胫骨微动Dynamise.ppt

DYNAMISATIONandFRACTURE HEALING What would happen to Juliet’s fractured tibia after she had fallen from her balcony? Tibia: Diaphysis Traction in Bed Plaster Functional Brace Plate and Screws Intramedullary Nail External Fixation Aim of Fracture Treatment Relieve pain and immobility Ensure fracture heals in good position Avoid disturbing natural healing process Avoid risk of complications Restore normal function as soon as possible Periosteum critical for callus formation periosteum ablated periosteum spared Kojimoto et al, Ext. Fix. Funct. Bracing, Ch. 49, Coombs, Green Sarmiento, Orthotext, 1989. The Osteogenic Potential of Fracture Haematoma Four day old femoral fracture haematoma inserted intra-muscularly in rats. In 40% of 30 rats new bone formation was seen. This was not seen after insertion of two day old fracture haematoma. No new bone formation was seen after insertion of haematoma from peripheral blood or bone marrow aspirate. Mizuno et al, Kobe University Medical School, JBJS, 1990, 72-B, 822 - 829 The Osteogenic Potential of Fracture Haematoma Conclusion: In rats, a haematoma collected from a femoral fracture develops independent osteogenic potential between two and four days after the fracture. This phenomenon is not seen with similar experiments using haematoma from peripheral blood or bone marrow aspirate Mizuno et al., 1990 Development of Fracture Haematoma In Situ Two days: granulation tissue only; most cells derived from fibroblasts. Four days: osteoid tissue enveloped by fibroblasts. Evidence of osteoclastic activity also. In a rat femoral fracture haematoma, the processes of osteogenesis and remodelling develop between two and four days after the fracture. Mizuno et al., Kobe, 1990 Tibial Diaphysis: Plate Periosteal stripping and infection cause bone to die. Haematoma is lost Deep infection rate even in closed fractures will be at least 6% (T. Rüedi’s best figures) De Bastiani (JBJS, 1984) Unlock the Central Body Locking Nut to “