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A closed fracture is defined as a break in the continuity of the bone which does not communicate with the outside of the body. Management of the patient includes a thorough assessment of the fracture, evaluation of other injuries, and reduction as indicated. The patient is carefully observed for complications should problems arise.
Thirty-one closed fractures of the lower extremity in diabetics were retrospectively reviewed to determine healing times. There was a prolonged union time overall (163% of expected) and in both insulin and oral hypoglycemic-controlled diabetics (157% and 176% of expected). Displaced fractures showed a prolonged union time, while nondisplaced fractures healed in the normal time period (187% and 96% of expected). Fractures treated by open reduction had a more prolonged healing time than those treated by closed reduction (186% and 142% of expected), but this was primarily related to displacement. Sex and age had no effect on union time. The known effects of diabetes mellitus on bone and mineral metabolism in both experimental animals and humans may explain these prolonged union times.
Osteomyelitis developed at closed fracture sites in two children. The infection responded to antibiotic therapy, and the fractures healed without chronic infection developing, impairment of bone growth, or loss of function. It is rare for a closed fracture to develop acute hematogenous osteomyelitis, but the diagnosis should be considered in a child with a closed fracture in whom a fever develops or who complains of increasing pain after the fracture has been reduced and immobilized. In children, the condition has an excellent prognosis.
Acute osteomyelitis following a closed fracture is very rare. A case following a closed epiphyseal (type II) injury of the distal end of the radius is reported and the role of injury as a contributing factor in acute haematogenous osteomyelitis is discussed.
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The principles of treatment of bone fractures in children differ from those in adults and are determined by the morphofunctional features of the growing and developing child organism: the anatomo-physiological peculiarities of the structure and blood supply of the bone of a child, the high regenerative possibilities, the capability for self-correction of some types of residual displacement during growth. Peculiar types of bone injuries occur in childhood which are not encountered in adults. These are subperiosteal linear and folded fractures, fractures of the green stick type, damage to the growth zones (epiphyseolysis and osteo-epiphyseolysis), etc. The localization of the fracture and the size (degree) of displacement of the fragments are very important in the choice of the therapeutic tactics. Predominantly qualitative appraisal of the displacement suffices in metaphyseal and diaphyseal fracture and in injury to the growth zones (extra-articular fracture). Quantitative appraisal of the size of the displacement is advisable in intra-articular fractures, for which the techniques are suggested. Four degrees of fragment displacement are distinguished. Depending on the localization and character of the fracture and the size of the displacement of the fragments, conservative, active surgical, and operative therapeutic tactics may be chosen according to strictly differentiated indications. Each of them includes various methods of fracture management.
A rat model for the study of closed fracture healing is described. Standard closed tibial fractures were produced with specially designed pliers in 24 rats. All fractures were located in the middle third of the tibia and healed without complications as delayed union, infection or soft tissue problems. The average angle of the fracture line with the axis of the tibia on lateral view was 80 +/- 2 degrees (SEM). The model is considered to be suited for the study of closed fracture healing processes. Closed intramedullary fracture fixation, can also be evaluated in this model.
OBJECTIVE: Comparison of the healing process in open osteotomy and closed fracture models that were used to study fracture healing. DESIGN: Randomized, prospective study in experimental animals, with a recovery duration of two and four weeks. SETTING: Unrestricted cage activity with weight bearing as tolerated. ANIMALS: Thirty-four skeletally mature, female New Zealand White rabbits. INTERVENTIONS: Closed fractures and open osteotomies of the tibial diaphysis were reduced and immobilized with four-pin, double-bar external fixators. MAIN OUTCOME MEASUREMENTS: Callus circumference was measured with a tape measure, bridging callus was assessed on biplane radiographs and evaluated histologically, and torsional stiffness and maximum torque were measured. RESULTS: Periosteum damage was more severe and hematoma formation was smaller in the osteotomy model, resulting in a delay in biological healing and restoration of the biomechanical properties. CONCLUSIONS: Investigators should consider the difference between the closed fracture and open osteotomy models when selecting an animal model to investigate fracture healing.
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One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. Thirteen patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional five patients were lost to follow-up. Thus, seventy-two patients (seventy-three fractures) who had been managed with nailing with reaming and sixty-three patients (sixty-three fractures) who had been managed with nailing without reaming were available for follow-up at an average of twelve months (range, three to thirty-three months) postoperatively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the procedures done with reaming (p = 0.0013). The duration of fluoroscopy was not significantly different between the two groups (p = 0.35, Mann-Whitney test). The average estimated blood loss was identical for the two groups. Seventy fractures (96 per cent) that were treated with nailing with reaming and fifty-six (89 per cent) that were treated with nailing without reaming united without the need for an additional operation (p = 0.19). Because of the small sample size, the study has insufficient power (34.7 per cent) to detect this difference if it is real. There was only one deep infection, which developed after nailing without reaming. The nail fractured after one procedure with reaming. A screw fractured after two procedures with reaming and after ten without reaming (p = 0.012); multiple screws fractured after three procedures in the latter group. Malunion occurred after three nailing procedures with reaming and after two without reaming. Four malunions were of very proximal fractures and one was of a very distal fracture. Seventeen screws and twenty-four nails were removed after nailing with reaming, and twenty screws and nineteen nails were removed after nailing without reaming; neither of these prevalences was significantly different between the two groups (p = 0.27 and 0.89; chi-square test). We concluded that there are no major advantages to nailing without reaming as compared with nailing with reaming for the treatment of closed fractures of the shaft of the tibia. There was a higher prevalence of delayed union and breakage of screws after nailing without reaming.
A new technique of elevation of depressed skull fracture in infants without surgical incision has been advocated by the author. It consists of making percutaneously a little burr hole in the thin skull and elevating the depressed bone area with a special instrument serving both as perforator and elevator. The instrument and the technique are described in full. The infant leaves hospital the second day without complications. Five patients aged from six to twelve months were submitted to this new mode of treatment.
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