Non-Vascularised Fibular Graft as an Intramedullary Strut for Infected Non-Union of the Humerus

Purpose. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. Methods. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected nonunion who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2–4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3–10) months. Results. The mean length of the fibulae harvested was 13 (range, 12–15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4–8) months. The mean follow-up period was 15 (range, 13–24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. Conclusion. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.

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Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162822 ◽

2016 ◽

Vol 2 (3) ◽

pp. 86

Author(s):

Rajesh Govindasamy ◽

Ramkumar Gnanasundaram ◽

Saravanan Kasirajan ◽

Fawas Thonikadavath ◽

Jeff Walter Rajadurai

Keyword(s):

Bone Grafting ◽

Locking Compression Plate ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Functional Evaluation ◽

Postoperative Function ◽

Non Union ◽

Humeral Shaft Nonunion ◽

Compression Plate ◽

The Mean

Background: Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.Methods: Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22). The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.Results: All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.Conclusions: LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

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Autologous osteochondral graft for traumatic defects of finger joints

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411412870 ◽

2011 ◽

Vol 37 (3) ◽

pp. 251-257 ◽

Cited By ~ 5

Author(s):

W. C. Wu ◽

M. W. M. Fok ◽

K. Y. Fung ◽

K. H. Tam

Keyword(s):

Donor Site ◽

Joint Space ◽

Donor Site Morbidity ◽

Finger Joint ◽

Osteochondral Graft ◽

Range Of Movement ◽

No Donor ◽

The Mean ◽

Open Injuries

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

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A case report of recalcitrant non union humerus treated with on lay fibular bone grafting and locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180690 ◽

2018 ◽

Vol 4 (2) ◽

pp. 342

Author(s):

Vivekananda Bheemisetty ◽

Rentala Vamshi ◽

S. Sreenivasa Reddy ◽

Y. Thimma Reddy

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Dynamic Compression ◽

Fibular Graft ◽

Disuse Osteoporosis ◽

Non Union ◽

Locking Compression Plates ◽

Compression Plate ◽

Diaphyseal Fractures ◽

Segmental Bone

Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. Fixation using a compression plate and a non-vascularised fibular graft achieves good outcome for infected non-union of the humerus despite prior multiple failed surgeries. We report a failed case of fracture shaft humerus which was operated three times, first with DCP and next two times with DCP and autologous cancellous bone graft from iliac crest. The patient is now treated with LCP and on lay fibular bone grafting.

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Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6511 ◽

2021 ◽

Vol 9 (C) ◽

pp. 118-123

Author(s):

Falih Waheed Hashmi ◽

Mohammed Baqir Al-Shara ◽

Mohammed Al-Edanni

Keyword(s):

Functional Outcome ◽

Nonoperative Treatment ◽

Humeral Shaft ◽

Teaching Hospitals ◽

Previous Surgery ◽

Infected Nonunion ◽

Hardware Failure ◽

Non Union ◽

Onlay Graft ◽

Compression Plate

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

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Vascularised fibular graft in the management of non-union of fracture shaft of radius: a less ventured entity

Ghana Medical Journal ◽

10.4314/gmj.v54i4.13 ◽

2020 ◽

Vol 54 (4) ◽

pp. 284-286

Author(s):

Tapas K. Panigrahi ◽

Ramesh C. Maharaj ◽

Debi P. Nanda

Keyword(s):

Donor Site ◽

Major Complication ◽

Fibular Graft ◽

Dash Score ◽

Forearm Fractures ◽

Non Union ◽

Fibula Graft ◽

Excellent Functional Outcome ◽

Both Bones

Introduction: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft. Case Report: We describe a case of 45yr old lady with closed fracture of both bones of left forearm. She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity. Conclusion: In management of gap non-union of Shaft radius with gap (>6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications.

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Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires

Plastic Surgery ◽

10.1177/2292550317750147 ◽

2018 ◽

Vol 27 (1) ◽

pp. 29-37

Author(s):

Yalcin Yontar ◽

Sedat Tatar ◽

Ahmet Aydin ◽

Atilla Coruh

Keyword(s):

Primary Closure ◽

Low Cost ◽

Donor Site ◽

Operating Time ◽

Kirschner Wires ◽

No Donor ◽

Female Ratio ◽

Delayed Primary Closure ◽

Hospitalization Time ◽

The Mean

Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.

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Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120937798 ◽

2020 ◽

Vol 8 (7) ◽

pp. 232596712093779

Author(s):

Lu Bai ◽

Siyao Guan ◽

Sanbiao Liu ◽

Tian You ◽

Xiaoxiao Xie ◽

...

Keyword(s):

Cartilage Repair ◽

Donor Site ◽

Arthroscopic Surgery ◽

Case Series ◽

Osteotomy Site ◽

Osteochondral Lesions ◽

Level Of Evidence ◽

No Donor ◽

Second Look ◽

The Mean

Background: Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat. Purpose: To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery. Results: In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 ± 4.8 preoperatively to 93.7 ± 4.6; t = –13.708; P < .0001). The 1- and 2-year AOFAS scores were similar ( t = –0.755; P = .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 ± 0.67 preoperatively to 0.47 ± 0.69; t = 18.974; P < .0001). The 1- and 2-year VAS scores were similar ( t = –0.705; P = .455), as were the 1- and 2-year MOCART scores (64.2 ± 7.5 vs 67.4 ± 7.3, respectively; t = –1.312; P = .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients. Conclusion: Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.

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Management of distal femur fractures with locking compression plate: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180459 ◽

2018 ◽

Vol 4 (2) ◽

pp. 208

Author(s):

Sridhar Reddy Konuganti ◽

Sreenath Rao Jakinapally ◽

Vennamaneni Pratish Rao ◽

Sivaprasad Rapur

Keyword(s):

Prospective Study ◽

Distal Femur ◽

Femoral Fractures ◽

Locking Compression Plate ◽

Functional Score ◽

Non Union ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Compression Plate ◽

The Mean

Background: Distal femur fractures need to be treated operatively to achieve optimal outcomes. Different types of internal fixation devices have been used but, the number of revisions for non-union, loss of reduction and implant failure has been high.Methods: This prospective study reviewed 20 cases of distal femoral fractures surgically managed with distal femoral locking compression plate between December 2013 and December 2015 at Mediciti Institute of medical sciences, Ghanpur, Medchal, tertiary care referral and trauma centre. Fractures were categorized according to OTA classification by Muller.Results: Highest number of patients was in their 3rd decade (25%) 18 out of 20 patients had closed injury. Type A2 Muller’s fracture was the most common fracture type 7 out of 20 patients (35%).The mean follow up period in this study was 8 months. The average range of knee flexion achieved was about 109°. The mean score 81.75 points were rated using Neer’s functional score (Max 100). Conclusions: The locking compression plate is the treatment of choice in the management of comminuted distal femoral fractures especially Type A fractures where we have found higher Neer scores. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is valuable in the management of these fractures.

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Functional outcome of non-vascularized fibula in gap non union

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195816 ◽

2019 ◽

Vol 6 (1) ◽

pp. 205

Author(s):

Amit Kumar Yadav ◽

Eknath Pawar ◽

Prasanna Kumar G. S. ◽

Akash Mane ◽

Abhishek Harssor ◽

...

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Bone Grafting ◽

Donor Site ◽

Fibular Graft ◽

Effective Treatment Option ◽

Non Union ◽

Special Skill ◽

Vascularized Fibula

Background: Gap non-union is one of the most perplexing problems facing the orthopedic surgeon today. Fibula is the preferred site of non-vascularized bone graft due to its easy accessibility to surgical resection and minimal donor site complications.Methods: The study comprised 11 patients of gap non-union between 13 to 80 years (mean=34.9 years). The fibular graft was harvested from the mid shaft and cortico-cancellous bone graft taken from the iliac crest was applied at both ends of the fibular graft to aid in union.Results: The average bone gap was 7 cm (4-13 cm). 64% of the patients achieved bone union after the first procedure, of the remaining 4 patients, 1 patient showed union after secondary cortico-cancellous bone grafting, while two are planned for the same. The remaining one patient has only completed 16 weeks follow-up at present and is not showing signs of union at present. Functional range of motion was achieved in both the proximal and distal joints in all cases.Conclusions: Non-vascularized fibular bone grafting is a simple and effective treatment option which does not require any special skill, has a very low complication rate and has very high patient compliance.

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The Safety and Antimicrobial Properties of Stabilized Hypochlorous Acid in Acetic Acid Buffer for the Treatment of Acute Wounds—a Human Pilot Study and In Vitro Data

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211015656 ◽

2021 ◽

pp. 153473462110156

Author(s):

Ewa A. Burian ◽

Lubna Sabah ◽

Klaus Kirketerp-Møller ◽

Elin Ibstedt ◽

Magnus M. Fazli ◽

...

Keyword(s):

Pilot Study ◽

Hypochlorous Acid ◽

Treatment Time ◽

Donor Site ◽

Antimicrobial Properties ◽

Prolonged Treatment ◽

Wound Irrigation ◽

The Mean ◽

And Performance

Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min ( P < .0001), and a 50% decrease for Staphylococcus aureus ( P = .1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.

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