The aetiology and pathophysiology of non-union is still unclear, but in this condition there is an abnormal bone metabolism. The paracrine matrix RAS has been implicated in the regulation of bone remodeling and injury responses, possibly via its effects on kinins. The influence of the local RAS or the genetic influence of the ACE/ BK2R genes to bone remodelling may thus be central to the disorder, or augmented in these conditions. We thus compared the distribution of the ACE I/D and BK2R “+9/-9” functional polymorphisms in patients with non-union and compared them to appropriate control. Gene analysis was performed on buccal cells collected from all subjects and the data was analysed for 59 patients (46 males, 13 females; mean age 40.1±15.7 years) with non-union and 81 control subjects (49 males, 32 females; mean age 51.4±22.81 years. The overall genotype distribution was consistent with Hardy-Wein-berg equilibrium for the overall and individual groups for ACE ( As the -9 allele is associated with greater gene transcription and higher mRNA expression of the receptor we combined the -9/-9 homozygous and -9/+9 heterozygous groups and compared them with the homozygous +9/+9 groups. This showed a significant difference between the non-union and control groups, with the +9/+9 homozygous being less prominent in the former ( The B2BKR -9 allele is associated with the incidence of non-union in fracture healing, in this first study to address this question. We found no association with either the In conclusion, with previous findings that the absence of the -9 allele of the B2BKR +9/-9 polymorphism is associated with greater gene transcription and higher mRNA expression of the receptor our findings are suggestive that increased BK activity via the B2BKR may predispose to the development of non-union.
This paper describes the outcome of type III pilon fractures of the distal tibia treated primarily with an llizarov ring fixator. Only patients with intra-articular fracture of the tibial plafond on plain radiographs that corresponded to type III pattern of Ruedi and Allgower were included. There were thirteen patients with a mean age of 45 (range 29–65), twelve males and one female. The mechanism of injury in all the patients was high-speed road traffic accident. Operative fixation consisted of fracture reduction and stabilisation using the Ilizarov circular frame external fixator and olive tipped wires. Further insult to the already damaged soft tissues was avoided. Bony union was achieved in all cases. Treatment in the frame lasted between 3 and 10 months (average of 6.3 months). Neither deep infection nor soft tissue complications occurred. Outcomes measured using the Olerud ankle score, modified Ovadia and Beals radiological criteria, and the SF-36 Health Questionnaire and our results compare well with other fixation techniques. The use of the llizarov circular frame external fixator without any additional internal reduction or fixation procedures is a definite option for the treatment of these high-energy injuries.
To investigate the use of the Ilizarov circular fixator in treating diaphyseal non-union following previous intra-medullary nailing. The stability of each non-union was augmented using an Ilizarov fixator with nail retention. We retrospectively reviewed nine consecutive patients (mean age 31 years, range 24–53 years) who were treated in our institution between 1993 and 1997 (mean follow up 19.2 months, range 6–33 months). Two femoral, three tibial and four humeral non-unions were included in the study. All patients were referred from other centers after failure to achieve bone union with intramedullary nailing. Patients who had non-union with other fixation devices in situ, those with active infection and those who had their non-unions explored at the time of fixator application were excluded from the study. The patients had undergone an average of 2.4 operations (range 1–5 operations) prior to fixator augmentation. The circular fixator was applied over the nail as a closed procedure (non-union not surgically explored) in all nine patients. The non-union was manipulated either by compression or oscillation during fixator treatment. The mean duration of fixator treatment was 6.2 months (range 3–11 months). Outcome measures assessed were bone union, deformity, shortening and functional outcome. Bone union was achieved in all nine patients. The bone results were graded as six excellent, one good and two fair. All patients reported a reduction in pain and satisfaction with their final outcome. We recommend the use of the Ilizarov fixator with nail retention in resistant long bone union in carefully selected patients. This technique is particularly useful in the humerus where it avoids the morbidity associated with nail removal and plating. The augmentation method can shorten the fixator time and has the advantage of a simpler frame construct.
