scholarly journals Prospective Evaluation of Role of Limb Reconstruction System (Rail External Fixator) in Open Fractures and Infected Non-union of Femur

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hemant Singh Chahar ◽  
Mayur Gupta ◽  
Vinod Kumar ◽  
Rohit Yadav ◽  
Jaydeep Patel ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Functional Results ◽  
Open Fractures ◽  
Long Bone ◽  
Limb Reconstruction ◽  
Non Union ◽  
Femur Fractures

Introduction: Severe open fractures continue to be a nightmare for orthopedicians even with use of more accepted line of treatment. Open fractures and infected non-union of femur bone are not infrequently seen in orthopedic wards as femur is the most common long bone injured. We present a case series of 14 such patients treated successfully with limb reconstruction system enabling recovery to pre-injury status and activities. Case Series: The present study was done to access the role of limb reconstruction system in the management of open femur fractures and in infected non-union with modifications to meet the requirements of each case. We viewed the results of treatment of 14 cases of late presentation with complicated open femur fractures and infected non-unions. Average time of fixator removal was 4 months–24 months. Average follow-up duration was 18 months (range 6?36 months). Evaluation of results was based on ASAMI criteria. The excellent bone results were obtained in 85.72% of cases while 7.14% showed good and 7.14% were poor results. Excellent functional results were observed in 71.43% of cases and 28.57% of cases shows good and fair results. Conclusion: The use of limb reconstruction system is based on compression and distraction technique. It was found to be a simple and effective modality for open injuries in terms of enhanced union rate, rapid rehabilitation, and easy care of soft-tissue injury along with bone loss, thus avoiding multiple surgeries. Keywords: Open fracture, non-union, femur, limb reconstruction system, ASAMI criteria.

scholarly journals Open fractures of the lower extremity

2018 ◽  
Vol 3 (5) ◽  
pp. 316-325 ◽  
Author(s):  
Abdel Rahim Elniel ◽  
Peter V. Giannoudis
Keyword(s):  
Lower Extremity ◽  
Injury Severity ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Open Fractures ◽  
Long Bone ◽  
Definitive Treatment ◽  
Severe Injuries ◽  
Non Union ◽  
Severity Scores

Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate. This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management. The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility. Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type. Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality. Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

Role of Reamed and Unreamed Interlocking Intermedullary Nailing in the Management of Compound Fracture of Shaft Tibia

2014 ◽  
Vol 23 (Number 2) ◽  
pp. 21-26
Author(s):  
Md. F Ahmed ◽  
Md. M Rahman ◽  
K Dipu ◽  
Md. N Islam
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Deep Infection ◽  
Medullary Canal ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Non Union ◽  
Interlocking Nailing ◽  
Open Injury

Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. The study was done to compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

scholarly journals Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Karim Bakhsh ◽  
Faridullah Khan Zimri ◽  
Atiq -Ur- Rehman ◽  
Eid Mohammad ◽  
Muhammad Saaiq
Keyword(s):  
Distraction Osteogenesis ◽  
Case Series ◽  
Femoral Fractures ◽  
Functional Results ◽  
Rehabilitation Medicine ◽  
Bone Union ◽  
Ilizarov Method ◽  
Non Union ◽  
Femur Fractures ◽  
Case Series Study

Objective: To evaluate the management outcome of complex non-union of femoral fractures with Ilizarov method in terms of bone union, functional results and any complications. Methods: This case series study was carried out at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of three and half years, January 1, 2015 to June 30,2018. Results: There were 50 patients in the study. There were 48(96%) males and 2(4%) females. The ages ranged between 17-54 years with a mean of 33.58±8.9 years. As per ASAMI criteria, the bone results were excellent in 17(34%), good in 30(60%), fair in 1(2%) and poor in 2(4%) patients. The functional results were excellent in 15(30%), good in 24(48%), fair in 8(16%) and poor in 3(6%). The bone union rate was 98% whereas infection eradication rate was 94%. The most frequent complications were pin tract infection affecting 80% patients, knee stiffness 60% patients and K-wires loosening 20% patients. Conclusion: The Ilizarov method provides an effective solution to address the complex non-union of femur fractures. It helps to ensure fracture healing, eradicates infection and provides good functional outcome. The attended complications are mild to moderate and manageable with conservative means. doi: https://doi.org/10.12669/pjms.35.4.244 How to cite this:Bakhsh K, Zimri FK, Atiq-Ur-Rehman, Mohammad E, Saaiq M. Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.244 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals APPROACH TOWARDS DEVELOPING AN ALGORITHM FOR GAP NONUNION

2020 ◽  
pp. 1-6
Author(s):  
Nirjhar Maji
Keyword(s):  
Tertiary Care ◽  
Functional Results ◽  
Time Frame ◽  
Activity Level ◽  
Treatment Modalities ◽  
Long Bone ◽  
Care Hospital ◽  
Non Union ◽  
Formidable Challenge ◽  
Back Ground

Back ground and objectives The treatment of Gap or Defect non-union presents a formidable challenge to Orthopaedic surgeons. Not only a union but also good functional outcome is the target of modern-day Orthopaedics. The objective of this study is to consider knowledge of all treatment modalities, time frame, and functional results of long bone defects and develop an algorithm. Summary The study is designed as retrospective, prospective observational study. It is conducted in tertiary care hospital (MIOT Hospitals, Chennai). Initial evaluation of all cases were done by Maurizio Catagni’s Classification. Type of surgeries, time spent in hospital, union time were calculated. Patients were followed up for a period of 1year. Patients with average defect size of 6.29cm on an average underwent 4.47 procedures and for an overall time of 17.8 weeks with around 83.80 % of individuals were able to return to their preinjury activity level. Analysis of all data was done and algorithm developed.

Analysis of Outcomes of Vascularized Flap Reconstruction in Patients with Advanced Mandibular Osteoradionecrosis

2009 ◽  
Vol 141 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Daniel S. Alam ◽  
Michael Nuara ◽  
James Christian
Keyword(s):  
Data Collection ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Fistula Formation ◽  
Wound Complications ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
End Stage

OBJECTIVE: To examine outcomes of vascularized bone flap reconstruction of end-stage osteoradionecrosis of the mandible. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care academic hospital. SUBJECTS: Patients with end-stage radiation-induced osteoradionecrosis (ORN) refractory to conservative therapy with wound complications including chronic infections, fistula formation, and pathologic fracture were included. RESULTS: Outcomes of 33 patients were prospectively collected and analyzed, making this the largest series on this subject in the literature and the only one with planned data collection. Data on preoperative variables including radiation dose, sub-site location, treatment date, and prior therapy, along with intraoperative issues and postoperative outcomes, were tracked and are presented. ORN was seen to develop in a bimodal distribution based on the timing of interval surgical intervention. The extent of local soft tissue injury often required the use of contralateral recipient vessels. Local wound complication rates were higher than that seen in primary reconstructions. CONCLUSIONS: Successful reconstruction was achieved in all of the patients in this series. Long-term resolution of infectious complication and disease resolution was seen in 91 percent of the patients in this series.

scholarly journals The role of valgus osteotomy with DHS fixation in the management of fracture nonunion of the neck of femur

2017 ◽  
Vol 4 (1) ◽  
pp. 166
Author(s):  
Yeshwanth Subash
Keyword(s):  
Femoral Head ◽  
Functional Results ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Non Union ◽  
Neck Shaft Angle ◽  
Fracture Nonunion ◽  
The Mean ◽  
The Right

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral head</span><span lang="EN-IN">in younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation</span><span lang="EN-IN">(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 34<sup>0</sup> while the neck shaft angle was 135.2<sup>0</sup>. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results.</span></p>

scholarly journals Role of PRP injection in delayed union and non union of long bone fractures

2020 ◽  
Vol 6 (1) ◽  
pp. 35-40
Author(s):  
Apser Khan ◽  
◽  
Suresh Kumar Kaushik ◽  
Mrigank Mathur ◽  
Milan Jaiswal ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Long Bone Fractures

scholarly journals Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

2014 ◽  
pp. 173-178 ◽  
Author(s):  
Carlos Oliver Valderrama-Molina ◽  
Mauricio Estrada-Castrillón ◽  
Jorge Andres Hincapie ◽  
Luz Helena Lugo-Agudelo
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Interobserver Agreement ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Lower Extremities ◽  
Tibial Pilon ◽  
Pilon Fractures

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series

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