Treatment of Navicular Stress Fractures With an Algorithmic Approach

2021 ◽  
pp. 107110072110348
Author(s):  
James A. Nunley ◽  
Cynthia Green ◽  
Joel Morash ◽  
Mark E. Easley
Keyword(s):  
Internal Fixation ◽  
Bone Grafting ◽  
Open Reduction ◽  
Iliac Crest ◽  
Stress Fractures ◽  
Ct Scans ◽  
Return To Sports ◽  
Iliac Crest Bone Grafting ◽  
Difficult Cases ◽  
Vascularized Bone

Background: Navicular stress fractures are becoming increasingly more common. There is no universal consensus on treatment. We provide an algorithm that we feel will be useful in determining treatment. Methods: A retrospective study was performed on all patients having operative treatment of navicular stress fractures during a 10-year period. Acute fractures were treated with open reduction internal fixation. Chronic fractures greater than 3 months were treated with open reduction and internal fixation (ORIF) and iliac crest bone grafting. Chronic fractures with evidence of sclerosis, avascular changes, or those who failed previous surgery were treated with ORIF, iliac crest bone grafting, as well as vascular bone grafting. Patients’ pain scores were recorded and a return-to-sports scale was used. Radiographic union was compared among the 3 groups using computed tomographic (CT) scans or radiographs. Results: Forty-three patients were identified. Fifteen received ORIF alone, 12 were treated with ORIF and bone graft, and 16 had ORIF with vascularized bone grafting. No difference was found among the median age of the 3 groups. In terms of radiographic healing, 3 patients in the ORIF group received radiographs alone. All other patients had follow-up CT scans. ORIF alone group had 80% union, ORIF with bone graft had 75% union, and ORIF with vascularized bone grafting had 100% union. Return to sports did not show any difference among the 3 groups. Conclusion: The algorithm dividing navicular stress fractures into 3 distinct groups with different operative techniques helped us address these difficult cases. Vascularized bone grafting certainly appeared to be beneficial for the more difficult cases. Level of Evidence: Level IV, case series.

Surgical management of an isolated symptomatic talonavicular coalition: a paediatric perspective

2021 ◽  
Vol 14 (11) ◽  
pp. e243761
Author(s):  
Keval Patel ◽  
Abdullah Khawaja ◽  
Aman Patel ◽  
Michail Kokkinakis
Keyword(s):  
Paediatric Patient ◽  
Reconstructive Surgery ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Early Stage ◽  
Operative Management ◽  
Lateral Column ◽  
Iliac Crest Bone Grafting ◽  
Lateral Column Lengthening

Talonavicular (TN) coalition is a rare pathological union of the talus and navicular bones. We report the case of a 7-year-old girl with a symptomatic TN coalition, who underwent operative management with a lateral column lengthening procedure using autologous iliac crest bone grafting. There are no complications to report and the graft was incorporated at an early stage. At 3 year follow-up the patient has remained pain-free since the operation and maintained alignment. To our knowledge, this is the first reported case of TN coalition treated with reconstructive surgery in a paediatric patient.

scholarly journals Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Dongxu Feng ◽  
Xiaolong Wang ◽  
Liang Sun ◽  
Xiao Cai ◽  
Kun Zhang ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Nerve Palsy ◽  
Iliac Crest ◽  
Humeral Shaft ◽  
Autogenous Bone ◽  
Salvage Procedure ◽  
Iliac Crest Bone Grafting ◽  
Ulnar Nerve Palsy ◽  
Humeral Shaft Nonunion ◽  
The Mean

Abstract Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial

2013 ◽  
Vol 19 (4) ◽  
pp. 412-419 ◽  
Author(s):  
Feizhou Lu ◽  
Hongli Wang ◽  
Jianyuan Jiang ◽  
Wenjun Chen ◽  
Xin Ma ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Plate Fixation ◽  
Cervical Collar ◽  
Therapeutic Effects ◽  
Iliac Crest Bone Grafting ◽  
Anterior Cervical Decompression ◽  
Significant Difference ◽  
Internal Plate Fixation

Object Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies—discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)—for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated. Methods Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively. Results Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found. Conclusions The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.

Pain following iliac crest bone grafting of alveolar clefts

1996 ◽  
Vol 24 (3) ◽  
pp. 151-154 ◽  
Author(s):  
K.H. Dawson ◽  
M.A. Egbert ◽  
R.W.T. Myall
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Iliac Crest Bone Grafting
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