Abstract:
OBJECTIVES:To evaluate the effect of both high-pressure pulsatile lavage and bulb syringe irrigation on the biomechanical parameters of fracture healing using an in vivo open noncontaminated diaphyseal femoral fracture model in rats. BACKGROUND:The utility of high-pressure pulsatile lavage irrigation on soft tissue debridement has been extrapolated to a similar perceived benefit in the debridement of bone. However, there have been several reports of a possible deleterious effect that high-pressure pulsatile lavage may have on bone architecture, intramedullary bacterial and contaminant seeding, and fracture healing. Although a previous in vivo histologic study suggests damage to bone architecture and impairment of early bone formation, it remains unclear whether these microscopic findings translate to a detectable decline in the biomechanical strength of the healing fracture. To our knowledge, there have been no reports of the in vivo effects high-pressure pulsatile lavage on fracture healing in open diaphyseal fractures. MATERIALS AND METHODS:Using sterile technique, standard open transverse mid-shaft femur fractures were created in thirty-six rats randomized into three groups: a control group underwent retrograde intramedullary pinning only; a bulb syringe irrigation group and a high-pressure pulsatile lavage group underwent identical procedures as the control group, except that the osteotomy site was irrigated with bulb syringe irrigation and high-pressure pulsatile lavage, respectively, before insertion of the intramedullary pin. Six rats from each group were killed at three weeks and six weeks, and the femora was mechanically tested in bending. RESULTS:Mechanical testing of the thirty-six femora revealed that the peak bending force (17.7 +/- 10.2 N) and stiffness (21.2 +/- 5.1 N/mm) of the healing fracture in the high-pressure irrigation group were significantly lower at three weeks when compared with the control (peak force, 28.1 +/- 5.9 N; stiffness, 31.4 +/- 5.8 N/mm) and the bulb syringe (peak force, 27.7 +/- 3.3 N; stiffness, 23.6 +/- 4.5 N/mm) irrigation groups (p < 0.05). The 37 percent lower peak bending force and 32 percent lower stiffness in the high-pressure pulsatile lavage group after three weeks of fracture healing were not present in the femora tested at six weeks. The high-pressure pulsatile lavage group did reveal a trend toward a lower peak bending force and stiffness after six weeks of fracture healing when compared with the control and bulb syringe irrigation groups, but the differences were not statistically significant at the 95 percent level. CONCLUSIONS:The use of high-pressure pulsatile lavage in open noncontaminated diaphyseal femur fractures in rats has a significant negative impact on the mechanical strength of the fracture callous during the early phases (three weeks) of fracture healing. However, it appears that the early deleterious effect of high-pressure pulsatile irrigation is not apparent in the late phases (six weeks) of fracture healing. Further study is required to evaluate the effect of high-pressure pulsatile lavage on fracture healing in the presence of wound contamination, fracture comminution, and soft tissue damage. CLINICAL SIGNIFICANCE:The findings of this study suggest that selective use of high-pressure irrigation in the management of open fractures appears warranted. In situations in which high-pressure lavage may be deleterious to bone healing, alternative strategies that optimize bacterial removal from soft tissues while preserving bone architecture will need to be investigated.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Adili A,Bhandari M,Schemitsch EHdoi
10.1097/00005131-200207000-00008subject
Has Abstractpub_date
2002-07-01 00:00:00pages
413-7issue
6eissn
0890-5339issn
1531-2291journal_volume
16pub_type
杂志文章abstract:OBJECTIVE:To review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGN:Retrospective review. SETTING:Level 1 trauma center. PATIENTS:Between 1991 an...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200111000-00003
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate forearm rotation after volar plating of the distal radius fractures with and without pronator quadratus repair. DESIGN:This was an institutional review board-approved retrospective review of prospectively collected data. SETTING:The study was conducted at an Academ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182539333
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PAT...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000840
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVES:To determine the angular rotation that maximizes screw tension without sacrificing screw pullout force yet minimizing loss of screw purchase. METHODS:Three pairs of human humeri in each of the 3 groups (osteopenic, osteoporotic, and normal) underwent screw tension and pullout protocols. For screw tension, 3...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000435631.71393.60
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to evaluate functional outcome, patient self-assessment, and radiographic outcome at 1 year in displaced three- and four-part proximal humeral fractures (OTA group 11-B2 and 11-C2). DESIGN:Randomized controlled trial. SETTING:Academic medical center. PATIENTS/PARTICIPANTS:Fif...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,随机对照试验
doi:10.1097/BOT.0b013e31821c2e15
更新日期:2012-02-01 00:00:00
abstract::American survivability during the current conflicts in Iraq and Afghanistan continues to improve, though the rate of extremity injury remains quite high. The decision to proceed with amputation versus limb salvage remains controversial. Exposure to combat wound with severe high-energy lower extremity trauma during the...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000669
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVES:We evaluated the economic aspects of an orthopaedic trauma section at a regional Level I, semi-academic community hospital. This study analyzes the economics of a dedicated hospital-based orthopaedic trauma program. METHODS:Institutional financial reports were analyzed for 2 time periods. In the pre-program...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31816bae67
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVES:Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome. DESIGN:...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318221e94e
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:To determine whether surgeons' and patients' perceptions of outcomes after high-energy lower-extremity trauma are similar and to identify factors associated with disagreement. DESIGN:Prospective study. SETTING:Eight level 1 trauma centers. PATIENTS:Four hundred sixty-three patients treated for limb-threat...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,多中心研究
doi:10.1097/BOT.0b013e3181ab2c90
更新日期:2009-11-01 00:00:00
abstract::Femoral neck nonunions are a difficult complication in the treatment of femoral neck fractures and have traditionally been managed using an intertrochanteric valgus osteotomy and blade plate. We propose an alternative method, a proximal femoral valgus osteotomy using a sliding hip screw instead of a blade plate. This ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200608000-00006
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVES:To compare radiographic and clinical outcomes of supination external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B2.1) treated with transsyndesmotic screw fixation with those treated with deltoid and posterior inferior tibiofibular ligament (PITFL) repair. DESIGN:Case se...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000318
更新日期:2015-05-01 00:00:00
abstract::This report presents a case demonstrating the nonunion of a capital femoral physeal fracture with a large metaphyseal fragment in a 10-year-old boy. To our knowledge, there is no previously reported case of this type of nonunion. The treatment of this nonunion presented a potential risk of premature physeal closure an...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c83a3b
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To review our series of open calcaneal fractures compared with other series. DESIGN:Retrospective review. SETTING:All patients were treated at a single Level 1 trauma center. PATIENTS/PARTICIPANTS:We reviewed 19 consecutive patients, each with an open fracture of the calcaneus. Fracture morphology ranged f...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200401000-00002
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the outcomes of a single-stage surgical protocol to treat a presumed aseptic long-bone nonunion with positive intraoperative cultures obtained at the time of surgery. DESIGN:Retrospective comparative series. SETTING:Orthopaedic specialty hospital. PATIENTS AND METHODS:We retrospectively identif...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001084
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVES:To assess mechanism of injury as a clinical course predictor in patients with complete anterior and posterior pelvic ring disruptions [innominosacral dissociation (ISD)]. DESIGN:Retrospective review of radiographs and medical data. SETTING:R Adams Cowley Shock Trauma Center, Baltimore, Maryland, statewide ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199702000-00002
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:To characterize the type and magnitude of lower extremity physical performance deficits in military service members who have undergone rehabilitation after limb salvage or transtibial amputation. DESIGN:Cross-sectional prospective. SETTING:Level I trauma military medical and rehabilitation center. PATIENT...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001103
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVES:The diagnosis and treatment of syndesmotic ankle fractures is controversial. This systematic review was performed to clarify the current understanding addressing several clinical questions that arise in the treatment of such injuries. DATA SOURCES:The English language literature was searched using PubMed, E...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000937
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:This cadaveric study sought to evaluate the accuracy of syndesmotic reduction using direct visualization via an anterolateral approach compared with palpation of the syndesmosis through a laterally based incision. METHODS:Ten cadaveric specimens were obtained and underwent baseline computed tomography (CT) ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001322
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:This review aims to summarize current knowledge regarding the underlying patho-mechanisms of delayed fracture healing in polytraumatized patients. DATA SOURCES AND STUDY SELECTION:The following search terms were used: "fracture", "hemorrhage," "chest trauma," "inflammation," "inflammatory response," "fractur...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,meta分析,评审
doi:10.1097/BOT.0000000000000489
更新日期:2016-03-01 00:00:00
abstract::Autologous bone graft is usually necessary for reconstruction of nonunions with shortening or bone loss. We developed a new technique to reconstruct such nonunions or delayed unions without bone grafting by chipping and lengthening of bone at the original fracture site. Five in six nonunions with shortening or bone lo...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318041f6d1
更新日期:2007-07-01 00:00:00
abstract::A study was undertaken to review the results of donor site morbidity of cancellous bone grafts obtained from the proximal tibial metaphysis. Two hundred six patients who underwent 230 proximal tibial bone graft harvestings were reviewed. Patients with lower-extremity fractures or nonunions who required cancellous bone...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199112000-00014
更新日期:1991-01-01 00:00:00
abstract::Young surgeons and their spouses experience a myriad of stresses in the first few years of practice. Issues related to job search, moving to a new community, learning one's craft, time management, changes to spouse's career, child rearing, and the ever blurring line between work time and free time may all contribute t...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182641fd8
更新日期:2012-09-01 00:00:00
abstract::Over the last several decades, interest in global health across all fields of medicine, including orthopaedic surgery, has grown markedly. Cross-national collaborations are an effective means of conducting high-quality clinical research and offer many advantages over single-center investigations. Successful collaborat...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000466
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:To determine whether the cost of nonoperative treatment, including those who require delayed operative treatment, is less than those receiving initial operative management. METHODS:We identified 4 recent randomized controlled trials comparing operative and nonoperative treatment of displaced midshaft clavic...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,meta分析,评审
doi:10.1097/BOT.0000000000000225
更新日期:2015-04-01 00:00:00
abstract::Although there is little doubt that arthroplasty of one form or another is appropriate treatment for many patients with a displaced femoral neck fracture, there is ongoing controversy about the relative merits of different types of arthroplasty among specific groups of patients. In particular, total hip arthroplasty i...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0b013e3181761490
更新日期:2009-07-01 00:00:00
abstract::Periprosthetic fractures after shoulder arthroplasty occur in up to 2% of patients. In patients with stable components who fail or cannot undergo nonoperative management, stable fixation is required. We present a new technique to obtain proximal fixation around the humeral component using a 4.5-mm large fragment plate...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000935
更新日期:2017-12-01 00:00:00
abstract::Healing patterns were compared between transverse and 60 degrees oblique osteotomies in canine tibiae stabilized under external fixation. Under similar in vitro testing conditions (osteotomy ends in contact), the axial stiffness of the oblique osteotomy under external fixation was 45% of the paired transverse osteotom...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199109000-00016
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this article was to present results of cases using a subcutaneous bone pouch technique and to assess the potential "autosterilization" effect that occurs when these contaminated free bone fragments are placed in nontraumatized tissue. DESIGN:Retrospective review of prospectively collected dat...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000352
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS:Seven hund...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000554
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the cost-effectiveness of screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in low-demand elderly patients. METHODS:We constructed a Markov decision model using a low-demand, 80-year-old patient as the base case. Costs, health-state utilities, mortality rates, and tra...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001747
更新日期:2020-07-01 00:00:00