractures and pseudoarthroses of the forearm bones. Treatment was accomplished by means of external fixation apparatuses which in comparison with intramedullary and epiosseous osteosynthesis provide a better stability of the site of bone injury and create ortimal biomechanical conditions for consolidation of ununited fractures and pseudoarthroses of the forearm bones. Radionuclide examination was conducted before the treatment to determine the initial activity of reparative regeneration in the zone of the pseudoarthrosis and the adjacent healthy regions, 2-3 weeks after perosseous osteosynthesis when the bone fragments were reduced and the compression or distraction regimen was established, and before removal of the apparatus when consolidation of the pseudoarthrosis was demonstrated radiologically. This made it possible to control the activity of reparative regeneration during treatment and to introduce corrections, if necessary. The radionuclide method is preferable to the radiological method in the intermediate stages of treatment not only because of the lesser exposure of the patient to radiation but because of the higner informativeness.

Adolescent↗
PubMed1974

One-bone forearm.

Six patients with complicated forearm injuries with ununited fractures of the ulna and soft-tissue deficits, and one patient with the same deficit from infection, were treated by production of a one-bone forearm positioned in neutral of supination-pronation. A stable, functional extremity resulted in each patient and only mild complications were encountered.

Adult↗
PubMed1994

[Non-contact, biologically adequate, electromagnetic stimulation of reparative regeneration of osseous, cartilagenous and muscular tissues in children].

The authors analyse the results of using a Kaskad electromagnetic apparatus in 508 children with long-term ununited fractures, false joints, contractures, sluggish wounds, decubituses, trophical ulcers, osteochondropathies, Pertes' disease, and crush syndrome. The efficiency of the therapy was 75-90%, depending on the type of an abnormality. The authors had developed and put into practice a Kaskad-synchro electromagnetic apparatus synchronized with the pulse of a patient's arterial vessel. Such a high efficiency of the electromagnetic therapy bioadequate to man is likely to be explained by the exposure of electromagnetic waves directly to the areas of bone marrow hemopoiesis. To elucidate this, the authors made an experiment on dogs. The results of this experiment are being processed.

Animals↗
PubMed1995

Fibrogenesis imperfecta ossium.

The clinical features, investigation, treatment and outcome of two adults with fibrogenesis imperfecta ossium are described. In this rare acquired disorder of bone, normal lamellar collagen is replaced by structurally unsound collagen-deficient tissue, which leads to extreme bone fragility and ununited fractures. Transmission microscopy and SEM showed striking ultrastructural changes in bone structure and mineralisation. Both patients had monoclonal IgG paraproteins in the plasma and one excreted monoclonal lambda light chains in the urine. No abnormal plasma cells were found in the bone marrow and there was no evidence of amyloid deposition in the tissues. In both patients initial treatment with 1 alpha-hydroxycholecalciferol appeared to be ineffective, but in one, repeated courses of melphalan and corticosteroids over three years together with 1 alpha-hydroxycholecalciferol produced striking clinical and histological improvement. The findings in these and other patients strongly suggest that paraproteinaemia is an integral feature of fibrogenesis imperfecta ossium, and this needs further investigation.

Adrenal Cortex Hormones↗
PubMed1993

The effect of electromagnetic field stimulation on corticosteroids-inhibited intestinal wound healing.

Electromagnetic field (EMF) stimulation has been used successfully in the clinical setting to promote healing of ununited fractures. In a few studies, EMF stimulation enhanced soft tissue healing. To investigate the effect of EMF stimulation on intestinal wound healing in normal rats and in those treated with corticosteroids, 80 Wistar rats received twice-daily injections of either saline dexamethasone (0.1 mg/kg/day for 2 weeks. Animals then underwent creation of single-layer, inverting small intestine anastomoses. All injections were continued postoperatively. Animals were grouped as intestinal anastomoses; intestinal anastomoses plus EMF stimulation; intestinal anastomoses plus dexamethasone; and intestinal anastomoses plus dexamethasone plus EMF. On postoperative days 7 and 14, the anastomosed intestines were removed and the tensile strength (TS) and hydroxyproline (OH-P) contents measured. EMF stimulation significantly increased intestinal wound healing in normal animals by the 7th and 14th day. Corticosteroids significantly impaired the healing of the small intestine anastomoses, with decreased TS and OH-P contents after the first and second weeks. However, EMF stimulation significantly reversed this inhibitory effect.

Animals↗
PubMed1993

Treatment of chronic osteomyelitis with muscle flaps.

This article discusses a study of 36 patients with chronic osteomyelitis that had local or free muscle flaps. Reconstruction of chronic osteomyelitis requires infection control and assessment of soft tissue and bone. In patients with osteomyelitis with an ununited fracture or nonunion, stabilization of the fracture is needed.

Adult↗
PubMed2004

Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture.

BACKGROUND: Nonunion is a rare complication of a fracture of the clavicle, but its occurrence can compromise shoulder function. The aim of this study was to evaluate the prevalence of and risk factors for nonunion in a cohort of patients who were treated nonoperatively after a clavicular fracture. METHODS: Over a fifty-one-month period, we performed a prospective, observational cohort study of a consecutive series of 868 patients (638 men and 230 women with a median age of 29.5 years; interquartile range, 19.25 to 46.75 years) with a radiographically confirmed fracture of the clavicle, which was treated nonoperatively. Eight patients were excluded from the study, as they received immediate surgery. Patients were evaluated clinically and radiographically at six, twelve, and twenty-four weeks after the injury. There were 581 fractures in the diaphysis, 263 fractures in the lateral fifth of the clavicle, and twenty-four fractures in the medial fifth. RESULTS: On survivorship analysis, the overall prevalence of nonunion at twenty-four weeks after the fracture was 6.2%, with 8.3% of the medial end fractures, 4.5% of the diaphyseal fractures, and 11.5% of the lateral end fractures remaining ununited. Following a diaphyseal fracture, the risk of nonunion was significantly increased by advancing age, female gender, displacement of the fracture, and the presence of comminution (p < 0.05 for all). On multivariate analysis, all of these factors remained independently predictive of nonunion, and, in the final model, the risk of nonunion was increased by lack of cortical apposition (relative risk = 0.43; 95% confidence interval = 0.34 to 0.54), female gender (relative risk = 0.70; 95% confidence interval = 0.55 to 0.89), the presence of comminution (relative risk = 0.69; 95% confidence interval = 0.52 to 0.91), and advancing age (relative risk = 0.99; 95% confidence interval = 0.99 to 1.00). Following a lateral end fracture, the risk of nonunion was significantly increased only by advancing age and displacement of the fracture (p < 0.05 for both). On multivariate analysis, both of these factors remained independently predictive of nonunion (p < 0.05), and, in the final model, the risk of nonunion was increased by a lack of cortical apposition (relative risk = 0.38; 95% confidence interval = 0.25 to 0.57) and advancing age (relative risk = 0.98; 95% confidence interval = 0.97 to 0.99). CONCLUSIONS: Nonunion at twenty-four weeks after a clavicular fracture is an uncommon occurrence, although the prevalence is higher than previously reported. There are subgroups of individuals who appear to be predisposed to the development of this complication, either from intrinsic factors, such as age or gender, or from the type of injury sustained. The predictive models that we developed may be used clinically to counsel patients about the risk for the development of this complication immediately after the injury.

Adult↗