A Rare Presentation with Segmental Gap Non-union in Proximal Phalanx Fracture of Thumb in Child: A Case Report

Introduction:Traumatic injuries of to hand are not uncommon in the pediatric population and most of them are managed by conservative means and rarely surgical intervention required. There is a very rare incidence of delayed union or non-union in these fractures and found a very few numbers of sporadic cases documented in English literature. Case Report:We described delayed presentation of post-traumatic gap non-union of proximal phalanx of thumb in a child who presented with severe disability of hand especially writing and grasping. He was managed as open reduction, tibial strut bone grafting, and internal fixation with crossed Kirchner wire and followed for a period of minimum of 2 years. The fracture united radiologically and healed well clinically, whereas functional outcomes were excellent. There was no difficulty in writing and activity of daily living with operated hand while having comparative cosmetic appearance to other hand. Conclusion:Non-union of phalanx fractures are very rare in the pediatric population whereas excellent clinical and functional outcomes can be achieved with adequate stable fixation and autologous bone grafting. Keywords:Gap non-union, proximal phalanx, fracture, skeletally immature, tibial strut graft

Download Full-text

Principles of bone grafting: non-union, delayed union

Surgery (Oxford) ◽

10.1383/surg.2006.24.6.207 ◽

2006 ◽

Vol 24 (6) ◽

pp. 207-210 ◽

Cited By ~ 2

Author(s):

JL Marsh

Keyword(s):

Bone Grafting ◽

Delayed Union ◽

Non Union

Download Full-text

Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications

Journal of Nepal Medical Association ◽

10.31729/jnma.2847 ◽

2016 ◽

Vol 55 (204) ◽

pp. 55-60 ◽

Cited By ~ 9

Author(s):

Kapil Mani KC ◽

Parimal Acharya ◽

Arun Sigdel

Keyword(s):

Functional Outcomes ◽

Skin Irritation ◽

Limb Lengthening ◽

Delayed Union ◽

Tibial Fractures ◽

Entry Site ◽

Superficial Infection ◽

Non Union ◽

Fractures In Children ◽

Tibia Fractures

Introduction: Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation.Methods: This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination.Results: Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture.Conclusions: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions. Keywords: complications; functional outcomes; tibia fractures. | PubMed

Download Full-text

Principles of Bone Grafting: Non-union, Delayed Union

Surgery (Oxford) ◽

10.1383/surg.21.9.213.16925 ◽

2003 ◽

Vol 21 (9) ◽

pp. 213-216 ◽

Cited By ~ 1

Author(s):

JL Marsh

Keyword(s):

Bone Grafting ◽

Delayed Union ◽

Non Union

Download Full-text

Platelet-Rich Plasma Combined With Autologous Grafting in the Treatment of Long Bone Delayed Union or Non-union: A Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.621559 ◽

2021 ◽

Vol 8 ◽

Author(s):

Weijun An ◽

Peng Ye ◽

Tao Zhu ◽

Zhizhong Li ◽

Jianbin Sun

Keyword(s):

Subgroup Analysis ◽

Bone Grafting ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Combined Treatment ◽

Delayed Union ◽

Long Bone ◽

Non Union ◽

Autologous Bone Grafting ◽

Autologous Bone

Background: Platelet-rich plasma (PRP) has been suggested as an emerging treatment for bone defects. However, whether PRP could enhance the therapeutic efficacy of autologous bone grafting for long bone delayed union or non-union remains unknown. A meta-analysis of randomized and non-randomized controlled trials (RCT and NRCT) was performed to summarize current evidence.Methods: Relevant RCTs and NRCTs comparing the influences of autologous bone grafting on healing of long bone delayed union or non-union with and without PRP were obtained by searching PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure, and WanFang databases from inception to September 10, 2020. A random-effect model was applied to pool the results with the incorporation of the potential heterogeneity. Subgroup analysis according to study design was also performed.Results: Six RCTs and two NRCTs with 420 patients were included. Compared to patients allocated to autologous bone grafting alone, those allocated to combined treatment with PRP and autologous bone grafting were not associated with higher rates of radiographic bone healing [risk ratio (RR): 1.06, 95% confidence interval (CI): 0.99–1.13, P = 0.09; I2 = 24%] or excellent/good posttreatment limb function (RR: 1.14, 95% CI: 0.95–1.37, P = 0.37; I2 = 0%) but was associated with a shorter healing time (mean difference: −1.35 months, 95% CI: −1.86 to −0.84, P < 0.001; I2 = 58%). Subgroup analysis according to study design showed similar results for the above outcomes (P-values for subgroup difference all >0.10).Conclusions: Combined treatment with PRP and autologous bone grafting may be effective to accelerate the healing of long bone delayed union or non-union compared to autologous bone grafting alone.

Download Full-text

Operative fixation for complex tibial fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221498668 ◽

2012 ◽

Vol 94 (1) ◽

pp. 34-38 ◽

Cited By ~ 10

Author(s):

AJP Hutchinson ◽

AE Frampton ◽

R Bhattacharya

Keyword(s):

English Literature ◽

Surgical Techniques ◽

Delayed Union ◽

Tibial Fractures ◽

Fixation Technique ◽

Non Union ◽

Fixation Techniques ◽

Secondary Procedures ◽

Operative Fixation ◽

Tibial Shaft Fractures

INTRODUCTION The management of open tibial shaft fractures remains challenging. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation technique remains unresolved. In this article the outcomes of these two surgical techniques are compared. METHODS A comprehensive literature search was conducted through MEDLINE® using Ovid® and MeSH (Medical Subject Heading) terms for articles published in the English literature between 1999 and 2009. The outcome measures compared were time to fracture union, infection rates and complications. RESULTS Forty-one studies were identified, of which only three met the inclusion criteria. The average time to union was variable. Delayed union and non-union appeared to be more prevalent in the external fixator group although this was not statistically significant. Both techniques were associated with secondary procedures as well as infection. CONCLUSIONS The current literature indicates little evidence to suggest the superiority of one fixation technique over another for open tibial fractures.

Download Full-text

Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191046 ◽

2019 ◽

Vol 5 (3) ◽

pp. 417

Author(s):

Jaspreet Singh ◽

Harpal Singh Selhi ◽

Rahul Gupta ◽

Gurleen Kaur

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Locking Plate ◽

Femoral Fractures ◽

Delayed Union ◽

Bony Union ◽

Proximal Femoral Fractures ◽

Superficial Infection ◽

Non Union ◽

Wound Breakdown

Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted.

Download Full-text

Failure of Surgery for Scaphoid Non-Union is Associated with Smoking

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.12.010 ◽

2006 ◽

Vol 31 (3) ◽

pp. 252-255 ◽

Cited By ~ 58

Author(s):

C. P. LITTLE ◽

B. J. BURSTON ◽

J. HOPKINSON-WOOLLEY ◽

P. BURGE

Keyword(s):

Bone Grafting ◽

Smoking Prevalence ◽

Screw Fixation ◽

Delayed Union ◽

Proximal Pole ◽

Non Union ◽

Scaphoid Fractures ◽

The Uk ◽

Vascularized Bone

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3–10.1, p = 0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

Download Full-text

Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist

Journal of Wrist Surgery ◽

10.1055/s-0036-1597681 ◽

2016 ◽

Vol 06 (03) ◽

pp. 183-187 ◽

Cited By ~ 2

Author(s):

Matthias Vanhees ◽

Roger van Riet ◽

Annemieke van Haver ◽

Radek Kebrle ◽

Geert Meermans ◽

...

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Delayed Union ◽

Percutaneous Technique ◽

Dash Score ◽

Delayed Presentation ◽

Nonunion Site ◽

Significant Difference ◽

Radiographic Union

Purpose We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting. Methods Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients with bone graft, sclerotic bone debridement, or displacement of the fragment at the nonunion site were excluded. A percutaneous transtrapezial fixation technique was used in all cases. Patients were reviewed until clinical and radiographic union was observed. At the final follow-up, DASH (Disabilities of the Arm, Shoulder and Hand) and PRWHE (Patient-Rated Wrist and Hand Evaluation) outcome scores were completed. Results Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow-up of 36 months (range: 12–98 months). No complications from the percutaneous technique were noted. The average DASH score was 6 (range: 0–39) and the average PRWHE score was 10 (range: 0–56). No statistical significant difference in range of motion and grip strength was found between the operated side and the contralateral side. Conclusion Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid fractures without bone grafting is promising. At a mean of 4 months, 94% union was obtained with good functional results when there was no sclerosis, minimal osteolysis, and no displacement at the scaphoid nonunion site. Type of Study Therapeutic study. Level of Evidence IV.

Download Full-text