The radiological and histological comparison of effects on fracture healing of epiphysis fracture fixation with screw or n-butyl-2-cyanoacrylate(NBCA): An experimental study on rabbits

Epiphyseal fractures are common pediatric traumas that couse physeal closure. For today there isn?t any golden standart treatment. Epiphyseal fractures are different from adult bone fractures in terms of formation mechanism, bone healing process and complications. Because of the epiphyseal injuries after fracture healing, extremity disparities and angular deformities can be seen. Advanced functional deficiencies can be seen in both lower and upper extremities. At Salter-Harris Type 4 epiphyseal fractures (fracture starts from epiphysis contunies to metaphysis) percutaneus fixation with Kirschner wire and open reduction + fixation with screw treatment models are used very often. For these treatment models a permenant injury to the physis plate can be occur and a second surgical procedure can be needed to remove the implants. Also infection of bottom of the pins can be seen and after the second surgery the chance of infection can increase. In our study , we are going to try a tissue adessive called N-Butyl-2-Cyanoacrylate(NBCA) to reduce the surgical complications or to support the treatment methods used today at epiphyseal fracture fixation. At our research we didn?t find any study about NBCA usage at epiphyseal fracture fixation.After ethical committee aproval 1000 gr avarage weight, 7 weeks old 42 New Zealand White Rabbit?s left distal femurs were studied. Rabbits were divided into 2 groups ; Group 1 (NBCA) and Group 2 (Screw). We made Salter-Harris Type 4 distal femur fractures with an osteotome by the way medial parapatellar incision. We used NBCA in Group 1 and Screw in Group 2 for fixation. We took the X-ray graphies of left femurs at postoperative 1 ? 3 and 6.th weeks. Then we excised the left femurs and put hem into Na-EDTA and formaldehyde solutions. At the end of the study, we compared the results by using Mann-Whitney-U method at SSPS 17.0 statistical program. We accepted p<0,05 as significant value.There wasn?t any difference between 2 groups for 6. week fracture healing on X-ray graphies. For hystological results there was significantly statistical difference (p<0,004) between two groups; at the end of the 1. week, callus was seen earlier in 2. Group than 1. Group. When we evaluate the radiologic and hytologic results together , we saw that healing is faster in Group 2 than Group 1, but at the end of the treatment (end of 6.th week) we didn?t see any significantly statistical difference on fracture healing. So we think that NBCA can be used safely at physeal fractures.Key words : Epiphyseal fractures, Salter-Harris Type 4, N-Butyl-2- Cyanoacrylate