Background. Fractures of the metatarsal bones are the most frequent fracture of the foot. Up to 70% involve the fifth metatarsal bone, of which approximately eighty percent are located proximally. Low-intensity pulsed ultrasound (LIPUS) has been shown to be a useful adjunct in the treatment of delayed fractures and non unions. However, there is no study looking at the success rate of LIPUS in fifth metatarsal fracture delayed unions. Objectives. The aim of our study was to investigate the use of LIPUS treatment for delayed union of fifth metatarsal fractures. Study Design & Methods. A retrospective review of patients who were treated with LIPUS following a delayed union of fifth metatarsal fracture was conducted over a three-year period (2013 – 2015).
Nonunion is incomplete healing of fracture and fracture that lacks potential to heal without further intervention. Nonunion commonly presents with persistent pain, swelling, or instability. Those symptoms affect patient quality of life. It is known that using low intensity pulsed ultrasound (LIPUS) for fresh fractures promotes healing. However, effectiveness of LIPUS for nonunion is still controversial. If LIPUS is prove to be effective for healing nonunion, it can potentially provide an alternative to surgery. In addition, we can reduce costs by treating nonunion with LIPUS than performing revision surgery. The two authors carried out a systematic search of PubMed, Ovid MEDLINE, and the Cochrane Library. Meta-analysis of healing rate in nonunion and delayed union patients who underwent LIPUS was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) instruction method using a random effects model.Introduction and Objective
Materials and Methods
Ten patients with humeral shaft fractures and no clinical or radiographic signs of healing after at least six weeks' immobilisation were treated by flexible intramedullary nailing using a closed retrograde technique. Bone grafting was not performed, and active movement was encouraged after operation. Nine fractures healed; the mean time to union was 10.5 weeks (range 6 to 22 weeks). One patient needed compression plating and bone grafting at 22 weeks, and another required re-operation for distal migration of the rods. There were no infections, nerve palsies or other complications. Stiffness of the shoulder which had developed during early treatment improved after operation.
There is limited evidence regarding HIV infection as a risk factor for delayed union and implants sepsis in patient with fractures treated with surgical fixation. Most studies have included patient with a variety of different fractures and hence very different risks regarding delayed union and implant sepsis. We have looked at a single fracture, closed femoral shaft fractures treated with intramedullary nailing, to see if HIV infection is a risk factor with for the development of delayed union and implant sepsis. We present a prospective study of 160 patients with closed femoral shaft fractures treated with intramedullary nailing. Primary outcomes were delayed union of more than 6 months and implant sepsis in the first 12 months. From February 2011 until November 2012 all patient with closed femoral shaft fractures treated at our hospital were included in the study. Patients were tested for HIV infection and a number of clinical parameters were documented, including: AO fracture score, duration of surgery, level of training of surgeon, comorbidities, CD4 count, high energy injury and number of operations.Background:
Methods:
1. A series of 102 cancellous strip grafts for delayed union of long bone fractures has been reviewed. 2. Half of the initial injuries were open. 3. Half of the fractures were butterfly or segmental lesions or were comminuted. 4. After strip grafting 84 per cent of the fractures were united within sixteen weeks, and only four took longer than twenty weeks. 5. Complete failure of union occurred in only one case, a tibial fracture complicated by low-grade pyocyaneus osteomyelitis. 6. A more aggressive attitude to the problem of delayed union is advocated.
Despite continuous advances in the treatment of long bone fractures, disturbances of healing processes remain a difficult challenge. Currently, autologous cancellous bone and bone marrow grafting has become the standard treatment of delayed unions and non-unions. Platelet concentrates rich in growth factors – platelet-rich plasma (PRP) – represent a novel osteoinductive therapy that could be valuable for the treatment of disturbances of bone healing processes. This article reports the efficiency of percutaneous autologous platelet-leukocyte rich gel (PLRG) injection as a minimally invasive method as alternative to open grafting techniques. Following the outpatient procedure, each of 32 participants was followed up on a regular basis with clinical examinations, roentgenograms, dual-energy x-ray absorptiometry (DEXA) examinations and functional evaluations. In the delayed-union group the average time to union after PLRG injection was 9,3 weeks and the union was achieved in all cases. In the nonunion group, the union was observed in 13 of 20 cases and the average time to union after PLRG injection was 10,3 weeks. Interestingly, in patients with non-union, who a union was not achieved, the ave time from the fracture and/or from the last operation was longer than 11 months. Probably the fibrous tissue in the gap interposing the bone ends becomes more ossified with time and the vascular vessels diminish, so the PLRG is no longer able to induce the bone healing processes in such cases. This is our initial experience with the use of PLRG as biologic treatment for delayed union or nonunion. Our investigation showed that percutaneous PLRG injection in delayed union is a sufficient method to obtain union, which is less invasive procedure than bone marrow injection. Also percutaneous PLRG grafting can be an effective method for the treatment of selected cases of nonunion. One critical factor is the average time of PLRG injection to the index operation – the time less than 11 months after initial surgery seems to be critical to achieve good outcomes in percutaneous PLRG injections for nonunion.
Our aim is to study the epidemiology of delayed union and pseudarthrosis of femoral fractures which were treated in our clinic with intramedullary nailing technique and simultaneously to speculate for the application of the method and for the reasons which might guide to these complications. During a 36 month-period, from 1999 to 2001, 46 patients suffering femoral shaft fractures were treated in our clinic. They were 43 men and 3 women and their average age was 22.8 years. Twenty-eight fractures were in the right leg and 18 in the left. All patients underwent primary closed intramedullary locked nailing with AO type of nail, except 4 patients who also suffered a unilateral intertrochanteric fracture and were treated with AO-PFN nail. Reaming was done in 33 cases. No condition or disease able to inhibit fracture healing was observed. All patients were operated in the first three days after submission by the same team of surgeons. Thirty patients underwent static intranaedullary locked nailing and the rest dynamic from the beginning. The average time of post-operative follow up, clinical and radiological, was seven months. Thirty-three fractures were healed successfully in six months (mean: 4.2 months). In 10 cases delayed union was observed (mean: 7.2 months) and in the rest three pseudarthrosis. The last group underwent revision of the intramedullary nailing with an AO nail of greater diameter. Reasons for delayed union (21, 74%) and pseudarthrosis (6, 52%) are considered: a)soft tissues enclosed between the bony segments, b)lated nail dynamization, c)factors concerning the technique. Undoubtfully, closed intramedullary locked nailing is the method of choice for the surgical treatment of femoral fractures. However, fracture healing sometimes exceeds the usual period of 4–6 months. Unfortunately, whereas infrequently, the surgeon also faces pseudarthrosis which is a difficult to solve problem.
The delay looks radiographically as a fracture callus not very evident or absent 6 months after osteosynthesis. Patients undergo a long period of immobilization and this fact causes the increase the social cost of the disease. The technique we suggest aims to the reduce the period of immobilization and as a consequence the management costs of the disease. Our technique includes the infiltration of the delay focus with platelet rich fibrin, bone marrow concentrated and demineralized bone matrix. Outpatients and radiographic checks were carried out 3, 6 and 12 months after surgery. The treatment was considered fail in case of absence of bone callus at 3 out of 4 corticals at the rx after 6 months from surgery.Introduction
Materials and methods
Shockwave therapy has been shown to induce osteoneogenesis in animal models. The mechanism of action is unclear, but experimental evidence suggests micro-fracture formation and increased blood flow as the most likely explanation. Several reports from Europe have suggested good results from the treatment of delayed fracture union with shock-waves. We present the results of a randomised double-blind placebo-controlled pilot study. Fourteen patients with clinically and radiologically confirmed delayed union of long-bones consented to enter the trial. The treatment group had a single application of 3000 high-energy shockwaves using the Stortz SLK unit with image intensifier control. The control group had the exactly the same treatment but with an ‘air-gap’ interposition to create a placebo-shockwave. Each patient was followed-up with serial radiographs as well as visual analogue pain scores and EuroQol assessments. All of the patients were reviewed for a minimum of three years post treatment.Background
Method
This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation. This was a retrospective analysis of 20 patients. All cases were delayed presentations (n = 15) or failed nonoperatively managed scaphoid fractures (n = 5). Surgery was performed at a mean duration of 27 months (7 to 120) following injury with arthroscopic debridement and arthroscopic iliac crest autograft. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 12 wrists, a headless screw in six, and a combination of a headless screw and single K-wire in two. Clinical outcomes were assessed using grip strength, patient-reported outcome measures, and wrist range of motion (ROM) measurements.Aims
Methods
This review is aimed at clinicians appraising
preclinical trauma studies and researchers investigating compromised bone
healing or novel treatments for fractures. It categorises the clinical
scenarios of poor healing of fractures and attempts to match them
with the appropriate animal models in the literature. We performed an extensive literature search of animal models
of long bone fracture repair/nonunion and grouped the resulting
studies according to the clinical scenario they were attempting
to reflect; we then scrutinised them for their reliability and accuracy
in reproducing that clinical scenario. Models for normal fracture repair (primary and secondary), delayed
union, nonunion (atrophic and hypertrophic), segmental defects and
fractures at risk of impaired healing were identified. Their accuracy
in reflecting the clinical scenario ranged greatly and the reliability
of reproducing the scenario ranged from 100% to 40%. It is vital to know the limitations and success of each model
when considering its application.
Diabetes mellitus (DM) is known to impair fracture healing. Increasing evidence suggests that some microRNA (miRNA) is involved in the pathophysiology of diabetes and its complications. We hypothesized that the functions of miRNA and changes to their patterns of expression may be implicated in the pathogenesis of impaired fracture healing in DM. Closed transverse fractures were created in the femurs of 116 rats, with half assigned to the DM group and half assigned to the control group. Rats with DM were induced by a single intraperitoneal injection of streptozotocin. At post-fracture days five, seven, 11, 14, 21, and 28, miRNA was extracted from the newly generated tissue at the fracture site. Microarray analysis was performed with miRNA samples from each group on post-fracture days five and 11. For further analysis, real-time polymerase chain reaction (PCR) analysis was performed at each timepoint.Objectives
Methods
A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed.Objectives
Methods
Aims. The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. Methods. From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors. Results. The mean follow-up period was 70.2 months (36 to 191). There were 146 AFFs (99.3%) in female patients and the mean age was 71.6 years (48 to 89). The AFFs were located in the subtrochanter and shaft in 52 cases (35.4%) and 95 (64.6%), respectively. The preoperative mean anterior/lateral femoral bowing angles were 10.5° (SD 5.7°)/6.1° (SD 6.2°). The postoperative mean anterior/lateral bowing values were changed by 8.7° (SD 5.4°)/4.6° (SD 5.9°). Bisphosphonates had been used contemporarily in 115 AFFs (78.2%) for a mean of 52.4 months (1 to 204; SD 45.5) preoperatively. Nailing was performed in 133 AFFs (90.5%), and union was obtained at a mean of 23.6 weeks (7 to 85).
Aims. The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of tibial diaphyseal fractures treated with intramedullary nailing. The secondary aim was to assess the Radiological Union Scale for Tibial fractures (RUST) score as an early predictor of tibial fracture nonunion. Methods. A consecutive series of 647 patients who underwent intramedullary nailing for tibial diaphyseal fractures were identified from a trauma database. Demographic data, comorbidities, smoking status, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and steroid use were documented. Details regarding mechanism of injury, fracture classification, complications, and further surgery were recorded. Nonunion was defined as the requirement for revision surgery to achieve
Introduction. Metabolic bone disease encompasses disorders of bone mineralization, abnormal matrix formation or deposition and alteration in osteoblastic and osteoclastic activity. In the paediatric cohort, patients with metabolic bone disease present with pain, fractures and deformities. The aim was to evaluate the use of lateral entry rigid intramedullary nailing in lower limbs in children and adolescents. Materials and Methods. Retrospective review was performed for an 11-year period. Lower limb rigid intramedullary nailing was performed in 27 patients with a total of 63 segments (57 femora, 6 tibiae). Majority of patients had underlying diagnoses of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright disease). Mean age at surgery was 14 years. Indications for surgery included acute fractures, prophylactic stabilisation, previous nonunion and malunion, deformity correction and lengthening via distraction osteogenesis. Results. All fractures healed. Correction of deformity was successfully achieved in all segments.
Purpose. Analyze the results of reconstruction of post osteomyelitic bone defect using non-vascularised fibula graft in children and correlation of results with magnitude of defect. Methods. 11 boys and 15 girls (mean age 6.8±2.33 years) were prospectively enrolled in the study. All had primary acute hematogeneous osteomyelitis with diaphyseal sequestration and active discharging sinuses. 7 femur, 12 tibia, 3 humerus, 3 radius and 1 ulna were the bone involved. As first step a radical debridement and sequestrectomy was performed. Second step was considered after a ‘dry’ period judged clinically and by normalized CRP. A subperiosteal resection of fibula was done and used as graft to fill in the diaphyseal defect. Graft was stabilized using intramedullary ‘K’ wires and supported by post-operative casts. Weight-bearing was started on radiological evidence of union. Results. mean follow up was 3.02±0.74 years with mean union time of 38.76±12.02 weeks.
To analyse the management of open paediatric tibial fractures treated at a children's Major Trauma Centre (MTC), comparing fixation methods, union and complications. We retrospectively identified all patients admitted to RMCH with an open tibia fracture between 2008 – 2016. Demographics, mechanism, inpatient stay and follow-up management were reviewed. There were a total of 44 patients, with an average age = 10 years (3–15). 93% of cases were caused by road traffic accidents, commonly pedestrian versus car. Older children were more likely to sustain higher grade injuries, requiring increased length of stay. 35 patients had primary / delayed wound closure, 1 patient required fasciotomies and 4/44 needed skin grafts and/or flap. 7 patients were treated in plaster, 9 by elastic nailing, 15 had mono-lateral fixators and 12 with circular frame. The average number of surgeries = 3 (1–7) with older children having increased risk of revision surgery. Monolateral fixators were the most common primary fixation method (n=15), however 60% required revision to ring fixator due to displacement or delayed union. The main risk factor for displacement was inadequate fracture reduction in theatre, as well as those fracture patterns involving butterfly fragments. Union (defined as RUST score = 3 on >3 cortices) was achieved in all patients (ave 6 months).
1. Fibrous union of an osteotomy occurred in only 3 per cent of osteotomies done during a four-year period. 2.
Objective. To determine what factors affect fracture healing with low-intensity pulsed ultrasound (LIPUS) for delayed unions and nonunions. Patients. A consecutive cohort of 101 delayed unions and 50 nonunions after long bone fractures treated with LIPUS between May 1998 and April 2007. Main Outcome and Measurements. Radiographic determination of osseous bone union within one year after start of LIPUS therapy. Recognition of predictable factors that affect treatment results of LIPUS. Main Results. 1)
Objective. Combined metatarso-phalangeal and inter-phalangeal deformity represents about 1% of hallux valgus deformity, and its treatment remains a debated topic, because a single osteotomy does not entirely correct the deformity and double osteotomies are needed. The aim of this study is to review the results of 50 consecutive combined metatarso-phalangeal and inter-phalangeal hallux valgus treated by Akin proximal phalangeal osteotomy and SERI minimally invasive distal metatarsal osteotomy. Material and Methods. Fifty feet in 27 patients, aged between 18 and 75 years (mean 42 years) affected by symptomatic hallux valgus without arthritis were included. Two 1-cm medial incisions were performed at the metatarsal neck and at proximal phalanx. Then SERI osteotomy was performed to correct metatarso-phalangeal deformity and Akin osteotomy was performed to correct interphalangeal deformity. Both osteotomies were fixed with a single K-wire. A gauze bandage of the forefoot was applied and immediate weight-bearing on hindfoot was allowed. K-wire was removed after 4 weeks. All patients were checked at a mean 4 year follow-up. Results. All osteotomies healed.
Purpose of study:. Up to 30% of distal femur fractures treated with a locked plate have problems with union. Distal femur locked plates have become a very popular means of internal fixation because of their ability to provide stable distal peri-articular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locked plate fixation may be too rigid if used in certain configurations preventing the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing. Description of method:. We undertook a retrospective review of 92 consecutive cases performed at our institution from 2007–2010. Case notes and X-rays were reviewed. Working length, plate to fracture zone ratios and working length to fracture zone ratios were calculated. Union was assessed radiographically and clinically. Covariates of smoking, age, sex and fracture severity were included. Outcomes considered were union or established non-union.
There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion.Aims
Methods
Twenty consecutive patients treated by arthrodesis for failed knee arthroplasty are reviewed. Eight hinged, five stabilised and seven compartmental prostheses were removed, for infection (15 cases), loosening (4) and instability (1). One patient refused a second-stage operation but the remainder gained sound fusion. Infected knees had a two-stage procedure with temporary insertion of gentamicin-loaded beads after removal of the prosthesis; all infections healed. Six arthrodeses using a Hoffmann-Vidal external fixator resulted in two temporary failures. One Ace-Fischer external fixation was successful. Of 10 primary attempts at arthrodesis with an intramedullary Kuntscher nail, nine were successful; the tenth fused after two more attempts by the same method. The two failures of external fixation and two failures after Charnley single-frame compression done elsewhere were successfully fused with intramedullary nails.
Surgery to the midfoot (usually fusion) may be performed for trauma, arthritis, deformity or combinations. There are reports of good results, meaning primary fusion rates of 90+percent, 12 % serious complication rates and need for hardware removal 1n 25% of cases from specialist centres (Nemec et al AOFAS 2010). But even these good results mean 10% of patients needing lengthy revision surgery, and a third needing some additional intervention. Surgery to the midfoot, like all surgery has both consequences (which everyone experiences) and complications (which some peolple get). The consequences of midfoot surgery are time in hospital, long periods in cast (often non-weight bearing) and long rehabilitation periods leading to a “second best” result where pain is relieved, but mechanics and full function are not restored, and longterm stiffness and swelling are comon. Usually the patient still needs to restrict activities and wear orthotics or adaptive footwear. The commonest complication is probably a failure to inform patients of the consequences of surgery – inevitably leading to disappointment with result and outcome. Common complications include:. Wound, nerve and vascular problems.
The aim of limb-salvage surgery in malignant bone tumours in children is to restore function and eradicate local disease with as little morbidity as possible. Allografts are associated with a high rate of complications, particularly malunion at the allograft-host junction. We describe a simple technique which enhances union of allograft to host bone taking advantage of the discrepancy in size between the adult allograft and the child’s bone. This involves lifting a flap of periosteum before resection from the host bone, which is then telescoped into the allograft medullary canal, which may require internal burring or splitting, for a distance of 1.5 to 2 cm and covering the bone junction with the periosteal flap. This is more stable than conventional end-to-end opposition. For each centimetre of telescoping the surface area available for bony union is increased more than three times. The periosteal flap also augments union. Additional surface fixation with a plate and screws is not necessary. We have used this technique in nine children, in eight of whom there was complete union at a mean of 16 weeks.
This study was done to determine the effectiveness of percutaneous autologous bone marrow injection in fracture healing and to determine if centrifuged bone marrow is more effective in bone healing as compared to uncentrifuged marrow. This is a randomized interventional trial of 106 patients who had bone marrow injection. The study was done in 2 parts. In the first part, 51 patients were divided into three groups – a) Fresh fractures,(within 6 weeks of injury) b)
AIM. SIGN-nail system was elaborated to reduce the need in image intensifier during IM-nailing and to allow use of this method in poor countries with restricted medical facilities. The aim of this study was to evaluate efficacy of SIGN-nailing in tibia fractures treatment. MAT. 119 patients with 120 tibia fractures were treated with SIGN nails from 2006 to 2009. Mean age 41.4±12.9 years (17–72). Closed fractures - 106, open - 14 (Gustilo I-6, II-6, III-2 III). Interval from the injury to operation: 6.24±7.9 days (0–45); 71.7% of patients were operated within a week after the injury. Closed reposition achieved in all but 7 cases. Manual reaming was performed in most cases, power -9, no reaming -8 cases. Distal locking was performed with use of supplied jig. RES. Satisfactory reposition and fixation was achieved in most cases, axial deviations more than 5° were noticed post-operatively in 6 cases, or developed within 2 months in other 2, but were well tolerated clinically. All deviations were seen in joint-adjacent fractures (proximal 5, distal 3). Purulent complications were seen in 2 cases (1.6%). Follow-up results in terms exceeding 12 months were obtained in 106 patients (mean 13.6±6.6, range 6–36). No non-unions were seen.
Aim: Distal extra articular fractures of femur and tibia are difþcult to treat by conventional nails because of inability to use distal locking screws. The aim of this study is to analyse the effectiveness of this new I.M. Nail that does not require the use of distal locking screws for rotational stability. Methods &
Material: Since 1994 we have treated a total of 68 such cases. Of these 40 were fractures of distal tibia and 28 were that of femur. Age range was from 11– 92. After insertion of the nail in the usual way, a ÒTrio WireÒ was introduced through the nail. This wire fans out in the distal segment which maintains rotational stability. Patients were mobilised with partial weight bearing within 3 weeks. Results: Most of the fractures were united without any signiþcant problem.
Aims: We reviewed 100 paediatric lateral condylar fractures of the elbow treated with k-wire þxation. We compared the complication rates of wires left percutaneous versus wires buried beneath the skin. Methods: 68 patients had wires left percutaneous and 32 patients had their wires buried. Fractures were classiþed as displaced or undisplaced. Lengths of time for Ôwires in situñ, limb immobilisation and follow up were recorded. All complications of treatment and outcomes were recorded. Results were analysed using Chi-square tests. Results: Buried k-wires stayed in situ longer than percutaneous wires (average 6.7 versus 4.9 weeks). Fracture types along with mean lengths of immobilisation and follow up were similar for both groups. In the Ôburiedñ group 6 (19%) patients wires migrated through the skin although only 1 (3%) case became infected. 1 (3%) patient developed an uncomfortable heterotrophic ossiþcation. In the Ôpercutaneousñ group 20 (29%) patients developed wire infection and/or granulation tissue requiring treatment. 3 (4%) of these cases severely compromised treatment.
Aim: To compare and evaluate results following fixation of displaced clavicle fracture using three different plates. Methods: Between 1994 and 2001, forty patients with displaced midclavicular fracture were plated with three different type of implants. The mean age of the patients was thirty-four years. Reconstruction Plate was used in twenty, 3.5 mm DCP in ten and 3.5mm LCDCP in ten. Twenty-eight fractures were multifragmentary. The interfragmentary screw technique was used in fifteen cases and one patient required bone grafting. Evaluation: In this retrospective study, the patients’ shoulder function, rate of fracture union, and complications between the three different types of plate were evaluated and compared. Results: Patients whose fracture was treated with DCP or LCDCP all achieved union within three months. One LCDCP lifted laterally after the patient went back to manual work within two weeks. Of the patients whose fracture was treated with reconstruction plate (20), only twelve united uneventfully within three months. Eight complications were recorded.
We aim to evaluate the effect of fasciotomies following compartment syndrome on the healing of closed tibia diaphyseal fractures. Between January 2002 and January 2005 165 patients were treated in our institution with closed tibial diaphyseal fractures. Patients were divided in to two groups; Group A (study group) consisted of patients that, after surgery, developed compartment syndrome and were submitted to fasciotomies and group B (control group) of patients who underwent reamed IM nailing and did not require such intervention. Patients with open fractures, pathological fractures, revision surgery, severe brain injuries, prolonged ITU stay and severe co-morbidities were excluded. Fracture pattern, ISS score, smoking habits, drugs intake, mode of mobilization and additional procedures were prospectively documented. Fracture healing more than 24 weeks was defined as delayed union and over 36 weeks as non-union. All patients had been followed-up clinically and radiologically until fracture union. One hundred twenty five out of 165 patients fulfilled the inclusion criteria for this study. 30 patients were classified in group A and 95 in group B. Eighteen patients of group A required skin graft coverage after the fasciotomies. There was no difference between the two groups in terms of the studied parameters. Four patients from group A and one from group B, went to non-union and required second procedures to achieve union. These patients were excluded from the final analysis.
Purpose: Fractures of the distal tibia are high energy fractures, associated with marked soft-tissue trauma. Management of these fractures is challenging. The purpose of this study is to present our experience on the treatment of these fractures using hybrid external fixation, with or without open reduction and minimal internal fixation of the fibular fracture. Patients and Methods: Forty eight patients with a distal tibial fracture were admitted to the authors’ institution since 2005. There were 33 men and 15 women. According to AO there were 24 A, 10 B and 14 C fractures. The mean age of the patients was 45.6 years. Eight patients had an open pilon fracture; according to the Gustilo classification, 1 patient had a grade I, 5 patients had a grade II, and 2 patients had a grade III open fracture. In all patients, the pilon fracture was treated using hybrid external fixation; in 18 patients, open reduction and minimal internal fixation of the fibular fracture using plate and screws was also done. Results: Mean follow-up was 14 months (range, 9 to 36 months). In all patients, the mean duration of the application of the external fixation was 2.85 months, followed by the application of a below-knee cast. In 42 patients, radiographic evidence of union was observed at 3,6 months (range, 3 to 9 months). Time for union was different between patients with closed and grade I open fractures compared to patients with grade II and grade III open fractures (union at 3.5 and 6 months, respectively). There were 5 non-unions (10,4%) with 3 of them septic (6,25%). All three deep infections were low grade and occurred in open fractures.
Aim: To evaluate the effect of fasciotomies following compartment syndrome on the healing of closed tibia diaphyseal fractures. Patients and Methods: Between January 2002 and January 2005 165 patients were treated in our institution with closed tibial diaphyseal fractures. Patients were divided in to two groups; Group A (study group) consisted of patients that, after surgery, developed compartment syndrome and were submitted to fasciotomies and group B (control group) of patients who underwent reamed IM nailing and did not require such intervention. Patients with open fractures, pathological fractures, revision surgery, severe brain injuries, prolonged ITU stay and severe co-morbidities were excluded. Fracture pattern, ISS score, smoking habits, drugs intake, mode of mobilization and additional procedures were prospectively documented. Fracture healing more than 24 weeks was defined as delayed union and over 36 weeks as non-union. All patients had been followed-up clinically and radiologically until fracture union. Results: One hundred twenty five out of 165 patients fulfilled the inclusion criteria for this study. 30 patients were classified in group A and 95 in group B. 18 patients of group A required skin graft coverage after the fasciotomies. There was no difference between the two groups in terms of the studied parameters. 4 patients from group A and 1 from group B, went to non-union and required second procedures to achieve union. These patients were excluded from the final analysis.
Faced with the challenge of managing war trauma in Afghanistan (1984–86), within limited resources and compromised conditions, we started managing open fractures with the pin and plaster method. With time a new External Fixation System evolved, which helped save hundreds of limbs and lives. Encouraged with the results, this system was used in the civilian practice, in India. There were further improvements in the design and refinements in technique. Subsequently biomechanical studies were conducted in Liverpool. The Fixator has been used at other centers in India and the UK with good results. This paper describes evolution of the model, and its use in 116 patients by a single surgeon between February 1987 and July 1990. It has been used on every limb segment and indications included open fractures, infected non-unions, arthrodesis, osteotomy, etc. Analysis of results in 41 open tibial fractures showed 97.3% united at an average of 21.4 weeks.
Introduction: The management of humeral diaphyseal fractures is in a state of flux, with humeral plating becoming more popular than humeral nailing. This change of opinion has been stimulated primarily by the American literature, which quotes significant complication rates associated with humeral nailing. Methods: We undertook a retrospective study, over a consecutive seven year period, to evaluate the complication rate and the functional outcome (American DASH scoring system) following humeral nailing. The study group was composed of 91 patients, with an average age of 50 years (22–90). All cases were performed by a consultant or under their direct supervision. The minimum follow-up was one year. Results: Of the 91 cases, 7 were lost to follow-up. Non-union was seen in 4 cases, all requiring removal of nail with additional surgical procedures.
Purpose: We reviewed all isolated tibial shaft fractures treated by operative means, with focus on prolonged healing and infection. Design; Retrospective Case Control Study; level of evidence; Prognostic level III. Methods: Patients: 821 isolated tibial shaft fractures, with a drop-out of 5.6% Open fractures: 400 (grade I &
II 280, grade IIIa,b,c 120) Type A,B fractures: 597 Type C fractures: 224 Skeletal Fixation Modes: Ex;Fix (unilateral-one plane): 192, UTN(Synthes): 337, Plate(LCDCP): 129, RTN(Synthes): 163. Outcome measurements: Union time, requirement for secondary treatment, and development of deep infection. Results: Infections: 94 (11,4%), Closed # which became infected: 21 (5%) Open # which became infected: 73 (18%) Ex.Fix: 56 (29%) Plate: 15 (12%) UTN: 16 (5%) RTN: 7 (5%) In a multiple logistic regression analysis, only Soft tissue damage had a statistical significant interference with the outcome infection (point estimate 0.117, 95% CI 0.053–0.262) Prolonged healing: 285 (34%)?
We describe the results of treatment of open fractures of the humerus, radius and ulna in 61 children. Most were due to low-energy trauma and were rarely associated with head or other injuries; 72% were Gustilo type I, 15% type II and 13% type III. Fifteen children (25%) had open diaphyseal, supracondylar or T-shaped fractures of the humerus. Arterial injuries occurred in two (13%) and nerve injuries in 7 (47%). All nerve injuries recovered spontaneously. The long-term results in 13 children were excellent or good in 11 (85%) and fair in two (15%). Forty-six children (75%) had open forearm fractures. Arterial injuries occurred in one (2%), nerve injuries in five (11%) and a compartment syndrome in five (11%). Ruptured radial and ulnar arteries and median and ulnar nerves were repaired in one child. All other nerve injuries resolved spontaneously. Early compartment release in five children prevented Volkmann's ischaemic contracture. Normal union occurred in only 36 children (78%).
Fractures of the proximal humerus account for 4 to 5% of all fractures. Most occur in elderly individuals caused in part by osteoporosis. Conservative treatment frequently led to poor clinical results because of the inability to gain and maintain satisfactory reduction. The preferred method for these fractures was open reduction and internal fixation especially in those fractures with displacement and in young patients. In 18 patients the fracture was operatively reduced and was secured with a plate and screws. Methods of plating: T plate, clover leaf plate or blade plate modified.
Aims: Clinical use of BMP-7: actual situation The tibial pseudoarthrosis. The Friedlander paper can be considered the only golden standard about the clinical application. It is a prospective, randomized clinical trial comparing BMP-7 with fresh bone autograft. The results of the BMP-7 are similar under to use of fresh bone autograft. Some cases of very serious pseudoar-throsis treated with BMP-7 have demonstrated an high percentual of clinical recovery. In UOA of traumatology and in I Orthopaedic Clinic of Turin University the pseudoarthrosis are treated with the Ilizarov’s technique, not with the autologous transplantation, so Friedlander’s results are not discriminant for the our work. Methods: In our department the guide lines for BMP-7 application are:.
Tibial tubercle osteotomy (TTO) facilitates surgical exposure and protects the extensor mechanism during revision total knee arthroplasty (rTKA). The purpose of this study was to determine the rates of bony union, complications, and reoperations following TTO during rTKA, to assess the functional outcomes of rTKA with TTO at two years’ minimum follow-up, and to identify the risk factors of failure. Between January 2010 and September 2020, 695 rTKAs were performed and data were entered into a prospective database. Inclusion criteria were rTKAs with concomitant TTO, without extensor mechanism allograft, and a minimum of two years’ follow-up. A total of 135 rTKAs were included, with a mean age of 65 years (SD 9.0) and a mean BMI of 29.8 kg/m2 (SD 5.7). The most frequent indications for revision were infection (50%; 68/135), aseptic loosening (25%; 34/135), and stiffness (13%; 18/135). Patients had standardized follow-up at six weeks, three months, six months, and annually thereafter. Complications and revisions were evaluated at the last follow-up. Functional outcomes were assessed using the Knee Society Score (KSS) and range of motion.Aims
Methods
Aims: The purpose of this retrospective review was to analyze our results with the use of the Marchetti-Vicenzi elastic locked nail in femoral shaft fractures. Methods: Between Jan.1994 and Dec.1997, 75 femoral fractures in 73 patients were treated in our department. There were 51 men and 22 women with a mean age of 29 years. All patients were followed to fracture union. In 67 cases (89%) the cause of injury was a R.T.A. According to Winquist and Hansen, there were 8 fractures of type 0 (no comminution), 5 of type I, 22 of type II, 29 of type III and 11 of type IV. Six fractures were open grade II and two were grade IIIa. Multiple injuries were seen in 22 patients (30%). Results: Certain intraoperative complications were encountered in 25 cases (33%). Open nailing was required in 21 fractures (28%) mainly because of the loss of reduction (absence of guide wire) or because the distal pins jammed at the fracture site. Distal locking mechanism problems (bending of protruding locking wire or breakage of safety loops) occurred in 11cases (15%). In 3 patients the distal pins protruded from the anterior cortex and in another 4 breakage of one or more pins occurred during the postoperative period.
Introduction ESIN is an established method of treatment of long bone fractures in children, which has been in regular use in our institution since 1996. We report on our 7-year experience of using ESIN for the treatment of long bone fractures in children. Method 92 fractures were nailed (26 femoral, 12 tibial, 17 humeral and 37 forearm). The average age was 12 years (7–15) and average follow-up 15 months. Main indications included unstable and severely displaced fractures, failure of conservative treatment and polytrauma or head injury. Data collection included mechanism of injury, fracture configuration, treatment delay, operation time and technique, length of hospital stay, rehabilitation, healing, nail removal and complications. Results 49% of fractures were caused by road traffic accidents. All were diaphyseal apart from 14 proximal humeral fractures. The average surgery delay was 7 days and operation time 78 minutes. Open reduction was performed in 3 femoral, 1 humeral and 18 forearm fractures. Single nailing was used for the proximal humeral and forearm fracture. The average hospital stay was 5.8 days, ranging from 12 days for femoral to 2 days for forearm fractures. Clinical healing was achieved at 3.5, 4.3, 2.4 and 2.1 months respectively for femoral, tibial, humeral and forearm fractures. The commonest complication (25%) was skiin irritation around the entry site, which invariably resolved after implant removal.