Timing and staging of antibiotic administration and surgery for open long bone fractures of the upper and lower limbs

Background: Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.Methods: We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.Results: 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.Conclusions: The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities.

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Management of Infection After Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes

The Open Orthopaedics Journal ◽

10.2174/1874325001307010219 ◽

2013 ◽

Vol 7 (1) ◽

pp. 219-226 ◽

Cited By ~ 23

Author(s):

Kostas G Makridis ◽

Theodoros Tosounidis ◽

Peter V Giannoudis

Keyword(s):

Bone Fractures ◽

Stage Iii ◽

Long Bone ◽

Unusual Complication ◽

Antibiotic Administration ◽

Treatment Protocols ◽

Long Bone Fractures ◽

Ilizarov Frame ◽

Exchange Nailing ◽

Im Nailing

Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.

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FORMING MECHANISM OF LONG BONE FRACTURES OF THE LOWER LIMBS AT A CAR INJURY

Bulletin of Problems Biology and Medicine ◽

10.29254/2077-4214-2020-2-156-374-379 ◽

2020 ◽

Vol 2 (1) ◽

pp. 374

Author(s):

V. K. Sokol ◽

I. Yu. Serbinenko I. ◽

Ye. A. Voitov

Keyword(s):

Bone Fractures ◽

Lower Limbs ◽

Long Bone ◽

Forming Mechanism ◽

Long Bone Fractures

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Intramedullary Interlocking Nailing for Long Bone Fractures of the Lower Limbs: Our Experience with Free-hand Locking

Journal of Advances in Medical and Pharmaceutical Sciences ◽

10.9734/jamps/2017/35079 ◽

2017 ◽

Vol 14 (4) ◽

pp. 1-7

Author(s):

Shamsuddeen Muhammad ◽

Abdurrahman Mamuda

Keyword(s):

Bone Fractures ◽

Lower Limbs ◽

Long Bone ◽

Interlocking Nailing ◽

Long Bone Fractures

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Comparison of Outcome of Bone Autograft and Allograft in Union of Long Bone Fractures

Acta Medica Bulgarica ◽

10.2478/amb-2021-0017 ◽

2021 ◽

Vol 48 (2) ◽

pp. 13-18

Author(s):

H. Valiyollahpoor-Amiri ◽

S. M. Esmaeilnejad-Ganji ◽

R. Jokar ◽

B. Baghianimoghadam ◽

S. Kamali-Ahangar ◽

...

Keyword(s):

Range Of Motion ◽

Bone Fractures ◽

Bone Allograft ◽

Fracture Site ◽

Lower Limbs ◽

Long Bone ◽

Long Bone Fractures ◽

Surgical Methods ◽

Long Bone Fracture ◽

Bone Autograft

Abstract Background and Purpose There are few studies addressing the rate of application of bone allograft and its use; hence, the present study aimed to compare the clinical outcomes of using bone allograft and autograft in patients with long bone fracture. Method In this clinical trial study, all patients who underwent bone graft surgery with the diagnosed long bone fractures of upper and lower limbs at Shahid Beheshti Hospital were included in the research. Patients were divided into two groups, autograft and allograft, according to type of treatment. They were evaluated for their union, complications, and range of motion. Results In the present study, 124 people were studied. Among them, 100 patients were eligible and included in the study. The allograft and autograft groups did not have any statistical significant differences in terms of age, sex, location, causes of fracture, and surgical methods. Results of the present research on patients in terms of fracture site indicated that there was no significant relationship between the two groups in rate of union (P = 0.18). Allograft and autograft had no difference in terms of complications. Studied range of motion indicated that patients were not different in terms of their ranges of motion. Conclusion Based on findings of the present study, allograft could be a suitable substitute for the autograft. The two graft methods were similar in terms of complications, union, and ranges of motion.

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