scholarly journals Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Neven Starčević ◽  
Andrija Karačić
Keyword(s):  
Bone Loss ◽  
Fracture Healing ◽  
Distal Femur ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Bony Defect ◽  
Leg Length ◽  
Infected Nonunion ◽  
Femoral Nail ◽  
Membrane Technique

The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking “classic” plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5 cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances.

scholarly journals Plate on Plate Osteosynthesis : A Novel Method For Periplate Fracture Fixation

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0004
Author(s):  
Jagjoth Singh ◽  
Kamarul Arifin Abdul Razak ◽  
Terence Michal Dass ◽  
Tan Weng Liang ◽  
Yogeshwarran Nadeson ◽  
...  
Keyword(s):  
Distal Femur ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
X Rays ◽  
Locking Plate Fixation ◽  
Simple Method ◽  
Invasive Approach ◽  
Novel Method ◽  
A Prospective Study

Periplate fractures may occur after plate fixation, especially in osteoporotic and non-united bones. We present a case of locking plate fixation over an existing plate for such fractures. Case Presentation: 58 years old man slipped and fell in sitting position 8 months post left distal femur LCP. He sustained pain and swelling of the left hip. The left thigh was externally rotated and shorter than the normal side. X-rays revealed a periplate fracture extending to the subtrochanteric region. A reverse right distal femur LCP was planned. A minimally invasive approach was used. Proximal screws were removed from the original plate and new screws were inserted through both plates which were of similar material, Titanium. Discussion: Elderly population makes a large subgroup of the cases due to osteoporosis and rigidity of the LCP construct2. This fixation provides a simple method to reduce surgical time, bleeding, and preserving more blood supply to enhance fracture healing, as opposed to using nails supplemented with cerclage/cable wires. Care should be taken to use the pre-existing screw holes in the overlapping segment of the two plates, as well as similar plate materials to avoid stress risers and reduce corrosion1. Conclusion: Plate on plate osteosynthesis is a novel method that may prove valuable due to the increasing population age and unique types of fractures. Further research is needed to determine any complications related to this type of fixation. References: Georgios Arealis et. al Plate On Plate Osteosynthesis For The Treatment Of Non Healed Periplate Fractures, Hindawi Publishing Corporation, Volume 2014, Article 367490 S. Ruchholtz, et al., “Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients,” Injury, vol. 44, no. 2, pp. 239–248, 2013

scholarly journals Locking compression plate osteosynthesis of complicated mandibular fractures in six horses

2009 ◽  
Vol 22 (01) ◽  
pp. 54-58 ◽  
Author(s):  
M. Kummer ◽  
J. A. Auer ◽  
D. Nitzl ◽  
A. E. Fürst ◽  
J. M. Kuemmerle
Keyword(s):  
Fracture Healing ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Corrective Osteotomy ◽  
Locking Compression Plate ◽  
Mandibular Fractures ◽  
Cerclage Wire ◽  
Compression Plate ◽  
Comminuted Fractures ◽  
Horizontal Ramus

SummaryComplicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while the other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of these patients had open and infected fractures. One foal had a bilateral horizontal ramus fracture with marked periosteal ‘new bone’ formation and malalignement which required corrective osteotomy. Each horse underwent locking compression plate (LCP) osteosynthesis consisting of open fracture reduction and application of one to three 4.5/5.0 mm LCP at the ventral, lateral or caudal aspect of the mandible under fluoroscopic control. Two 3.5 mm LCP were used in the foal. Plate fixation was supported by application of a cerclage wire construct between the incisor and premolar teeth in most patients. Complete fracture healing, with an excellent functional and cosmetic outcome, was achieved in all of the patients. Complications encountered included seroma formation, screw and wire breakage, as well as implant and apical tooth root infections. The LCP was removed after fracture healing had occurred in four patients.

The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss

2006 ◽  
Vol 88-B (2) ◽  
pp. 232-237 ◽  
Author(s):  
A. Saridis ◽  
E. Panagiotopoulos ◽  
M. Tyllianakis ◽  
C. Matzaroglou ◽  
N. Vandoros ◽  
...  
Keyword(s):  
Bone Loss ◽  
Distal Femur ◽  
Ilizarov Method ◽  
Salvage Procedure ◽  
Infected Nonunion

Radiation Exposure of Anaesthetists Visualised by Real-time Dosimetry

2019 ◽  
Vol 15 (2) ◽  
pp. 220-226
Author(s):  
Marcus Christian Müller ◽  
Michael Windemuth ◽  
Sophie Frege ◽  
Eva Nadine Striepens
Keyword(s):  
Radiation Exposure ◽  
Real Time ◽  
Vertebral Fractures ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Dose Monitoring ◽  
Osteoporotic Vertebral Fractures ◽  
Radiation Dose Monitoring ◽  
Dosimetry System

Background: Chronic exposure to occupational ionising radiation is seen as one reason for elevated cancer prevalence. </P><P> Objective: The aim of this retrospective study was to evaluate radiation exposure of anaesthetists by real-time dosimetry. Methods: Data of 296 patients were analyzed. Ten types of trauma operation procedures including osteosynthesis of upper and lower extremity fractures and minimally invasive stabilisation of traumatic and osteoporotic vertebral fractures were accomplished. Evaluation was performed by an occupational dosimetry system, which visualises anaesthetists radiation exposure feedback compared to surgeons in real-time. Results: A significantly lower radiation exposure to anaesthetists compared to surgeons was observed in four types of operative procedures: Plate fixation of proximal humerus fractures, osteosynthesis of proximal femoral fractures, stabilisation of traumatic and osteoporotic vertebral fractures. In four types of operations (plate osteosynthesis of proximal humeral, distal radial and tibial fractures and intramedullary nailing of the clavicle), anaesthetists` amount of radiation exceeded one-third of the surgeons' exposure, especially if the C-arm tube was positioned close to the anaesthetists work station at the patients' head. Conclusion: By using the occupational radiation dose monitoring system, radiation exposure to anaesthetists was visualised in real-time during trauma operations. Radiation exposure of anaesthetists depends on the type of operation and the position of the C-arm. The system may help to increase anaesthetists` awareness concerning radiation exposure and to enhance compliance in using radiation protection techniques.

scholarly journals Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

2021 ◽  
Author(s):  
Bjoern Vogt ◽  
Christoph Theil ◽  
Georg Gosheger ◽  
Adrien Frommer ◽  
Burkhard Moellenbeck ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Plate Fixation ◽  
Hip Dislocation ◽  
Leg Length ◽  
Total Hip ◽  
Femoral Lengthening ◽  
Shortening Osteotomy ◽  
Successful Approach ◽  
Staged Reconstruction

Abstract Background and purpose Total hip arthroplasty (THA) is a successful approach to treat unilateral symptomatic neglected hip dislocation (NHD). However, the extensive leg length discrepancy (LLD) can hereby only be partially corrected. In case of residual LLD of more than 2 cm, subsequent femoral lengthening can be considered. Patients/material/methods Retrospective analysis of clinical data and radiographs of five patients (age 38.1 (28–51) years) with unilateral NHD who underwent THA with (n  = 3) or without (n = 2) subtrochanteric shortening osteotomy (SSO) and secondary intramedullary femoral lengthening through a retrograde magnetically-driven lengthening nail (follow-up 18.4 (15–27) months). Results LLD was 51.0 (45–60) mm before and 37.0 (30–45) mm after THA. Delayed bone union at one SSO site healed after revision with autologous bone grafting and plate fixation. Subsequent lengthening led to leg length equalisation in all patients. Complete consolidation was documented in all lengthened segments. Conclusion Staged reconstruction via THA and secondary femoral lengthening can successfully be used to reconstruct the hip joint and equalise LLD. The specific anatomical conditions have to be taken into consideration when planning treatment, and patients ought to be closely monitored.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

scholarly journals Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect

2021 ◽  
Author(s):  
Jens Wermers ◽  
Benedikt Schliemann ◽  
Michael J. Raschke ◽  
Philipp A. Michel ◽  
Lukas F. Heilmann ◽  
...  
Keyword(s):  
Bone Loss ◽  
Linear Model ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Bony Defect ◽  
Stability Ratio ◽  
Anterior Glenoid ◽  
Shoulder Stability

Abstract Purpose Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. Methods The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. Results Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. Conclusion Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.

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