This document summarizes a study that evaluated outcomes of treating 38 patients with closed segmental tibial fractures using external fixation. Segmental tibial fractures involve two or more fracture lines separating the tibia into segments. The study assessed time to fracture healing, complications, and functional recovery. Most fractures (68%) healed without issues, while 24 fractures (32%) had complications like delayed or non-union that required further treatment, with most of these ultimately healing. The study concluded that external fixation is a suitable treatment for segmental tibial fractures, achieving an acceptable rate of healing and complications.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
a Study from Miami Children Hospital demonstrating action of Homeopathic Formulas (Phase 6 and Flu Terminator) at the cellular level (increase of Cytokines)
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Salinger : advocacy doses indexed to weight parturients for neuroprotection- ...Claude GINDREY
Magnesium sulphate for prevention of eclampsia: are intramuscular and intravenous
regimens equivalent? A population pharmacokinetic study
DOI: 10.1111/1471-0528.12222
www.bjog.org
WA 98195, USA. Email easter@u.washington.edu
Conclusions
"In summary, we have performed model-based PK analysis
on the concentration–time data from women with preeclampsia
treated with MgSO4. Several important clinical
observations can be made."....
First, the 4-g loading dose routinely
used in intravenous regimens provides lower initial
concentration than achieved with the intramuscular regimen.
Second, serum concentrations are low, and possibly subtherapeutic,
in a significant percentage of women in both
groups. Some of the variability is due to differences in
maternal weight, as a reflection of volume of distribution,
and to differences in serum creatinine concentration, as a
reflection of glomerular filtration rate.
The differences in extravascular volume due to oedema associated with preeclampsia
may also contribute to the variability in volume
of distribution. When local resources permit, individualisation
of dosing could be considered."
Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates
Treatment of displaced midshaft clavicle fracture with locking compression plate provides better biomechanical stability, good fracture union rates, high post-operative constant score, early pain resolution, early return to activity, high patient satisfaction rates and excellent functional outcome. These benefits of plating overweigh complications when used in specific indications like displaced with or without comminuted middle third clavicle fracture (Robinson Type 2B1, 2B2).
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Corrective Surgery for Malunited Tibial Plateau Fractureiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
Nervous fibrolipomatous hamartoma is said to be a rare tumor-like condition involving the peripheral
nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
Lempuyang gajah (Zingiber zerumbet (L.) Smith), lempuyang pahit (Zingiber amaricans BL.), and
lempuyang wangi (Zingiber aromaticum Vahl.) are used as traditional medicine (jamu) in Indonesia. It is also
used for treatment of microbial infections, helps to increase appetite and stimulate digestion in chickens.
Information on their uses are available, but only limited in the scientific data on their bioactivity. The study was
conducted on the antibacterial effect of organic extracts of these plants with Mycoplasma gallisepticum as the
agent of chronic respiratory disease in chickens. Juice and extracts of fresh and dried rhizome are evaluated
through the disc diffusion assay and minimum inhibitory concentration. Oxytetracyclin (30 µg) are used as
standards. All extracts are individually exhibited as antibacterial activity against Mycoplasma gallisepticum (7
± 0.11 mm to 21 ± 0.86 mm). The minimum inhibitory concentration (MIC) determination of plants extracts are
ranged from 7.8 mg/ml to 31.2 mg/ml. The preliminary results suggested promising antibacterial properties of
wild ginger from Indonesia, and probably could be used in management of chronic respiratory disease in
chickens.
A case of allergy and food sensitivity: the nasunin, natural color of eggplantiosrphr_editor
Abstract: Allergies and food sensitivities can both be considered as "adverse reactions individualistic" to food.
Are pathological and individual forms because they affect a few individuals in way rather serious; immediate
or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
studies on allergies caused by eggplant are lacking, however, it was highlighted the presence of allergens in
edible parts of eggplant with preponderance in the peel .
The purpose of this study was to propose an extraction method rapid, efficient and cost of natural dye from
waste products from the food industry, such as the peels of eggplant, from which it was extracted, isolated and
purified the nasunin,a colored molecule in red-fuchsia.
Nasusin was tested on 58 patients to evaluate the potential sensitizing effect on the skin. The results demonstrate
that allergenic effects are negligible and therefore the nasunin can be used as a colorant in various industrial
sectors with a certain safety margin
Complete NMR Assignment of MogrosidesII A2, II E andIII A1Isolated from Luo H...iosrphr_editor
NMR analysis allowed complete assignments of three known mogrol glycosides, Mogroside IIA2 (1),
II E (2)and IIIA1 (3), isolated from the extracts of Luo Han Guo. Herein, complete 1H and 13C NMR
assignmentsof all threemogrosidesare described based on NMR experiments (1H NMR, 13C NMR, COSY,
HSQC-DEPT, HMBC, NOESY and 1DTOCSY) and mass spectral data.
Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
: Nanoemulsion is referred type of emulsion with uniform and extremely small droplet size in the range
of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
emollient, not staining, soluble in water, longer shelf life, bio-friendly, translucent and agreeable appearance.
Pharmacokinetics of High-Dose Methotrexate in Egyptian Children with Acute Ly...iosrphr_editor
Aim:Since several factors have been shown to influence the clearance of methotrexate, the purpose of this study
was to identify potential relationships between patient covariates and the methotrexate clearance estimates and
deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
patients that may help dosage adjustment and achieve target steady-state plasma concentrations in a similar
sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
(standard-/high-risk arm) given every other week by intermittent intravenous infusions over 24 hours as
a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
Epidemiology of Tuberculosis (TB) in Albania 1998-2009iosrphr_editor
Abstract : In Albania, many people erroneously think that tuberculosis (TB) is a disease of the past-an illness
that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
Objective: To examine the distribution and sources of increased tuberculosis (TB) morbidity and reporting
system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
during the period 1998-2009. The statistical analysis is based on data reported from regional level (regional
epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
discordance between the collected data (individual form) and reported data (monthly form); tuberculosis
incidence rate shows little oscillations which ranges from 6.67 to 9.2 cases/100.000 population; 50% of the
regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
limitations of current control measures and the need for new tests and treatments, including an effective
vaccine; improving information system, regulation of individual form and personnel training.
Total Phenol and Antioxidant from Seed and Peel of Ripe and Unripe of Indones...iosrphr_editor
Study on total phenol and antioxidantactivity ofsugar apple fruits of various solvent, part of fruits, and level of ripening. Solvent extraction used were 80% (v/v) methanol, 50% (v/v) acetone, boiling water, and 50% (v/v) ethanol. Part of fruits thatbeen used for samples were seed and peel which are normally by products of sugar apple processing, level of ripening were unripe, and ripe sugar apple fruits. Total phenol was determined by Folin-ciocalteau method. Total antioxidant was quantified by 1,1-diphenyl-2-picrylhydrazyl(DPPH) method.Therewas a difference in type of solvent, part of fruits, and level of ripeningon total phenol and antioxidant concentration of sugar apple fruits. Seeds have higher total phenol concentration than peels of this fruits. Unripe sugar apple fruits have higher total phenol and antioxidant than ripe fruit. The best solvent for phenol extraction was ethanol 50%butthe best solvent for antioxidant extraction was acetone 50%.
A Review on Step-by-Step Analytical Method Validationiosrphr_editor
When analytical method is utilized to generate results about the characteristics of drug related samples it is essential that the results are trustworthy. They may be utilized as the basis for decisions relating to administering the drug to patients. Analytical method validation required during drug development and manufacturing and these analytical methods are fit for their intended purpose. To comply with the requirements of GMP pharmaceutical industries should have an overall validation policy which documents how validation will be performed. The purpose of this validation is to show that processes involved in the development and manufacture of drug, production and analytical testing can be performed in an effective and reproducible manner. This review article provides guidance on how to perform validation characteristics for the analytical method which are utilized in pharmaceutical analysis.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.iosrphr.org Volume 4, Issue 6 (June 2014), PP. 48-57
48
Assessment & Evaluation of the Outcome for Closed and Open
Method in Treatment of Segmental Tibial Fracture
Dr.JamalKadhimShwayel AL-Saeedi,
Lecturer,College Of Medicine University Of Thi-Qar
Abstract: Segmental tibial fractures are considered to be a special type of injury associated with high
complication rates and are defined by the presence of two or more distinct fracture lines with completely
isolating an intermediary segment і.е interruption of bone integrity at two levels(majority) or moreand are
usually caused by a high-energy direct trauma with important soft tissue damage effect the both intramedullary
and periosteal vascularization, which are predisposed to slow healing with creation of unsuitable biological
conditions for fracture union. The aim of our study was to evaluate and assess the outcome of our policy on
dealing with closed segmental fracture of the tibia treated by (closed or open) application of external tubular
device fixator (AO group of ASIF) .Within the period between October 1, 1998 and September 30, 2010 in Al
Nasiriya military hospital, AL Amara military hospital and Al Husain teaching hospital, we collect 38 patients
with displaced and minimally displaced closed segmental tibial fractures. We exclude the multiply injured
patients died after surgical treatment in the course of further management, open fractures, and all the patients
lost for follow up.
The minimally or undisplaced fractures were treated by closed application of the external device,
while those with significantly displaced fractures, firstly managed by calcaneal continuous traction for a few
days as an attempt for reduction, some of them were reduced to minimally displaced or acceptable position
which were treated also by closed method, and some are remain significantly displaced, treated by open
reposition and external fixation with the help of X-ray control for all cases. A range of motion exercise of
ankle and knee joints post operatively were encouraged.
The mean age was 38.81 years. We collect and study 38 closed segmental tibial fractures i.e. (two
fractures focuses for one bone), so we are dealing with 76 fractures in 38 patients. All the patients were treated
by AO unilateral external fixator arranged in multiplanartechnique for more rigid fixation and regarded as a
definitive procedure for holding the fractures until clinical& radiological union.Once a considerable callus
seen, a loosening of the distal clamps and a very graduated weight bearing started, with the help of the crutches
to permit an axial compression on the fractures sites until a secure union of the bone. Then the external fixation
was removed and a partial weight bearing was continued with the help of the crutches until consolidation.
Healing of the bone occurred in 52 fracture focuses (68.42%) patients, and 24 fractures (31.57%) patients
reported significant complications in the course of treatment that required further surgical management, 18 of
them delayed union (23.68%) patients and 6 of the fracture focuses(7.89)patients go to nonunion.The delayed
union treated simply by dianamyzation with chips bone graft and sometimes rearrangement of the external
fixator particularly the loose pines, all of them healed completely, while the nonunited were treated by (Revision
procedure):- (revision of the external fixator with wider pins and extensive refreshment of the fracture ends and
added a considerable amount of bone graft), so all of them were united successfully. We conclude that the
external fixation is a suitable method for the treatment of segmental tibial fractures with an acceptable rate of
complications.
I. INTRODUCTION
A segmental fracture is defined as a fracture with two or more fracture lines with one or more
cylindrical intercalary segment(s). The majority of segmental tibial fractures have one intercalary segment (two
fracture lines). These fractures are rare, according to the literatures, the frequency of segmental tibial fractures
ranges from (1-6%)(4)
and accounting for only up to about 12.8% of tibial fractures(9)
.The goal of our study
was to evaluate the clinical outcomes of tibial segmental fractures treated by external fixation( closed & open)
techniques, and we was assessing our experience and protocols for dealing with such problematic cases
according to the available facilities in our circumstances and analyzing the problems and complications and
how to resolved them. Segmental fractures are usually caused by high-energy trauma; motor vehicle and
motorcycle crashes, falls from a height, industrial injures(25,45)
. In the traffic accidents, are usually due to the
effect of direct violent forces in which that a car, moving at high speeds, hits a pedestrian with a bumper into the
lower leg.This injury is rarely isolated(16)
, and associated with severe soft tissue damage of the lower extremity
and accompanying injury(9)
.
2. Assessment & Evaluation Of The Outcome…
49
This kind of damage creates unsuitable biological conditions for fracture healing, and because of the
damage for both intramedullary and periosteal vascularization, segmental fractures are predisposed to slow
healing and development of union complications (delayedunion, nonunion and pseudoarthrosis)(9)
. However,
there is no reliable scientific data to suggest that the presence of fractures at two different levels of the tibia
necessarily compromises osteogenesis. The mechanism of healing of the two fractures is independent from each
other. When the fractures are treated by means of rigid fixation with a plate or external fixator the medullary
blood supply is rapidly restored, but peripheral callus does not form (24, 25, 41, 40)
. The treatment of segmental tibia
fractures is demanding and time consuming, in which case a choice has to be made from different stabilization
techniques, each with its own limits and morbidity (26,21,12,1,15,33)
.The end result is oftenmediocre (20,30)
.
II. PATIENTS AND METHODS
Within the period between October 1, 1998 and September 30, 2010 in Al Nasiriya military hospital,
AL Amara military hospital and Al Husain teaching hospital, we collect 38 patients of closed segmental tibial
fractures with different configurations (undisplaced, minimally or acceptable displacement and significantly
displaced). We exclude the multiply injured patients died after surgical treatment in the course of further
management, open fractures, and all the patients lost for follow up. The undisplaced and the acceptable
displaced were treated by closed application of the external fixation, while those with significant
displacement, firstly managed by calcaneal traction for a few days, some of them have been reduced to
minimally or acceptable displacement : the apposition neednot be complete but the alignment must be near-
perfect and no more than 7 degrees of angulation but the rotation should be absolutely perfect , and those also
have been treated by closed application of the external fixation.While those which were remain significantly
displaced, treated by open reduction, and in order to prevent further damage of intramedullary and periosteal
bone vascularization, which is important for fracture healing, we had used a minimally access approaches (less
invasive surgery as possible as we can): a two small incisions, one on each fracture focus with a small window
just to reach the fracture ends for reduction and holding the reduction with the help of the X-ray control for
repositioning of the fragments as anatomically as possible, then applied the fixator pins away from the fracture
zones.Again the position of the fractures were checked during surgery by the X-ray control for both open &
closed method and sometimes with the help of the pins of the external fixator placed outside the fracture zone as
joysticks with little manipulation; and any minor degree of angulation and incomplete apposition can still be
corrected more.Displacement of the fibular fracture, unless it involves the ankle joint, is unimportant and can be
ignored.A range of motion exercise of ankle and knee joints post operatively were encouraged. We collect and
study the 38 case (two fractures focuses for one bone), (76) fractures in 38 patients.All the patients were treated
by AO unilateral external fixator with each fracture segment was stabilized at least by two levels of fixation or
more depend on the length of the segment and arranged in multiplanar technique to obtain more rigid fixation
and regarded as a definitive procedure for holding the fractures until secure union.
The limb is elevated and the patient is kept under observation for 48–72 hours with broad spectrum
antibiotic then discharge from the hospital and usually allowed up in the second or third day on the crutches
with only touch-down weight bearing is allowed and followed at regular three- to four –weekly review and at
physiotherapy sessions until a visible callus was appeared usually after 6 weeks, then loosen the distal clamps,
and bearing a very minimal weight with the aid of crutches was allowed and gradually increasing the transfer of
weight through the limb not the fixator to permit an axial compression on the fractures sites i.e. the frame will
be converted to a dynamic configuration allowing the bone to bearweight. The weight bearing was progressed
as callus develops. As further healing occurs until a secure union, this can be determined clinically and
radiologically.The clinical union was achieved when the patient could bear weight fully through the affected leg
without supporting aids or the fracture can be manually stressed, and this can be obtained by loosening the pin-
to-bar clamps and sliding the bar out through the clamps and on one side of the fracture, if very mild movement
and or pain is detected, that means the fracture is still not securely united and so that the bar is replaced in its
previous position.
Radiologically, the callus bridging across the fracture site on both the AP and the lateral projections
was assessed. In well-reduced fractures with a barely visible gap, blurring of a fracture line was all that visible
in some cases. When radiological and clinical union had been achieved, removal of the frames was carried out
under a parenteral sedation& analgesia in the clinic or rarely under general anesthesia. Sometimes when the
patient seems to be non- cooperative, the limb is protected in a cast for few weeks. A graduated weight bearing
ambulation was encouraged with crutches, and increased as the confidence and ability improved. A follow-up
examination was every (3 - 4) weeks until consolidation. When full weight bearing is achieved without
ambulatory aids, progressive strengthening exercises can be added. The vigorous activities usually are not
3. Assessment & Evaluation Of The Outcome…
50
allowed for approximately 6 months after fixator removal, and when the fracture site is strongly solid, and the
pin sites have completely healed.
On the other hand If the amount of the callus has not increased over a 3-month period, so these are
regarded as delayed union and further interventionneeded, such as chips bone grafting (usually taken from tibial
tuberosity) which is necessary to promote healing, pins that become loose or grossly infected (persistent
purulent drainage, radiographic lucency around pin) require removal and curettage and are replaced in a
different sites if they are needed to maintain the stability. Oral antibiotics may be needed periodically to treat
minor pin site infection. If there is still no visible radiological signs of healing or further callus formation again
after three month, so these are regarded as nonunion and treated by Revision procedure:in which there was
replacement of the external apparatus,we were using a more diameter schanizes(in order to obtained a more
secure fixation and because of moderate disused osteoporosis) and arranged in multiplanar & compression
technique , a large amount of bone graft which was taken from iliac crest, extensive refreshment of the fractures
site and removal of all fibrous tissue until the fracture ends bleed then incarcerate the big pieces of the graft in
between the ends of the fracture segments. Sometimes and because of other injuries, some patients were unable
to manage weight-bearing with crutches for several weeks.
The final follow-up examination was at least 1 year after surgery.
Healing of the bone occurred in 52 fractures (68.42%) patients, and 24 fractures (31.57%) patients reported
significant complications in the course of treatment that required further surgical management, 18 fractures
develop delayed union (23.68%) patients treated by dianamyzation, chips bone graft and replaced the loose or
infected pines in a different site, and 6 fractures go to nonunion (7.89%) patients which were treated by a
(Revision procedure).
Collection of data was achieved by write down all the information of the cases, review of case notes,
radiographs and clinical examination. The outcome measures were assessed: healing of the fracture,
complicationsof treatment, functional recovery and general health status.
Healing was represented as time to union and the different fracture levels were also considered. Pin-site
infection, which is common with the use of external fixators, was recorded, but listed as a complication only if
secondary intervention other than the administration of antibiotics was needed. We was recording (4) cases
(10.5%). The care of pin sites was according to the recommendations of the Russian Ilizarov Scientific Centre
for Restorative Traumatology and Orthopaedics (RISC RTO). This involves a weekly regimen of cleaning with
alcoholic chlorhexidine and occlusion of the pin site by a bulky dressing. This protocol has previously been
found to give a lower incidence of infection than daily cleaning with normal saline (7)
.
Persistent drainage from a pin site, especially with loosening, should be treated by pin removal and curettage of
the pin track and addition of a new pin at a different site, if necessary, for stability.
The functional recovery was recorded at the final review for the movement of the knee and ankle.
III. RESULTS
Between October1, 1998 and September 30, 2010, we collect 38 patients with closed segmental tibial
fractures (two fracture focuses for one bone), so we are dealing with 76 fractures at different levels in 38 case, in
order to evaluate and assess the final result of our protocol or policy on dealing withsuch problematic cases, and
the prognosis or functional outcome of these fractures according to the available facilities in our hospitals at that
time.In the analyzed group there were 32 male( 84.21%) and 6 female(15.78%), The mean age was 38.81 years,
ranging from 17years the youngest to 66years the oldest as mentioned in table(1) in this study.Having analyzed
the side of injury, we found that the right side injury 26 cases (68.42%) and the left side was 12 cases
(31.57%)table (2).By analyzing the etiological factors of injury, we found that different mechanisms were
causing the closed segmental tibial fractures:a passenger in motor vehicles 15 patients (39.47 %), a pedestrians
struck by motor vehicles 12 patients (31.57%), a fall from a height 6 patient (15.78 %), a motor cycle accident 3
patients (7.89 %) and a direct blow by heavy things 2 patient (5.26%)table (3).The segmental fractures means
two fractures focuses in one bone at different levels so we have 38 tibias with 76 fractures: 22 metaphyseal and
54 diaphysial fractures in form of segments with different locations, table (5).Distal to proximal metaphyso-
metaphyseal segment (DP. M-M) 2 cases 5.26% = 4 fractures 2 distal metaphysial which was united completely
and 2 proximal metaphyseal also united.Proximal diaphyso-metaphyseal (P. D-M) 15 cases 39.47% = 30
fractures (15 proximal metaphyseal in which 11 of them united and 4 delayed which was united after
treatment of delayed union, while the other 15 fractures of the same segment was located in the diaphysis in
which 10 of them united and 5 develop union complication, a 3 was united after treatment and 2 develop
nonunion which was treated by more comprehensive procedure and united completely.
4. Assessment & Evaluation Of The Outcome…
51
Diaphyso-diaphyseal segment (D-D)18 cases 47.36% = 36 fracture located in the diaphysis in which 23
of them were united and 13 develop union complication also, a 9 of them was united after treatment and 4
develop nonunion which was also treated and united.Distal diaphyso-metaphyseal segment (D. D-M) 3 cases
7.89% = 6 fracture, a 3 in the metaphysis,2 of them united and 1 was delayed which was treated and healed
completely, the 3 diaphysial a 2 of them united and 1 was delayed and treated also, {tables (4) &(8)}.
From 38 cases, there was14cases (36.84%) undisplaced or minimally displaced which were treated by closed
application of the external fixation.On the other hand a 24 cases (63.15%) with displaced fractures were
initially managed by calcaneal traction for few days, 8 cases (33.33% ) of the 24 displaced had been reduced to
acceptable displacement and also treated by closed external fixation while the 16 cases( 66.66%) of the 24
displaced remain in unacceptable position which were treated by open reduction and external fixation, and the
help of the X-ray were used in all 38 cases(open & closed) table(6).
By analyzing the fracture healing and the procedures used for treatment: 44 fractures treated closed
(22patients), a 40 of them united completely (90.90%), and 4 fracture (9.09%) develop union complication.32
fractures treated open (16patients), a12 of them were united( 37.5%), while 20 fracture( 43.75%) also
develop union complication, therefore the total 76 fractures (38 patients) , a 52 fracture(68.42%) were united
completely on the other hand a 24 fracture(31.57% ) develop union complication(delayed union & nonunion)
table(10).
Having analyzed the union complications and the anatomical site of the fractures, we found that: in
22(28.94%) metaphyseal fractures, 17 (77.27%) of them united and 5 (22.72%) delayed union. In 54 (71.05%)
diaphysial fractures, 35 (64.81%) united and 19 (35.18%) of them develop union complication (13united+
6nonunion), therefore an out of 76 fractures in a 38 patients with segmental tibial fractures, a 52 (68.42%)
united; while a 24 (31.57%) develop union complications which also treated and unitedtable (9).Regarding
union complication in our study, we found that a 24 fracture out of 76 develop union complication, in which 18
regarded as delayed union, and 6 non-union, all of them were treated and united completely, table (11).
In 4 (10.5%) patients, the pin site infection was registered, and all of them were treated successfully,
table (7).Secondary loss of reduction (redisplacement) was not occurred in our study.Callus and consolidation
appeared earlier posterolaterally, both in the proximal and the distal fractures.Most of the 38 patients were
returned to their previous activities with special modification for those associated with other major injuries.
Table (1): Distribution of patients by age and sex
Table (2): Sideof Injury
Side of injury No. of cases Percentage
Right 26 68.42%
Left 12 31.57%
5. Assessment & Evaluation Of The Outcome…
52
Table(3):Mechanism of injury
Mech.of injury No. of cases Percentage
Passenger in motor vehicles 15 39.47 %
Pedestrians struck by motor vehicles 12 31.57 %
Fall from a height 6 15.78 %
Motor cycle accident 3 7.89 %
Direct blow by heavy things 2 5.26 %
Table(4):Site Of The Segment
The segment NO. of cases percentage
distal-proximalmetaphyso-metaphyseal (DP. M-M) 2 5.26%
proximal diaphyso-metaphyseal(P. D-M) 15 39.47%
diaphyso-diaphyseal(D-D) 18 47.36%
distal diaphyso-metaphyseal(D. D-M) 3 7.89%
Table(5):Site Of The Fractures
No. of the cases No. of the fractures Metaphysial fractures Diaphysial fractures
38 76 22 54
Table(6):Fractures configuration and Method of treatment
Fractures configaration No.of cases Method of treatment percentage
Undisplaced or minimally dis. 14 Closed ext. fix. 36.84%
Displaced 24
Reduced by skeletal
Traction
8 33.33%
Closed ext. fix.
63.15%
Remain displaced 16
66.66% Open ext. fix.
Total 38 Closed +open 100%
Table(7):Pin tract infection
No.of cases percentage
4 10.5%
Table (8): Fractures healing with anatomical situation
segments NO.of
cases
No. of
fractures
Dist.Metap
hysial
fractures
Prox.Metaphysial
fractures
Diaphysalfrctures
DP. M-M 2 4 2-united 2-united -
P. D-M 15 30 -
15frctures
11-united
4delay
15frctures
10-united
5 delay(3united 2 nonunited)
D-D 18 36 - -
36fractures
23-Union 13Delay
(9united +4non)
D. D-M 3 6 2-united
1-delay
- 2-united
1-delay
6. Assessment & Evaluation Of The Outcome…
53
Table(9):Union complications
DP. M-M :- distal-proximal metaphyso-metaphyseal
P. D-M :- proximal diaphyso-metaphyseal
D-D :-diaphyso-diaphyseal
D. D-M :- distal diaphyso-metaphyseal
Table(10):Fracture healing with method of treatment
No.of the fractures&patients union percentage Delayed union percentage
44 fractures treated closed
(22patients)
40 90.90% 4 9.09%
32 fractures treated open
(16patients)
12 37.5% 20 43.75%
Total 76 fractures
(38 patients)
52 68.42% 24 31.57%
Table(11):Union, union complication&method of treatment
No. of fractures union Union complication surgical management
76 52 24
18 delayed union treated by
dianamyzation, chips bone graft
and replaced the loose or infected
pines in a different site
6 nonunion treated by revision
procedure with large amount of
bone graft.
IV. DISCUSSION
Segmental tibial fractures are uncommon injuries .They are commonly caused by high-energy trauma.
It is estimated that many of these fractures are open, and often part of multiple injuries. They are challenging to
manage and have a significant complication rate, and because of the wide zone of injury, potentially reduced
viability of the bone and problems with stabilization. These high-energy fractures are likely to be associated
with injuries elsewhere. (9)
It is important to note that some of the segmental tibial fractures may require more than one surgery.
The surgeon therefore, needs to plan ahead to make subsequent surgical interventions possible. There has been a
significant change in the management of segmental tibial fractures. This has been made possible by the
development of new orthopaedic implants. Various favored methods of treatment have been currently proposed
including casting and functional bracing, internal fixation by plates and screws, intramedullary nailing and
external fixations.
Nonoperative treatment of a segmental tibial fracture may need a long period of cast immobilization
(35)
, from our experience, we have added that the weight of a high thigh cast with involvement of a joint above
and a joint below was a more disabling factor that not endeared by both the patient and the surgeon.
Site of the
fracture
No. of the
fracture
percentage union percentage Union complications perc
enta
ge
metaphyseal
22 28.94% 17 77.27% 5-delay 22.72%
diaphyseal
54 71.05% 35 64.81%
19delay(13united+
6nonunion) 35.18%
Total 76 100% 52 68.42% 24 31.57%
7. Assessment & Evaluation Of The Outcome…
54
Multilevel tibial fractures challenge the ability of standard implants to provide adequate stability at all levels.
Fixation with plate and screws may achieve this, but it requires a large incision with stripping of the contused
soft tissues, and this is an additional surgical injury to a compromised soft tissue envelope, with a substantial
risk of skin necrosis and deep infection even with modern submuscular techniques. Muller et al. in the treatment
of segmental tibial shaft fractures recommended a compression long plate that includes all three fragments. If
the condition of the lower leg soft tissues is good, medially padded plate is recommended; while in case of
compromised soft tissues of the lower leg and segmental tibial fractures, lateral plate placement is favored (27)
.
In our study we used the external fixation that includes all three fragments easily (multilevel stability), in case
of open reduction it requires a small incisions (minimally invasive technique), so not need too much periosteal
stripping and less soft tissue trauma which is adversely effect on healing processes.
Conventional Kuntscher intramedullary nailing can neither give enough rotational stability nor correct
the length of tibia. The use of reamed intramedullary nails and locking screws can be successful if the fracture
segments are neither too proximal nor too distal. However, reaming incurs a biological cost which affects the
blood supply to the tibial cortex(14)
Several reports in current orthopaedic literature have recommended
intramedullary nailing of segmental tibial fractures with varying degrees of success(3,6,11,13,16,19,22,44,45,46),
but his
method of fracture fixation, however, is not free of complications, among which chronic knee pain remains the
most elusive one.Court-Brown et al reported an incidence of knee pain in 56.2% of patients, most of them
significantly younger. There was considerable functional impairment with 91.7% of patients experiencing pain
on kneeling and 33.7% having pain even at rest. They stated that 24.4% patients required removal of the nail (5)
.
Orfaly et al reported the need for nail removal because of knee pain in 80% of 61 patients, and after 16 months
the pain had not resolved in 22 (36%) of these patients.(29)
In a recent and most comprehensive review of the
literature Katsouis et al., documented the high incidence of complications associated with intramedullary nailing
of tibial fractures (17)
. Muller et al. also indicate that the interlocking nail, possibly in combination with a narrow
plate on the edge of the tibia, is a good solution in the treatment of segmental fractures.The authors do not
suggest the reaming of the medullary canal as there is a danger that pieces of shaft fractures could be torn out of
the soft tissues (27)
.While in the our study the standard AO tubular external fixator give rise enough rotational
stability and correct the length of tibia, when the fixator is successfully applied even the fracture segments are
too proximal or too distal , and the fractures can be stabilized immediately, and early ambulation becomes
possible without reaming of the medullary canal and so there is no danger of the fragment could be torn out of
the soft tissues in addition to that, there was no chronic knee pain neither on kneeling nor at rest, and the fixator
device not stay there for a long period, it was removed once there is radiological & clinical union.
The final suitable option for us in the stabilization of these fractures is the external fixation. This
method has the potential to leave a very small effect on the biology of the fracture and is probably equivalent to
conservative methods if:- Fixation pins are kept away from the fracture zones. Closed application of the fixator
as in those with undisplaced or minimally displaced segmental fractures.In open reduction we used a minimally
access approaches (less invasive technique as possible as we can) as mentioned above.
Mitković et al mentioned that a possible explanation for some of the complications of the uniplanar stability
provided by standard external fixators, but unilateral external fixator with convergent pins orientation provides
necessary stability of the segmental fracture and support, which is important for fracture healing. Two pins of
the external fixator fix proximal and distal tibial fragment, and one or two pins of the external fixator fix the
intermediate fragment, depending on its size(25)
.
In our policy& protocol we had solved these problems successfully by try to produce multiplanar
rigidity with multilevel stability on the use of the standard AO external fixation in which the application of the
schanizes pins not only perpendicular but at a different angles (multiangles) with rotation of the clamps at the
same directions of the pins therefore we obtained a multiplanar rigidity, while the multilevel stability can be
obtained by increasing the number of the pins. Usually we used (2-4) pins for each segments according to the
size, but not used one pin for a segment even a small size. Previous reports have documented its success for
segmental tibial fractures, but have also stated problems with malunion, nonunion and deep infection(45, 34)
.
In this study, and from the our accumulative experience, as mentioned above, the external fixation has the
potential to provide multilevel stability with multiplanar rigidity of the fracture with minimal disruption of the
soft-tissue , in addition to that we have no interlocking nail facilities, it was not provided at that time and we
have no full experience on these procedures, therefore we were regarding the external fixation is the only
method on dealing with such type of injuries in our circumstances. We had also stated problems in union
(delayed union& nonunion):-
8. Assessment & Evaluation Of The Outcome…
55
We have 76 fractures in 38 patients in which 52 (68.42%) had been united and 24 (31.57%) had union
complications in which 18 of them delayed union & a 6 of them non-union. The delayed union wastreated by
dianamyzation, chips bone graft from tibial tuberosity and replaced the loose or infected pins at a different site,
on the other hand the nonunion was treated by total revision procedure with extensive refreshment of the
fracture ends and added a large fragments of bone graft taken from iliac crest.
In general, the treatment of segmental tibial fractures can be non-operative and operative. (34, 36)
But we are strongly emphasized on that the segmental fractures are rarely suitable for non-operative treatment,
except for sometimes in undisplaced fractures and particularly a young patients, can be treated by above knee
plaster cast, but still we are insist that these are a more disabling factors, a long period of casting with a heavy
weight and not moving the joints above and below, and so all these are sometimes not favorite by the surgeon
and the patient himself.
On the other hand, in case of displacement, and in order to achieve manual reposition, it is necessary to
provide stability of both fracture focuses by performing manual maneuvers, it can be accomplished in a single
focal point of fracture, and while trying to perform the reposition of the second, a displacement usually occurs in
the previous one. Maneuvers are repeated several times, thus damaging more soft tissues of the leg. And if a
satisfactory repositioning of the fragment under X-rays is achieved and plaster immobilization is applied, a
secondary displacement of the fragments usually occurs as soon as the edema at the fracture site subsides in
addition to that, on application of the cast, will included a joints and also the weight of the cast will induced
more disability than the frame of the external fixation which is lighter and can moving the joint above and the
joint below. For these reasons, the majority of segmental tibial shaft fractures require surgical treatment.
Unreamed nails have been proposed as a compromise, and the achievement of multilevel stability can be
difficult (16)
Very short proximal segments are notoriously difficult to control, even with modern intramedullary
nails and alterations to the technique of insertion have to be used to avoid malalignment. (43)
In a retrospective assessment, Giotakis N. et al. present their treatment of 20 patients with segmental
tibial fractures, who were treated between 2000 and in 2006 with circular external fixator. In 18 patients there
was fracture healing, whereas in 2 patients the nonunion and pseudoarthrosis formation were reported. In one
patient, the treatment was continued with circular external fixator, and in other one with open and autologous
bone grafting. In one patient, osteomyelitis developed around the wire, so that the replacement and debridement
were performed. In three patients, fracture healed with angular deformity, and also they emphasized that the
circular external fixation to be a reasonable method of treatment, which leaves a small biological ‘footprint’ and
can achieve multilevel stability. There is a good time to union, a low rate of re-operations and good functional
and general health-status (10)
.
From assessment of our study in which a segmental tibial fractures were treated by unilateral frame of
the AO tubular external fixation, it was also leaves a small biological ‘footprint’, and a good time to union, a
low rate of re-operations and good functional and general health-status outcome and can achieve multilevel
stability with multiplanar rigidity even when very short proximal segments, particularly when the pins are
arranged in multiangles and multi directional technique.
In our study a ( 76 ) fracture in 38 patient in which a 44 fractures (22patients) treated closed, 40 (90.90%)
united early and 4 fracture delayed union treated by simple procedure and united successfully, while a 32
fractures (16patients) treated by open reduction, 12 fracture (37.5%) united early and 14 fracture delayed
union also treated by simple procedure and united successfully, a 6 fractures developed nonunion which was
treated by more comprehensive procedure and was united completely.
Pin tract infection was developed in 4 cases (10.5%) which was treated and cured without reluctance.
We have no registration of any full blown pseudoarthrosis and the all fractures healed without any significant
angular deformity unless with ≤7 degrees of angulation can be considered to be clinically and cosmetically good
results, since such deviations from the normal are not complications. They are aesthetically difficult to recognize
with the naked eye, do not produce a limp, or are likely to produce late osteoarthritic changes (23)
.
V.
VI. CONCLUSIONS
1. We emphasized on that the multilevel fractures are considered to be a special type of injury associated with
high complication rates and are usually caused by a high-energy direct trauma.
2. We strongly believed that the segmental fractures are a difficult group to manage besides severe open
fractures (9)
.
3. These fractures are rarely encountered, and are an infrequent occurring injury in our region as stated by
others literatures also(4, 9)
.
9. Assessment & Evaluation Of The Outcome…
56
4. We have also found that callus formation and consolidation was observed earlier in the posterior and lateral
parts of the tibia, both in the proximal and the distal fractures. Our view is that supporting the fact (more
muscular coverage, better vascular supply).
5. Healing at the metaphysis is faster and union complication less than in diaphysis.
6. Healing in closed method is better with less union complications than in open method.
7. Calcaneal traction with gradual increasing the weight, according to the progress of the reduction for a few
days is a very important preliminary measure to produce gradual correction as an attempt for closed
reduction in significantly displaced fracture leg bones and also regarded as a provisional management when
the skin viability is doubtful.
8. We regarded the AO tubular external fixators with their different constructs as a highly versatility apparatus
that we can obtain multiplanar rigidity when the pins arranged in multiangles orientation and multilevel
stability when the number of the pins increased.
9. From this retrospective assessment, we conclude that the external fixator apparatus must be considered as a
reasonable method of treatment of the segmental tibial fractures with an acceptable rate of complications, a
low rate of re-operations and good functional and general health-status outcome and there was no
considerable functional impairment.
10. We conclude that the segmental fractures are better to be treated operatively rather than non-operative even
minimally displaced.
11. Bone graft must be considered as prophylactic measures for open reduction and external fixation segmental
tibial fractures.
12. They stated that an interlocking nail can offset the shortcomings of plating and conventional Kiintscher
nailing(8)
we concluded that the external fixation can also offset the shortcomings of plating and
conventional Kiintscher nailing and the fractures can be stabilized immediately, and early ambulation
becomes possible.
13. The satisfactory results and the acceptable rate of union in our study support the general facts that stated
by the authors : ( the closed or minimally invasive treatment of segmental fracture tibia and if allowed to
experience physiological motion at the fracture site usually heal uneventfully and also the early introduction
of the graduated weight bearing and the freedom of motion of all joints that the external fixation permits
result in a very little motion at the fracture site, which in turn enhances osteogenesis)(18,31,32,37,39,38,41,40,42)
14. We emphasized on that the management of these fractures in developedcountries poses a formidablechange
to the treating surgeon, a number of available implants has escalateddramaticallyover the last decades and
the treating surgeon is simply overwhelmed by these implants and the new concepts and surgical techniques
that accompany them (28)
. While in less developed countries these concepts more or less different, and
therefore in our city we are concentrated on the most available osteosynthesis(the standard external
fixation)with full experience on them and so this is very good lesson for the under developed countries on
dealing with such problematic injuries.
15. Lastly we strongly agree with Ching-Kuei Huang et al, that there are no clear therapeutically- relevant
guidelines regarding classification of segmental tibial fractures treatment approaches and evaluation of
functional outcome using validated scales. These are the crucial issues or challenges facing future clinical
research studies. Literature search retrieved very few articles (2)
.
REFERENCES
[1]. Bonnevialle P, Cariven P, Bonnevialle N, et al (2003) Segmental tibia fractures: a critical retrospective analysis of 49 cases. Rev
ChirOrthopAppar Mot 89: 423-432.
[2]. Ching-KueiHuang , Wei – Ming Chen , Tain – Hsiung Chen and Wai-Hee Lo. Segmental tibial fractures treated with interlocking
nails. ActaOrthop. Scand. 1997; 68 (6): 563 – 566.
[3]. Coosemans, W., Rommedss, P., Broos, P., Gruwez, J.A.: Specific problems in the management of segmental fractures of the
tibial shaft. ActaChir. Belg., 88:347–353, 1988.
[4]. Court-Brown CM, Mac Birnie J. The epidemiology of tibial fractures. J Bone Joint Surg(Br) 1995; 77: 417- 21.
[5]. Court-Brown, C. M., Gustilo, T., Shaw, A. D.: Knee pain after intramedullary nailing: its incidence, etiology, and outcome. J.
Orthop. Trauma, 11:103–5, 1997.
[6]. Court-Brown, C. M., Will, E., Christie, J., Mcqueen, M. M.: Reamed or unreamed nailing for closed tibial fractures. A
prospective study. J. Bone JtSurg 78-B:580–587, 1996.
[7]. Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg [Br] 2005;87-B:716-19.
[8]. Ekeland A, Thoresen B 0, Alho A, Stromsoe K, Folleras G, Haukebo A. Interlocking intramedullary nailing in the treatment of
tibial fractures-A report of 45 cases. ClinOrthop 1988; 231: 205-5.
[9]. Giannoudis , A.F. Hinsche, A. Cohen, D.A. MacDonald’s, S.J. Matthews, R.M. Smith. Segmental tibial fractures: an assessment
of procedures in 27 cases. Injury, Int. J. Care Injured. 2003; 34:756 – 762.
[10]. Giotakis N, Panchani S.K, narayan B, Larkin J.J, Maskari S. Al, Nayagam S. Segmental fractures of the tibia treated by circular
external fixation. J Bone Joint Surg (Br) 2010; 92(5): 687-92..
10. Assessment & Evaluation Of The Outcome…
57
[11]. Gregory, P., Sanders, R.: The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails. Clin. Orthop.,
315:48–55, 1995.
[12]. Henley MB, Chapman JR, Agel J, et al (1998) Treatment of Type II, IIIA and IIIB open fractures of the tibial shaft: A
prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma 12: 1-7
[13]. Hohaus, TH., Bula, F., Bonnaire, F.: Intramedullary osteosynthesis in the treatment of lower extremity fractures. ActaChir.
orthop. Traum. čech., 75:52–60, 2008.
[14]. Hupel TM, Aksenov SA, Schemitsch EH. Effect of limited and standard reaming on cortical bone blood flow and early strength
of union following segmental fracture. J Orthop Trauma 1998;12:400-6..
[15]. Johner R, Staubli HU, Gunst M, et al ( 2000) The point of view of the clinician: a prospective study of the mechanism of
accidents and the morphology of tibial and fibular shaft fractures. Injury 31:C45-49
Kakar S, Tornetta P 3rd. Segmental tibial fractures: a prospective evaluation. ClinOrthop 2007; 460: 196-207.
PMid:17353796….
[16]. Katsouis, E., Court-Brown, C., Giannoudis, P.: Incidence and aetiology of anterior knee pain after intramedullary nailing of the
femur and tibia. J. Bone Jt Surg., 88-B:576–580, 2007.
[17]. Kenwright, J., Richardson, J. B., Goodship, A. E., Evans, M., Kelly, D. J., Spriggins, A. Newman, J. H., Burrough, S. J., Harris,
J. D., Rowley, D. I.: Effect of Controlled Axial Micromovement on Healing of Tibial Fractures. Lancet, 2:1185, 1986.
[18]. Kuhn, M., Hansen, M., Rommens, M.: Extending the Indications of intramedullary nailing with the Expert Tibial nail. ActaChir.
Orthop. Traum. čech., 75:77–87, 2008.
[19]. McGraw JM, Lim EV (1988) Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. J
Bone Joint Surg (Am) 70: 900-911
[20]. Melichar J, Horalek F, Novotny F, et al ( 2004) Conversion of an external fixation to that with an intramedullary pin in cases of
complicated diaphyseal fractures. RozhlChir 83: 396-398
[21]. Melis, G. C., Sotgiu, F., Lepori, M., Guido, P.: Intramedullary nailing of segmental tibial fractures. J. Bone Jt Surg., 63-A:1310–
1318, 1981.
[22]. Merchant, T. C., Dietz, F. R.: Long-term follow-up after fractures of the tibial and fibular shafts. J. Bone Jt Surg., 71- A:599–
606, 1989. In: Orfaly, R., Keating, J. E., O’Brien, P. J.: Knee pain after tibial nailing: Does the entry point matter? J. Bone Jt
Surg.,77-B:976–7, 1995.
[23]. Merianos , K. Papagiannakos , E. Scretas , P. Smyrnis. Ender nails for segmental tibial fracture. Early weight bearing in 22 cases.
ActaOrthopScandanavia 1988; 59 (3) : 297-301.
[24]. Mitković M, Bumbasirević M, Golubović Z, Mićić I, Mladenović D, Milenković S, Lesić A, BumbasirevićV,Pavlović P,
Karalejić S, Kuljanin G, Petković D. New concept in external fixation. ActaChirIugosl 2005; 52(2):107-
[25]. Mueller CA, Eingartner C, Schreitmueller E, et al (2005) Primary stability of various forms of osteosynthesis in the treatment of
fractures of the proximal tibia. J Bone Joint Surg (Br) 87-B: 426-432 .
[26]. Muller ME, Allgover M, Schneider R. Manual of internal Fixation. 3rd edition, Springer Verlag, 1991
[27]. N. S. Motsitsi Chief Specialist / Head of Department.Dept. ofOrthopaedic Surgery., Kalafong Hospital Pretoria. Email:
silas.motsitsi@up.ac.za. Fax : (012); 373 9031. Management of Segmental Tibial Fractures. East and Central African Journal of
Surgery, Vol. 12, No. 2, November/December 2006, pp. 72-76.
[28]. Orfaly, R., Keating, J. F., O’brien, P. J.: Knee pain after tibial nailing. J. Orthop., Trauma, 11:10–3, 1997. 17.
[29]. Ostermann PA, Knopp W, Josten C, et al (1993) Unreamed intramedullary nail or external fixator in complicated tibial fractures?
A comparative analysis. Chirurg 64: 913-917
[30]. Park, Sang-Hyun, O’connor, K., Mckellop, H., Sarmiento, A.: The Influence of active Shear or Compressive Motion on Fracture
Healing. J. Bone Jt Surg., 80-A, 868–878, 1998.
[31]. Perrin, S.: Evolution of the Internal fixation of long bones fractures. J. Bone Jt Surg., 84-B:1093–110, 2002.
[32]. Piper KJ, Won HY, Ellis AM (2005) Hybrid external fixation in complex tibial plateau and plafond fractures: an Australian audit
of outcome. Injury 36: 178-184.
[33]. Rommens PM, Coosemans W, Broos PL. The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma
Surg 1989; 108: 238-42.
[34]. Sarmiento A, Gersten L M, Sobol P A, Shankwiler J A, Vangsness C T. Tibia1 shaft fracture treated with functional braces. J
Bone Joint Surg (Br) 1989; 71: 602-9.
[35]. Sarmiento A, Latta LL. Functional treatment of closed segmental fractures of the tibia. ActaChirOrthopTraumatolCech
2008;75(5):325-31. PMid:19026185 9
[36]. Sarmiento, A., Latta, L. L.: Closed Functional Treatment of Fractures. Springer-Verlag 1981. 21.
[37]. Sarmiento, A., Latta, L. L.: Periosteal Fracture Callus Mechanics. AAOS Symposium on Trauma to the Leg and Its Sequella.
Moore, T.M. (ed). The C.V. Mosby Company 1981, 175–186. 23.
[38]. Sarmiento, A., Latta, L. L.: The evolution of functional bracing of fractures. J. Bone Jt Surg., 88-B:141–148, 2006. 22.
[39]. Sarmiento, A., Mullis, D. L., Latta, L. L., Tarr, R. R., Alvarez, R.: A Quantitative Comparative Analysis of Fracture Bracing
Under the Influence of Compression Plating versus ClosedWeight Bearing Treatment. Clin. Orthop., 149:232–239, 1980..
[40]. Sarmiento, A., Schaeffer, J. F., Beckerman, L., Latta, L. L., Enis, J. E.: Fracture Healing in Rat Femora as Affected by Functional
Weight Bearing. J. Bone Jt Surg., 59-A: 369–375, 1977.
[41]. Toivanen, J. A., Vaisto, O., Kannus, P., Latvala, K., Honkonen, S. E., Jarvinen, M. J.: Anterior knee pain after intramedullary
nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J.
Bone Jt Surg., 84-A:580–5, 2002.
[42]. Tornetta P 3rd, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. ClinOrthop 1996;328:185-9. 15
15.
[43]. Wiss, D. A., Stetson, W. B.: Unstable fractures of the tibia treated with reamed intramedullary nails. Clin. Orthop., 315:56–63,
1995. 32.
[44]. Woll T.S, Duwelius P.J. The segmental tibial fracture. Clinical Orthopaedics and Related Research. 1992; 281: 204 – 207.
[45]. Zucman, J., Maurer, P.: Two level fractures of the tibia. Results in thirty six cases treated by blind nailing. J. Bone Jt Surg., 51-B:
686–693, 1969. 34.