Distal femur fractures are challenging injuries, frequently resulting in complications like non-unions, malunions, knee stiffness and infections. The role of newer and emerging techniques is also briefly discussed. Supracondylar fractures of femur, AO type A fractures of distal femur, extra-articular fractures of distal femur, current concepts in distal femur fractures, recent advances in distal femur fractures.
Abstract Bone is a unique tissue because of its mechanical properties, ability for self-repair, and enrollment in different metabolic processes such as calcium homeostasis and hematopoietic cell production.
Bone barely tolerates deformation and tends to fail when overloaded.
Fracture healing is a complex process that in particular cases is impaired. Osteoprogenitor cells proliferation, growth factors, and a sound tridimensional scaffold at fracture site are key elements for new bone formation and deposition. Mechanical stability and ample vascularity are also of great importance on providing a proper environment for bone healing.
From mesenchymal stem cells delivery to custom-made synthetic scaffolds, many are the biological attempts to enhance bone healing.
Non-pharmacological therapies are ways to decrease pain in addition to medicine. Your healthcare provider will help you choose therapies that are right for you. Your provider will explain the advantages for each treatment and which may work best for the cause of your pain. protection, and balance and exercise programs. Currently available pharmacologic agents are divided into antiresorptive and anabolic groups. Antiresorptive agents such as bisphosphonates limit bone resorption through fracture healing, so early administration for maintain bone densitometry is recommended). 1) Bisphosphonate-related. The patients had single-level disc degeneration, Grade 1 or less spondylolisthesis, mechanical low back pain with or without leg pain, and at least 6 months failure of nonoperative treatment. Results.
Impaired fracture healing represents a real burden to contemporary society. Sound basic science knowledge has contributed to newer approaches aimed to accelerate and improve the quality of bone healing. Bone fracture, Fracture healing, Angiogenesis, Callus, Endochondral, Intramembranous, Periosteal, Bone morphogenetic protein, Cancellous voids, Bone defects, Allograft, Bone substitutes, Scaffolds, Bone graft, Growth factors, Bone regeneration, Gene therapy, Physical stimulation, Ultrasound, Osteochondral graft, Knee injuries, Biological therapies Introduction Bone is a specialized tissue able to regenerate [ 12 ].
This special property assures that bone heals without connective tissue scar [ 3 ]. Fracture repair is a complex staged process that depends on mechanical and biological environment [ 45 ]. Blood supply and a certain degree of stability at the fracture site are requisites for bone healing [ 67 ].
Bone is only formed on a solid scaffold.
Intramembranous ossification and chondral ossification are the 2 ways by which bone develops [ 8 ]. In the first one, a base of connective tissue serves as a scaffold into which bone is deposited. In the latter, a base of mineralized cartilage is replaced by bone.
Mechanical environment dictates the modality of bone healing. There are 2 basic processes of bone healing [ 9 ].
Natural healing, also denominated secondary osseous repair, implies in callus formation and is observed when the blood supply is ample and a limited degree of motion exists at fracture site. This healing pattern is observed in fracture treatments adopting casts, intramedullary nails, and bridging plates.
In rare conditions, where the fracture site is reduced anatomically and maintained under compression, bone heals without callus formation.
In this process, where absolute stability is provided, osteonal units cross-fracture the site directly. This process is denominated as primary or direct healing.
Healing is, however, not the only aim of fracture treatment. Adequate restoration of limb function is also an ultimate goal. Therefore, uneventful bone healing associated with limb malalignment and joint incongruence, a condition described as malunion, should be avoided.
Malunions are generally avoided by the adoption of proper principles of fracture care, with adequate fracture reduction, stable fixation, and early joint motion [ 10 ].Healing is, however, not the only aim of fracture treatment. Adequate restoration of limb function is also an ultimate goal. Therefore, uneventful bone healing associated with limb malalignment and joint incongruence, a condition described as malunion, should be avoided.
Feb 29, · They are specialists in the areas of illness prevention and health promotion, and perform the tasks of ordering, performing, overseeing and interpreting lab and diagnostic tests, prescribing non-pharmacologic treatment and pharmacological mediators, and educating and advising their patients (American Association of Nurse Practitioners, ).
Osteobiologics and Pharmacologic Agents in Fracture Healing. Fracture healing, according to McKibbin, “constitutes one of the most noteworthy repair processes in the human body, since the result of this physiologic process is the restoration of the original form of the damaged tissue, something close to complete regeneration ().
Studies in humans and mice of the fracture hematoma, which is rich in these factors and immune cells, suggest that the early inflammatory events following fracture are critical to the outcome of fracture healing (Grundnes & Reikeras, ; Chung et al, ; Kolar et al, Kolar et al,, Hoff et al, ).
LIPUS is a relatively new tool for accelerating fracture healing. It has a frequency of MHz, a signal burst width of ms, a signal repetition frequency of 1 kHz, an intensity of 30 mW/cm, . Osteobiologics and Pharmacologic Agents in Fracture Healing.
Fracture healing, according to McKibbin, “constitutes one of the most noteworthy repair processes in the human body, since the result of this physiologic process is the restoration of the original form of the damaged tissue, something close to complete regeneration ().