Chapter 10: Managing Delayed Union and Non Union of Tibial Fractures Treated with Ilizarov Fixators

2002 ◽  
Vol 17 (1) ◽  
pp. 97-99
Author(s):  
James J. Hutson
Keyword(s):  
Delayed Union ◽  
Tibial Fractures ◽  
Non Union

scholarly journals Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications

2016 ◽  
Vol 55 (204) ◽  
pp. 55-60 ◽  
Author(s):  
Kapil Mani KC ◽  
Parimal Acharya ◽  
Arun Sigdel
Keyword(s):  
Functional Outcomes ◽  
Skin Irritation ◽  
Limb Lengthening ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Entry Site ◽  
Superficial Infection ◽  
Non Union ◽  
Fractures In Children ◽  
Tibia Fractures

Introduction: Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation.Methods: This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination.Results: Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture.Conclusions: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions. Keywords: complications; functional outcomes; tibia fractures. | PubMed

scholarly journals Operative fixation for complex tibial fractures

2012 ◽  
Vol 94 (1) ◽  
pp. 34-38 ◽  
Author(s):  
AJP Hutchinson ◽  
AE Frampton ◽  
R Bhattacharya
Keyword(s):  
English Literature ◽  
Surgical Techniques ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Fixation Technique ◽  
Non Union ◽  
Fixation Techniques ◽  
Secondary Procedures ◽  
Operative Fixation ◽  
Tibial Shaft Fractures

INTRODUCTION The management of open tibial shaft fractures remains challenging. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation technique remains unresolved. In this article the outcomes of these two surgical techniques are compared. METHODS A comprehensive literature search was conducted through MEDLINE® using Ovid® and MeSH (Medical Subject Heading) terms for articles published in the English literature between 1999 and 2009. The outcome measures compared were time to fracture union, infection rates and complications. RESULTS Forty-one studies were identified, of which only three met the inclusion criteria. The average time to union was variable. Delayed union and non-union appeared to be more prevalent in the external fixator group although this was not statistically significant. Both techniques were associated with secondary procedures as well as infection. CONCLUSIONS The current literature indicates little evidence to suggest the superiority of one fixation technique over another for open tibial fractures.

Percutaneous bone grafting in the treatment of the delayed union and non-union of tibial fractures

Injury ◽  
2002 ◽  
Vol 33 (3) ◽  
pp. 239-245 ◽  
Author(s):  
J. Kettunen ◽  
E.A. Mäkelä ◽  
V. Turunen ◽  
O. Suomalainen ◽  
K. Partanen
Keyword(s):  
Bone Grafting ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Non Union

scholarly journals Delayed-union and Non-union Fractures of the Lower Extremity

1964 ◽  
Vol 13 (2) ◽  
pp. 108-110
Author(s):  
K. Toguchida ◽  
K. Hasegawa ◽  
K. Yamaguchi ◽  
H. Setani ◽  
Y. Fukushima
Keyword(s):  
Lower Extremity ◽  
Delayed Union ◽  
Non Union

scholarly journals Fixation of Delayed Union or Non-Union Posterior Cruciate Ligament Avulsion Fractures

2014 ◽  
Vol 22 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Rohit Singla ◽  
Ashish Devgan ◽  
Paritosh Gogna ◽  
Amit Batra
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Delayed Union ◽  
Avulsion Fractures ◽  
Non Union

A STUDY ON OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN EXTRA ARTICULAR FRACTURE OF DISTAL 1/3RD TIBIA.

2021 ◽  
pp. 106-111
Author(s):  
Vaibhav Vaibhav
Keyword(s):  
Soft Tissue ◽  
Average Duration ◽  
Tibial Fractures ◽  
Categorical Variables ◽  
Minimal Risk ◽  
Distal Tibial Fractures ◽  
Non Union ◽  
Articular Fractures ◽  
Number Of Patients ◽  
Duration Of Surgery

BACKGROUND: Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. There is a considerable debate regarding the best method for treating distal tibial fractures. In present study we have treated distal tibial fractures using MIPPO technique OBJECTIVES: To evaluate the functional outcome following use of MIPO technique in lower 1/3rd fractures of tibia. MATERIAL AND METHODS: This is a longitudinal follow up study. In this study a total of 30 patients with fracture distal 1/3rd tibia admitted to CMRI hospital will be selected for treatment with MIPO technique according to inclusion and exclusion criteria. All patients were reviewed in CMRI Hospital and radiographs (Tibia AP and lateral views) obtained after surgery and then at 1 month, 3 months and nally at 6 months. From 5 weeks onwards symptoms and functions will be assessed using the scoring system of Olerud and Molander(1984). Statistical analysis of categorical variables was expressed as number of patients and percentage of patients and continuous variables are expressed as descriptive statistics. The statistical software SPSS version 20 has been used for the analysis. RESULTS: The age of patients ranged from 22-65 years. Fracture was most common in 4th and 5th decade of life. Average mean age was 44.03±10.74yrs. In this study majority of 17(56.7%) patients were male and there were 13(43.3%) were female. Road Trafc accident (RTA) was the main cause to produce lower end tibia fractures (83.3%) in our study. In this study right side (60%) was involved more than left (40%). In this study only 3 (10%) patients had open grade 1 injury. Majority of patients 27 (90%) had closed injury. In our study 66.67% (20) of patients had associated injuries and 33.33% patients had no associated injury. Average injury operation interval in this study was 3.27±1.53 days. Average no. of plate holes were 10.50±1.72. Average duration of hospital stay in this study was 10.07±2.75 days. Average duration of surgery in this study was 88.03±16.36 minutes. In this study 26 patients (86.7%) had no early post-op complications and 4 (13.3%) had complications. 3 patients (10%) had delayed wound healing and 1patient (3.3%) had supercial infection of suture lines. There was 1 non-union and majority of patients 21(70%) took 20-25 weeks for union. 7(23.4%) patients took less than 20 weeks and 1(3.33%) patient took more than 25 weeks. Average time of union in this study was 21.17±2.17 weeks. Average time of weight bearing was 17.72±1.91 weeks in this study. Most frequent late complication seen was swelling with frequency of 7 followed by stiffness and pain. 1 patient had malunion and 1 patient had non-union. In this study there were 28(93.3%) patients which showed union, 1 (3.3%) patient showed coronal malunion and 1(3.3%) had non-union. There were 21 patients (70 %) with excellent result, 7 patients (23.3%) with good result and 2 patients (6.7%) with fair result in our cases of study. Average clinical Olerud & Molander score was 81.17±16.07 in this study. CONCLUSION: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in peri-articular fractures. Biological xation of complex fractures gives stable as well as optimal internal xation and complete recovery of limb function at an early stage with minimal risk of complications.

scholarly journals Does Lag Screw Retightening Improve Compression in Hindfoot Arthrodesis?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0007
Author(s):  
Amanda Rugg ◽  
Melissa Requist ◽  
Brooks Johnson ◽  
Michelle Son ◽  
Alicia Alvarez ◽  
...  
Keyword(s):  
Stress Relaxation ◽  
Causative Factor ◽  
Delayed Union ◽  
Direct Compression ◽  
Maximum Compression ◽  
Non Union ◽  
Lag Screw ◽  
Inferior Aspect ◽  
Time Required ◽  
Hindfoot Arthrodesis

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Non-union and delayed union are common complications following hindfoot arthrodesis. The failure to obtain and maintain compression at the arthrodesis site may be a causative factor. Partially threaded cannulated ‘lag’ screws are commonly used for fixation in hindfoot arthrodesis; however, the ability of these screws to maintain compression in the hindfoot bones has not been well-characterized. The goals of this work were to: 1) quantify the stress relaxation response of hindfoot bones when compressed with a lag screw, particularly compression change upon screw retightening, and 2) compare the results to prior studies on stress relaxation in direct bone compression. Methods: 12 pairs of calcaneus, talus and tibia bone cylinders, 25mm in diameter, were cut with a keyhole saw from fresh thawed cadaveric feet. The bone cylinders were prepared for simulated arthrodesis by removing the cartilage and flattening the subchondral surface with an oscillating saw. A Futek LTH 300 donut load cell and two metal washers were sandwiched between the two bone cylinders. An 8.0mm partially threaded cannulated lag screw (Smith and Nephew) was placed from the posterior- inferior aspect of the calcaneus cylinder to the anterior-superior aspect of the talus cylinder to simulate subtalar arthrodesis, or from the superior aspect of the tibia cylinder to the inferior aspect of the talus cylinder. Compression was recorded continuously as the screws were tightened by three-quarters of a turn and left untouched for 3 minutes. Recording continued as the screws were retightened one quarter-turn and then left untouched for 30 additional minutes. Results: Both initial and subsequent compression with a lag screw demonstrated a stress relaxation pattern, with increased maximum compression and slowed decay upon retightening. Maximum compression after three quarter-turns and retightening averaged 284 N and 351 N, respectively (n=12; t=-2.55; p=0.0136). Time to decay to 80% of maximum compression after three quarter-turns and retightening averaged 34 and 528 (n=9; t=-2.59; p=0.0159) seconds, respectively, compared to 21 seconds for direct compression. Compression loss 30 minutes after retightening averaged 25.5% (SD=8.8%), compared to 34.3% for direct compression. Conclusion: The maximum compression attained following retightening was significantly greater than the maximum compression attained after initial tightening. The time required to reach 80% of maximum compression was significantly longer after subsequent compared to initial maximum compression. These findings suggest that screw retightening before surgical wound closure may slow compression loss, which could increase the likelihood of successful arthrodesis. Lag screw compression resulted in a lower percent compression loss and loss rate compared to direct compression, which was previously used to describe bone viscoelasticity.

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