Rigid Fixation as a Treatment for Non-Union

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

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RIGID FIXATION AS A TREATMENT FOR NON-UNION

The Lancet ◽

10.1016/s0140-6736(63)90173-9 ◽

1963 ◽

Vol 282 (7302) ◽

pp. 272-273 ◽

Cited By ~ 12

Author(s):

J.H. Hicks

Keyword(s):

Rigid Fixation ◽

Non Union

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RIGID FIXATION AS A TREATMENT OF NON-UNION

The Lancet ◽

10.1016/s0140-6736(63)93045-9 ◽

1963 ◽

Vol 282 (7303) ◽

pp. 364

Author(s):

Guy Rigby-Jones

Keyword(s):

Rigid Fixation ◽

Non Union

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Management of communited patellar fracture with combined Tension Band Wiring Technique and Encirclage

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185330 ◽

2018 ◽

Vol 5 (1) ◽

pp. 104

Author(s):

Tarun V. Desai ◽

Niravkumar P. Moradiya

Keyword(s):

Quadriceps Tendon ◽

Functional Results ◽

Tension Band ◽

Patellar Ligament ◽

Rigid Fixation ◽

Superficial Infection ◽

Non Union ◽

Active Flexion ◽

Extensor Lag

Background: The objective of the study was to evaluate functional results of combined encirclage wiring and tension band fixation in comminuted patellar fractures.Methods: This is a prospective study of 15 patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with encirclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. Knee function was evaluated using the Rasmussen scores at final follow-up.Results: 13 patients gained up to 90 degrees of active flexion at the end of the first week. 4 patients had 10–15 degrees of extensor lag at the end of the first week which improved after vigorous physiotherapy and none of them had any residual extensor lag at the subsequent follow-up. Two patients developed superficial infection. All fractures united at the end of 12 weeks. One patient underwent a second surgery; due to implant related complications. Malunion or non-union was not noted in any of the cases. The average Rasmussen scores was 27.9 out of 30 (range, 27–29).Conclusions: The tension band technique combined with cable encirclage for treatment of communited fractures of patella is a simple and technically less demanding operative technique producing a rigid fixation, stable osteosynthesis and minimal injury to the tendon. It can be done with easily available implants.

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

European Journal of Medical Research ◽

10.1186/s40001-021-00630-7 ◽

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.

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Non-restricted weight-bearing after modified Lapidus arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000322 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Manuel Pellegrini ◽

Giovanni Carcuro ◽

Natalio Cuchacovic ◽

Gerardo Muñoz ◽

Marcelo Somarriva

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Clinical Results ◽

Delayed Union ◽

Rigid Fixation ◽

X Rays ◽

Non Union ◽

Fixation Methods ◽

First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

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Therapeutical Management of the Tibial Plateau Fractures

ARS Medica Tomitana ◽

10.1515/arsm-2016-0047 ◽

2016 ◽

Vol 22 (4) ◽

pp. 278-284

Author(s):

B. Obada ◽

Madalina Iliescu ◽

Al O. Serban ◽

Crina Alecu-Silvana ◽

M. Zekra

Keyword(s):

Tibial Plateau ◽

Demographic Data ◽

Wound Dehiscence ◽

Contralateral Side ◽

Tibial Plateau Fractures ◽

Rigid Fixation ◽

Non Union ◽

Posttraumatic Arthrosis ◽

Early Motion ◽

Surgical Methods

Abstract The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°). Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.

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Functional Evaluation of Fracture Shaft of Humerus Treated By Antegrade Closed Interlocking Nail

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29629 ◽

2020 ◽

Vol 5 (1) ◽

pp. 938-941

Author(s):

Pradip Kumar Gupta ◽

Ajay Chaudhary

Keyword(s):

Road Traffic ◽

Humeral Shaft ◽

Prospective Clinical Study ◽

Rigid Fixation ◽

Functional Evaluation ◽

Superficial Infection ◽

Non Union ◽

Interlocking Nail ◽

Humeral Shaft Fractures ◽

Shaft Fractures

Introduction: Management of fractures shaft of humerus is always a challenging problem to deal with as they are very frequently associated with complex multiple injuries. Interlocking nails have gained popularity now a days for stabilization of humeral shaft fractures due to load sharing nature of implant, preservation of fracture hematoma, minimal exposures and rigid fixation with early mobilization. Objective: The objective of the study was to assess the outcome of the fracture shaft of humerus stabilized with interlocking nail. Methodology: A Prospective clinical study was done on fifty patients of fractures shaft of humerus stabilized using antegrade interlocking nail. Results: The most common causes of fractures shaft of humerus was road traffic accident (66%). The average union time was 12.7± 1.3 weeks. About 8% had delayed union and 10% had non-union which were treated with bone graft. There was no deep infection but two (4%)had superficial infection in open Gustilo grade II fracture. Four cases (8%) had radial nerve injury, mostly neuropraxias, which recovered in three months. There were 12 cases of significant restriction of shoulder movements which was resolved in six weeks after guarded physiotherapy. Conclusion: Closed interlocking nailing is a least invasive surgical option available to manage complex humeral shaft fractures.

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Non-rigid fixation of the glenoid bone block for patients with recurrent anterior instability and major glenoid bone loss: A systematic review

Shoulder & Elbow ◽

10.1177/1758573219872512 ◽

2019 ◽

pp. 175857321987251

Author(s):

Michael-Alexander Malahias ◽

Leonidas Mitrogiannis ◽

Dimitrios Gerogiannis ◽

Efstathios Chronopoulos ◽

Maria-Kyriaki Kaseta ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Anterior Shoulder Instability ◽

Bone Block ◽

Rigid Fixation ◽

Anterior Instability ◽

Non Union ◽

Bone Deficiency ◽

Pubmed Database ◽

Fixation Techniques

Background New types of glenoid bone block fixation, involving suture buttons, suture anchors or even implant-free impaction of the graft, have been recently introduced. In contrast to screws which allow for a rigid fixation of the bone block, these alternative procedures provide a non-rigid type of fixation. Methods Two reviewers independently conducted the search in a systematic way (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “Latarjet” OR “Eden-Hybbinette” OR “bone block” AND “anterior” AND “shoulder” AND “instability.” Results Eight out of the 325 initial studies were finally chosen according to our inclusion–exclusion criteria. In total, 750 patients were included in this review. The overall anterior instability recurrence rate for patients treated with non-rigid fixation was 2.6%, while the overall rate of non-union or graft osteolysis was 5.4%. Conclusions Regardless of the graft type, bone block non-rigid fixation showed satisfactory clinical and functional outcomes for the treatment of anterior shoulder instability with substantial glenoid bone deficiency. Furthermore, non-rigid fixation resulted in adequate bone graft healing and osseous incorporation. Lastly, given the relative lack of data, further prospective controlled studies are required to assess bone block non-rigid fixation procedures in comparison with the traditional rigid (with screws) fixation techniques. Level Systematic review, IV.

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Revision Arthrodesis of the Subtalar Joint

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00419 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Joseph Tracey ◽

Cyrus Taghavi ◽

Shuyuan Li ◽

Mark Myerson

Keyword(s):

Ankle Arthrodesis ◽

High Rate ◽

Bone Block ◽

Rigid Fixation ◽

Non Union ◽

Subtalar Arthrodesis ◽

Invaluable Tool ◽

Post Traumatic ◽

Adjusted Rate ◽

Traumatic Arthritis

Category: Hindfoot Introduction/Purpose: Subtalar arthrodesis is an invaluable tool in managing arthritis, deformity, and muscular imbalance of the hindfoot. However, failed arthrodesis is complicated by bone necrosis, sclerosis with loss of bone, less than ideal biologic settings, and the literature reports a high rate of non-union. The aim of this study was to review all subtalar arthrodeses performed within a single institution, and specifically describe the management of non-union. Methods: 492 consecutive subtalar arthrodesis cases were retrospectively analyzed between October 2001 and July 2013. From the primary arthrodesis group 91 (18%) were treated for subtalar coalition (100% arthrodesis), and were excluded to better depict the arthrodesis rate; the remaining 401 patients were treated primarily for post-traumatic arthritis. Pertinent demographics, comorbidities, and clinical notes were all retrieved through the electronic medical record and radiographs were reviewed through a PACS system. Results: 49 patients with a mean age of 49 years (range 23 - 80) presented with subtalar non-union (overall rate 10%, adjusted rate 18%). 41 (84%) underwent revision at a mean of 16.2 months (range 2.8 - 57.1) from the index arthrodesis. The rate of revision arthrodesis was 78%, 21/30 (70%) in situ arthrodeses, 7/7 bone block arthrodesis (p=.028), and 4/4 triple arthrodesis (p=.028). Arthrodesis was present at a mean of 3.4 months (range 1.6 - 7.6). 4/9 (44%) of the recurrent nonunions elected to abstain from surgery. Of the 5 remaining patients, 2/5 had a successful third attempt at arthrodesis, 1/5 had an additional nonunion followed by a successful fourth attempt at arthrodesis, 1/5 had a successful tibiotalocalcaneal arthrodesis, and 1/5 required a below-knee amputation. Conclusion: Risk factors identified for non-union were post-traumatic arthritis, ipsilateral ankle arthrodesis, and individual patient factors (smoking, diabetes, and infection). Different methods of screw fixation were not found to be significantly different between the fused and nonunion groups. Despite directed management to obtain rigid fixation and adequate compression, the rates of subtalar arthrodesis from primary (82%), revision (78%) and secondary revision (60%) cases were very poor with the exception of the group which underwent a bone block arthrodesis (100%, p=.028).

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