Cortical Bone Healing after Internal Fixation and Infection: by PD. Dr. med. W.W. Rittmann, PD. Dr. med. S.M. Perren (auth.)

By PD. Dr. med. W.W. Rittmann, PD. Dr. med. S.M. Perren (auth.)

The hazard of an infection continues to be the main critical problem to inner fixation. Prevention, utilizing all on hand prophylactic measures can be the crucial characteristic in each surgical division. notwithstanding the an infection price may possibly stay lower than the appropriate point of two percent, the contaminated sufferer derives little convenience from the massive variety of first-class ends up in folks. We needs to detect tips to provide those sufferers a beneficial analysis. this could now not be in response to instinct yet on transparent confirmed guiding rules. making plans the remedy for a sufferer whose inner fixation has develop into septic needs to make a decision among steps which could have merits or disadvan­ tages. the drawback of the presence of a international physique needs to be weighed opposed to the benefit of pressure. The authors have taken up this problem by means of deliberate animal experiments to review the therapeutic of internally mounted fractures that have been contaminated with staphylococci. they've got proven that below sturdy stipulations, even substantial an infection didn't smash the therapeutic method in cortical bone. Even below those conditions fracture union, within the type of basic bone therapeutic, can happen no matter if with much less regularity than in unin­ fected inner fixation.

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Microradiography of sequestrated osteotomy zone in sheep 4214 (group " no compression with one plate"): Within the sequestra little remodelling activity is found , while the fragment ends show very active cortical remodelling. The callus in the lower part of the picture shows incomplete bridging of the osteotomy gaps with fibrous or lamellar bone (" gap healing") [30] or by direct crossing over the osteotomy planes of osteons (" contact healing") [99] when the fragment ends were found to be well adapted 12.

Microradiographic view of the osteotomy zone in sheep 24 (group " no compression with one plate"): A huge fusiform-shaped callus unites the two main fragments; the endosteal callus formation is less extensive. Severe osteolysis with separation of the callus from the cortex over wide areas 49 fragment cortex; rarely, bony union of the fragment ends; spreading, local resorption zones of the cortical surface with sequestration; resorption with formation of abscess cavities within the cortex; and finally only slight Haversian remodelling.

48). The osteotomy as such was remarkably seldom attacked by the osteoly- 0,3 mm Fig. 47. Vascular tree in resorption cavity: Often resorption cavities contained a dense vascular network. High magnification of the cavity from the osteotomy zone (from microangiography of sheep 1829, group "compression with one plate") 53 <1 Fig. 48. Sequestration of osteotomy zone in sheep 1829 (group" compression with one plate"): The microradiography shows practically full sequestration of the osteotomy zone. ' 5 mm tic processes.

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