scholarly journals Early definitive internal fixation for infected nonunion of the lower limb

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yong-Cheol Yoon ◽  
Chang-Wug Oh ◽  
Jae-Woo Cho ◽  
Jong-Keon Oh
Keyword(s):  
Internal Fixation ◽  
Lower Limb ◽  
Functional Results ◽  
Radical Resection ◽  
Infected Nonunion ◽  
Tissue Healing ◽  
Additional Surgery ◽  
Radical Debridement ◽  
The Mean ◽  
Definitive Surgery

Abstract Background The management of an infected nonunion of long bones is difficult and challenging. A staged procedure comprising radical debridement followed by definitive internal fixation was favored. However, no standard treatment has been established to determine the appropriate waiting period between initial debridement and definitive internal fixation. We propose a management method that incorporates early definitive internal fixation in infected nonunion of the lower limb. Methods Thirty-four patients (28 men and 6 women; mean age 46.09 years; range 25–74 years) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed in each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and a third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). In cases of unplanned additional surgery, the reason for the requirement was analyzed, and radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria. Results Bone union was achieved in all patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.35%). The mean interval between primary debridement and secondary definitive fixation was 2.76 weeks (range 2–4 weeks). Six unplanned additional surgeries were performed, and the infection relapsed in two cases. The radiological and functional outcomes were good or better in 32 and 31 patients, respectively. Conclusions Early definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoration of defective bones, and soft tissue healing through a systemic approach.

scholarly journals Early Definitive Internal Fixation for Infected Nonunion of The Lower Limb

2021 ◽  
Author(s):  
Yong-Cheol Yoon ◽  
Chang-Wug Oh ◽  
Jae-Woo Cho ◽  
Jong-Keon Oh
Keyword(s):  
Internal Fixation ◽  
Lower Limb ◽  
Functional Results ◽  
Radical Resection ◽  
Infected Nonunion ◽  
Tissue Healing ◽  
Additional Surgery ◽  
Radical Debridement ◽  
The Mean ◽  
Definitive Surgery

Abstract Background Management of an infected nonunion of the long bones is quite difficult and challenging. A staged procedure comprising of radical debridement followed by definitive internal fixation is favored. However, no standard treatment has been established for determining the appropriate waiting period between the initial debridement and the definitive internal fixation. We proposed a management incorporating early definitive internal fixation for infected nonunion of the lower limb. Methods Thirty-four patients (28 men and six women; mean age, 46.1 years; range, 25–74 years) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed for each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and the third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). In cases of unplanned additional surgery, the reason for the requirement was analyzed, and radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria. Results Bone union was achieved in 100% of the patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.4%). The mean interval between the primary debridement and the secondary definitive fixation was 2.76 weeks (range, 2–4 weeks). Six unplanned additional surgeries were performed, and the infection relapsed in two cases. The radiological and functional outcomes were good or better in 32 and 31 cases, respectively. Conclusions Early definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoring defected bones, and soft tissue healing through a systemic approach.

scholarly journals Early Definitive Internal Fixation for Infected Nonunion of the Lower Limb

2021 ◽  
Author(s):  
Yong-Cheol Yoon ◽  
Chang-Wug Oh ◽  
Jae-Woo Cho ◽  
Jong-Keon Oh
Keyword(s):  
Internal Fixation ◽  
Lower Limb ◽  
Functional Results ◽  
Radical Resection ◽  
Infected Nonunion ◽  
Active Response ◽  
Tissue Healing ◽  
Radical Debridement ◽  
The Mean ◽  
Definitive Surgery

Abstract Management of an infected nonunion of the long bones is quite difficult and challenging. A staged procedure comprising of radical debridement followed by definitive internal fixation is favored. However, no standard treatment has been established for determining the appropriate waiting period between the initial debridement and the definitive internal fixation. We proposed a management incorporating early definitive internal fixation for infected nonunion of the lower limb. Thirty-four patients (28 men, 6 women) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed for each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and the third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). Radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria. Bone union was achieved in 100% of the patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.4%). The mean interval between the primary debridement and the secondary definitive fixation was 2.76 weeks (range, 2–4 weeks). The radiological and functional outcomes were good or better in 32 and 31 cases, respectively. In conclusions, Early definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoring defected bones, and soft tissue healing through a systemic approach.

scholarly journals Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

2016 ◽  
Vol 4 (1) ◽  
pp. 28
Author(s):  
Rajeev Dwivedi ◽  
Ruban Raj Joshi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Treatment ◽  
Functional Results ◽  
Supracondylar Fracture ◽  
Supracondylar Fractures ◽  
Radiological Criteria ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Mean Time

Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.   Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.   Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.   Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

FACTORS AFFECTING THE FUNCTIONAL RESULTS OF OPEN REDUCTION AND INTERNAL FIXATION FOR FRACTURE-DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 107-114 ◽  
Author(s):  
Kentaro Watanabe ◽  
Yoshitake Kino ◽  
Hiroki Yajima
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
Fracture Dislocation ◽  
Factors Affecting ◽  
Flexion Extension ◽  
Motion Exercise ◽  
Fracture Dislocations ◽  
Pip Joint ◽  
The Mean

To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.

The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate

2018 ◽  
Vol 100-B (8) ◽  
pp. 1094-1099 ◽  
Author(s):  
S. Gupta ◽  
A. Malhotra ◽  
N. Mittal ◽  
S. K. Garg ◽  
R. Jindal ◽  
...  
Keyword(s):  
Functional Results ◽  
Cement Spacer ◽  
Segmental Defect ◽  
Locked Plate ◽  
Infected Nonunion ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Emotional Acceptance ◽  
Patient Reported ◽  
The Mean

Aims The aims of this study were to establish whether composite fixation (rail-plate) decreases fixator time and related problems in the management of patients with infected nonunion of tibia with a segmental defect, without compromising the anatomical and functional outcomes achieved using the classical Ilizarov technique. We also wished to study the acceptability of this technique using patient-based objective criteria. Patients and Methods Between January 2012 and January 2015, 14 consecutive patients were treated for an infected nonunion of the tibia with a gap and were included in the study. During stage one, a radical debridement of bone and soft tissue was undertaken with the introduction of an antibiotic-loaded cement spacer. At the second stage, the tibia was stabilized using a long lateral locked plate and a six-pin monorail fixator on its anteromedial surface. A corticotomy was performed at the appropriate level. During the third stage, i.e. at the end of the distraction phase, the transported fragment was aligned and fixed to the plate with two to four screws. An iliac crest autograft was added to the docking site and the fixator was removed. Functional outcome was assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. Patient-reported outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score. Results The mean age of patients was 38.1 years (sd 12.7). There were 13 men and one woman. The mean size of the defect was 6.4 cm (sd 1.3). the mean follow-up was 33.2 months (24 to 50). The mean external fixator index was 21.2 days/cm (sd 1.5). The complication rate was 0.5 (7/14) per patient. According to the classification of Paley, there were five problems and two obstacles but no true complications. The ASAMI bone score was excellent in all patients. The functional ASAMI scores were excellent in eight and good in six patients. The mean MSTS composite score was 83.9% (sd 7.1), with an MSTS emotional acceptance score of 4.9 (sd 0.5; maximum possible 5). Conclusion Composite fixation (rail-plate) decreases fixator time and the associated complications, in the treatment of patients of infected nonunion tibia with a segmental defect. It also provides good anatomical and functional results with high emotional acceptance. Cite this article: Bone Joint J 2018;100-B:1094–9.

scholarly journals Novel piston technique versus Ilizarov technique for the repair of bone defect after lower limb infection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiafei Du ◽  
Zifei Yin ◽  
Pengfei Cheng ◽  
Pei Han ◽  
Hao Shen
Keyword(s):  
Bone Healing ◽  
Lower Limb ◽  
Joint Stiffness ◽  
Functional Results ◽  
Bone Defects ◽  
Ilizarov Technique ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background We aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection. Patients and methods We retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. There were 38 men and three women with a mean age of 43.41 (range, 12–69 years). The infected bone defects involved 36 tibias and five femurs. The piston technique (PT, group A) was used in 12 patients and the Ilizarov technique (IT, group B) in 29 patients. The mean follow-up period was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate bone healing and functional recovery. Results Complete eradication of the infection and union of docking sites were accomplished in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between groups A and B (p = 0.558) (excellent [9 vs. 19], good [3 vs.10]); group A showed better functional outcomes than group B (p < 0.05) (excellent [7 vs. 6], good [4 vs. 12], fair [0 vs. 10] and poor [1 vs. 1]). Pain was the most common complaint during follow-up, and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8), and delayed healing of the joint (0 vs. 3). Conclusions Satisfactory bone healing can be achieved by using both PT and IT, although PT demonstrated better functional results, lower EFI, and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation.

scholarly journals Novel Piston Technique Versus Ilizarov Technique for The Repair of Bone Defect After Lower Limb Infection

2021 ◽  
Author(s):  
Jiafei Du ◽  
Zifei Yin ◽  
Pengfei Cheng ◽  
Pei Han ◽  
Hao Shen
Keyword(s):  
Bone Defect ◽  
Bone Healing ◽  
Lower Limb ◽  
Functional Results ◽  
Bone Defects ◽  
Ilizarov Technique ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background We described the use of a novel Piston technique versus Ilizarov technique to compare the effectiveness and complications for the repair of bone defect after lower limb infection. Patients and methods: We retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. They were 38 males and 3 females with a mean age of 43.41 (range 12 to 69 years). The infected bone defects involved 36 tibias and 5 femurs. Piston technique (PT, group A) was used in 12 patients and Ilizarov technique (IT, group B) in 29 ones. The mean duration of follow-up was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate the bone healing and functional recovery. Results Complete eradication of infection and union of docking sites were accomplished well in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between group A and B (p = 0.558) [excellent (9 vs. 19), good (3 vs.10)]; group A showed better functional outcomes than group B (p < 0.05) [excellent (7 vs. 6), good (4 vs. 12), fair (0 vs. 10) and poor (1 vs. 1)]. Pain was complained most during follow-up and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8) and delayed healing of the joint (0 vs. 3). Conclusions Satisfactory bone healing can be obtained by using both PT and IT, while PT had better functional results, lower EFI and allowed early removal of the external fixation. We have found that this novel Piston technique can improve the comfort of patients, reduce the incidence of complications, and provide a rapid and convenient rehabilitation.

Osteotomy for Correction of Premature Growth Plate Closure in 24 Dogs

1994 ◽  
Vol 07 (03) ◽  
pp. 129-135 ◽  
Author(s):  
C.W. Miller ◽  
P.W. Morgan
Keyword(s):  
Corrective Osteotomy ◽  
Functional Results ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Angular Deformity ◽  
Dynamic Correction ◽  
Age At Surgery ◽  
Limb Deformities ◽  
The Mean ◽  
A Prospective Study

SummaryTwenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.

Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

2020 ◽  
Vol 133 (3) ◽  
pp. 830-838 ◽  
Author(s):  
Andrea Franzini ◽  
Giuseppe Messina ◽  
Vincenzo Levi ◽  
Antonio D’Ammando ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Lower Limb ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Vas Score ◽  
The Mean ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

Digital volumetric measurements based on 3D scans of the lower limb: A valid and reproducible method for evaluation in lymphedema therapy. (Preprint)

2019 ◽  
Author(s):  
Daniel Schiltz ◽  
Natalie Kiermeier ◽  
Dominik Eibl ◽  
Christoph Koch ◽  
Karolina Müller ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
T Test ◽  
Volume Changes ◽  
Quick Method ◽  
Reproducible Method ◽  
The Mean ◽  
3D Scans ◽  
Paired T Test ◽  
Volumetric Measurements

BACKGROUND Exact quantification of volumetric changes of the extremities is difficult. There are several direct and indirect methods to assess extremity volume. As water displacement volumetry is rarely viable in a clinical setting and circumference measurements are prone to errors due to poor reproducibility and high inter- and intra-observer variability, an objective and easily reproducible method is indispensable. OBJECTIVE The aim of this study was to establish a standardized method based on 3D scans with defined caudal and cranial landmarks of the lower leg which allows for measurements of exactly the same body area. Furthermore, this study tests the method in terms of reproducibility and evaluates volume changes after surgical therapy in patients suffering from lymphedema. METHODS 3D-scans of the lower limb were performed with a mobile 3D-scanner. Volumetric calculation was done digitally. “Repeatability“ and “Inter-observer reliability” of digital volumetry were tested. Furthermore, the method was applied on 31 patients suffering from chronic lymphedema. ANOVA (analyses of variance) was conducted to compare the digital volumetric measurements. To assess the sensitivity to changes in digital volumetry, the mean volume of 31 patients before and 3 months after therapy were compared by a paired t-Test. RESULTS Calculations of repeatability of the volume based on 20 3D-scans of the same lower leg showed a mean volume of 2,488 ± 0,011 liters (range: 2,470 – 2,510). The mean volume of the 7 measurements of the 3 examiners did not differ significantly (F(2,18) = 1,579, p = .233). The paired t-Test showed a significant mean volume decrease of 375ml (95% CI = 245/505ml) between pre and post treatment (t (30) =5,892, p < .001). CONCLUSIONS 3D-Volumetry is a noninvasive, easy and quick method to assess volume changes of the lower leg. Other than the costs, it is reproducible and precise and therefore ideal for evolution of therapy in lymphedema.

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