scholarly journals Risk Factors for Development of a Recalcitrant Femoral Non-Union

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Donald A Wiss ◽  
John Garlich ◽  
Sohaib Hasmi ◽  
Adam Neustein
Keyword(s):  
Risk Factors ◽  
Non Union

scholarly journals Risk Factors for Non-union in First MTPJ Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Andrew Molloy ◽  
Clifford Butcher ◽  
Lyndon Mason
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Univariate Analysis ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved

scholarly journals Roentgenological assessment of the lumbar anterior interbody fusion with regard to risk factors of the non-union.

1990 ◽  
Vol 38 (4) ◽  
pp. 1677-1679
Author(s):  
Yasuo Morio ◽  
Kichizo Yamamoto ◽  
Hiroshi Hagino ◽  
Mochiru Kamihira ◽  
Kenji Ohtsuki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Interbody Fusion ◽  
Non Union ◽  
Anterior Interbody Fusion

scholarly journals Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

2020 ◽  
Author(s):  
Qiang Xu ◽  
Bin Zhang ◽  
Min Dai ◽  
Xuqiang Liu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Internal Fixation ◽  
Weight Bearing ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Fracture Type ◽  
Multivariate Logistic Regression ◽  
Non Union ◽  
Limb Fractures

Abstract Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients

2019 ◽  
Vol 30 (4) ◽  
pp. 474-480
Author(s):  
Chun-Hung Chang ◽  
Shang-Wen Tsai ◽  
Po-Kuei Wu ◽  
Chao-Ming Chen ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Multivariate Logistic Regression Analysis ◽  
Alcohol Dependency ◽  
Old Patients ◽  
Non Union ◽  
Loss Of Reduction ◽  
Implant Retention ◽  
Neck Fracture

Purpose: The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified. Methods: We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel’s angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed. Results: The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54–12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08–9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11–13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09–22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05–12.77) and removal of implant (aOR 3.32; 95% CI, 1.02–10.77) were risk factors for ONFH. Conclusions: The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.

scholarly journals Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures

2021 ◽  
Vol 10 (15) ◽  
pp. 3331
Author(s):  
Michalis Panteli ◽  
James S. H. Vun ◽  
Robert M. West ◽  
Anthony Howard ◽  
Ippokratis Pountos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Femoral Fractures ◽  
Deep Infection ◽  
P Value ◽  
Superficial Infection ◽  
Revision Operation ◽  
Non Union ◽  
Prolonged Length ◽  
Micro Organisms

Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (p-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). Results: The overall incidence of infection was 6.4% (n = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56–3.38)), the presence of an open fracture (OR 4.23 (3.18–5.61)), the need for massive transfusion (OR 1.42 (2.39–8.39)), post-operative transfusion (OR 1.40 (1.10–1.79)) and prolonged length of stay (OR 1.04 (1.02–1.06)). The Commonest causes of superficial infection were Staphylococcus aureus (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and Staphylococcus aureus (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Conclusion: Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture.

scholarly journals Breakage of intramedullary femoral nailing or femoral plating: how to prevent implant failure

2022 ◽  
Vol 27 (1) ◽  
Author(s):  
Henrik C. Bäcker ◽  
Mark Heyland ◽  
Chia H. Wu ◽  
Carsten Perka ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plate Osteosynthesis ◽  
Femoral Shaft ◽  
Intramedullary Fixation ◽  
Implant Failure ◽  
Average Risk ◽  
Rigid Fixation ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures

Abstract Introduction Intramedullary (IM) fixation is the dominant treatment for pertrochanteric and femoral shaft fractures. In comparison to plate osteosynthesis (PO), IM fixation offers greater biomechanical stability and reduced non-union rates. Due to the minimally invasive nature, IM fixations are less prone to approach-associated complications, such as soft-tissue damage, bleeding or postoperative infection, but they are more prone to fat embolism. A rare but serious complication, however, is implant failure. Thus, the aim of this study was to identify possible risk factors for intramedullary fixation (IMF) and plate osteosynthesis (PO) failure. Materials and methods We searched our trauma surgery database for implant failure, intramedullary and plate osteosynthesis, after proximal—pertrochanteric, subtrochanteric—or femoral shaft fractures between 2011 and 2019. Implant failures in both the IMF and PO groups were included. Demographic data, fracture type, quality of reduction, duration between initial implantation and nail or plate failure, the use of cerclages, intraoperative microbiological samples, sonication, and, if available, histology were collected. Results A total of 24 femoral implant failures were identified: 11 IMFs and 13 POs. The average age of patients in the IM group was 68.2 ± 13.5 years and in the PO group was 65.6 ± 15.0 years, with men being affected in 63.6% and 39.5% of cases, respectively. A proximal femoral nail (PFN) anti-rotation was used in 7 patients, a PFN in one and a gamma nail in two patients. A total of 6 patients required cerclage wires for additional stability. A combined plate and intramedullary fixation was chosen in one patient. Initially, all intramedullary nails were statically locked. Failures were observed 34.1 weeks after the initial surgery on average. Risk factors for implant failure included the application of cerclage wires at the level of the fracture (n = 5, 21%), infection (n = 2, 8%), and the use of an additional sliding screw alongside the femoral neck screw (n = 3, 13%). In all patients, non-union was diagnosed radiographically and clinically after 6 months (n = 24, 100%). In the event of PO failure, the placement of screws within all screw holes, and interprosthetic fixation were recognised as the major causes of failure. Conclusion Intramedullary or plate osteosynthesis remain safe and reliable procedures in the treatment of proximal femoral fractures (pertrochanteric, subtrochanteric and femoral shaft fractures). Nevertheless, the surgeon needs to be aware of several implant-related limitations causing implant breakage. These may include the application of tension band wiring which can lead to a too rigid fixation, or placement of cerclage wires at the fracture site.

Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review

2021 ◽  
pp. 175857322110444
Author(s):  
Guilherme G Mouraria ◽  
José A S Santos Júnior ◽  
Fernando K Kikuta ◽  
Daniel R Zogbi ◽  
Rafael M Brigatto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Humeral Shaft ◽  
Categorical Variables ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Working Length

Introduction Fractures of the humeral shaft account for about 3% to 5% of all fractures. Although conservative treatment remains the first choice, there are a number of surgical indications. Minimally invasive plate osteosynthesis shows good functional results. However, complications have been reported, such as non-union. Objective To assess the prevalence and risk factors for non-union after treatment of humeral shaft fractures using minimally invasive plate osteosynthesis. Materials and methods This retrospective study was carried out in patients treated by minimally invasive plate osteosynthesis between 2009 and 2019. Demographic data and variables related to the fracture that could influence bone healing were analysed. The unpaired t-test and Mann–Whitney test were used for the statistical analyses. Categorical variables were analysed using the chi-square test or Fisher's exact test Results The study population showed a male predominance (53 of 75, 70.7%). The average time for fracture healing was 19.8 ± 15.3 weeks. Seven patients developed non-union. Only the presence of an open fracture increased the likelihood of non-union. Conclusions The prevalence of non-union in patients treated by minimally invasive plate osteosynthesis was 9.3%. Patients with open fractures were six times more likely to progress to non-union. Fracture characteristics (Arbeitsgemeinschaft für Osteosynthesefragen classification, fracture location and plate working length) did not influence progression to non-union.

scholarly journals The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success?

2017 ◽  
Vol 02 (02) ◽  
pp. e103-e110 ◽  
Author(s):  
Andreas Kolk ◽  
S. Haidari ◽  
K.-D. Wolff ◽  
A. Fichter ◽  
V. Kehl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Graft Loss ◽  
Tumor Resection ◽  
Vascular Occlusion ◽  
Mandibular Reconstruction ◽  
Skin Paddle ◽  
Non Union ◽  
Osteosynthesis Material ◽  
Optimum Selection ◽  
Fibular Flap

Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction. Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study. Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001). Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.

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