Descriptive study of outcome of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of weight bearing long bones

Background: Infected non-union of tibia and femur is a debilitating disorder for patient as well as challenging task for treating surgeon. Conventionally treatment of infected non-union is a two staged procedure. But antibiotic cement-impregnated intramedullary nailing (ACIINs) is a single staged and cost-effective procedure. Hence we intended to study the outcome of ACIIN use in infected non-union of tibia and femur.Methods: This is a hospital based prospective case series type of descriptive study conducted in Department of Orthopedics, SMS Medical College and Hospital, Jaipur. We studied 35 cases of infected non-union of femur and tibia fracture with interlock nail in situ. All patients were treated with interlock nail removal, debridement and freshening of sclerosed bony ends and fixation with ACIIN. All were followed for at least 6 months for infection control and bony union and final results were evaluated by Paley’s bony criteria and functional criteria.Results: Infection was controlled in 94.28% cases. Bony union was achieved in 88.57% cases (19 femur and 12 tibia). Average duration for bony union was 7.3 months for femur and 8 months for tibia. According to Paley’s criteria for bony outcome and functional outcome 65.71% and 51.43% had shown excellent outcome respectively.Conclusions: ACIIN is a good modality for treatment of infected non union of tibia and femur in terms of infection control and bony union and has a good functional outcome when bone gap is less.

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Comparative Study of Conservative Vs Surgical Management of Clavicle Fractures

Galore International Journal of Health Sciences and Research ◽

10.52403/gijhsr.20210101 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1-5

Author(s):

Vivek Phanswal

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Clavicle Fracture ◽

Delayed Fracture ◽

Non Union ◽

Conservative Group ◽

Excellent Outcome ◽

Fracture Management ◽

Clavicle Fractures ◽

Radiological Union

Background: Clavicle Fractures is one of the common fractures of upper limb accounting for approximately 40 % of all shoulder fractures. Till recently all clavicle fracture were treated conservatively, but now interest in surgical management is rising. This study was carried out to see if Surgical management outweighs the conservative treatment of Fractures Of Clavicle. Methods: A total of 40 cases satisfying inclusion and exclusion criteria were included in the study. Alternate patients were allocated to operative and conservation groups. In total 20 patients were operated operatively and 20 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Constant and Murley score was used as a score to evaluate final outcome. Results: In this study, the 20 patients who were operated upon had an average union time of 7.8 weeks; 1 patient had delayed fracture union by 12 wks. 20 patients in conservative group had normal union of fractures with 1 patient going into non-union. Average union time in the conservative group was 9.4 weeks, which was more than the 7.8 weeks seen in the group treated operatively. Mal-union was present in 7 of the 20 patients treated conservatively, and 5 of these 7 had a visible deformity. Out of these patients with mal-union 1 had poor functional outcome, 3 had good to excellent outcome and 3 had satisfactory functional outcome. 4 of these had restricted movements terminally and 2 had pain on movement. Conclusions: From our study based on patients of clavicle fractures, it can be concluded that the operative group had significantly higher excellent outcomes as compared to the conservatively- managed group, based on the Constant and Murley score. Keywords: Clavicle Fractures, Constant and Murley Score, Operative Clavicle Fracture Management, Clavicle Fracture Functional Outcome.

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Scaphoid Non-Union: Factors Affecting the Functional Outcome of Open Reduction and Wedge Grafting with Herbert Screw Fixation

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90114-u ◽

1993 ◽

Vol 18 (2) ◽

pp. 219-224 ◽

Cited By ~ 63

Author(s):

R. NAKAMURA ◽

E. HORII ◽

K. WATANABE ◽

K. TSUNODA ◽

T. MIURA

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Open Reduction ◽

Screw Fixation ◽

Functional Results ◽

Bony Union ◽

Proximal Fragment ◽

Factors Affecting ◽

Non Union ◽

Herbert Screw

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensiner control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.

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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171891 ◽

2017 ◽

Vol 3 (3) ◽

pp. 497

Author(s):

Vijaysing S. Chandele ◽

Abhishek P. Bhalotia ◽

Milind V. Ingle ◽

Maroti R. Koichade

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Weight Bearing ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Early Weight Bearing ◽

Non Union ◽

Approach Time

Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214965 ◽

2021 ◽

Vol 8 (1) ◽

pp. 72

Author(s):

Potharaju Swetha Rani ◽

M. Zeeshan Vasif

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Constant Score ◽

Clavicle Fracture ◽

High Energy ◽

Bony Union ◽

Non Union ◽

Fall From Height ◽

Clavicle Fractures ◽

A Prospective Study

Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.

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Functional Outcome of Antibiotic Impregnated Nail in Infected Non-Union of Tibia and Femur - A Prospective Observational Study, Trichur, Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/483 ◽

2021 ◽

Vol 8 (29) ◽

pp. 2620-2624

Author(s):

Arjun Dev Naroth Palakandy ◽

Manoj Murungodiyil Kunjappan ◽

Jose Francis

Keyword(s):

Side Effects ◽

Functional Outcome ◽

Bone Grafting ◽

Bony Union ◽

High Concentration ◽

Duration Of Treatment ◽

Infected Nonunion ◽

Non Union ◽

Open Injury ◽

Systemic Side Effects

BACKGROUND Infected non-union is a complex, debilitating and challenging disorder affecting orthopaedic surgeon and patient in terms of cost and time.1 Antibiotic impregnated nail has been a cheap and effective method used for treatment of infected nonunion. Factors that may lead to infected non-union are many.2,3 High local concentrations of antibiotics with minimal systemic levels and without systemic side effects make local antibiotic therapy a very useful technique in treating infected non-union. 4 Buchholz and Engelbrecht were the first to use antibiotic impregnated cement.5 Major advantage of using antibiotic impregnated cement is, it provides high concentration of antibiotics locally with less systemic side effects.6 The purpose of this study was to determine the functional outcome of antibiotic impregnated nail in treatment of infected non-union of femur and tibia. Antibiotic cement impregnated intra-medullary nail can provide stability, help in control of infection,7 is easy to remove, and also provides all the advantages of the cement beads.8,9 METHODS This prospective study was done on 25 cases at Government Medical College Thrissur from 01 September 2016 to 01 April 2018. Functional results were evaluated with regard to control of infection, bony union, deformity, limb leg discrepancy and complications (both intra and post-operative complications). RESULTS Most of the cases had type 2 open injury initially, accounting for 49 %. Staphylococcus aureus was reported in 56 % of cases. Infection control was achieved in 23 cases. Bony union was visualised in 18 cases, remaining 5 cases united following bone grafting. In 2 cases there was no control of infection and no bony union was achieved, later antibiotic nail removal and Ilizarov fixation was planned. Bone grafting was done in 10 cases. CONCLUSIONS Antibiotic impregnated cement nailing is a simple, economical and very effective procedure with less complication and shorter duration of treatment when compared with other conventional procedures. KEYWORDS Infected Non-Union, Long Bones, Antibiotic Impregnated Cement Nail

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Experience with free fibula transfer with screw fixation as a primary modality of treatment for congenital pseudarthosis of tibia in children - Series of 26 cases

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.105951 ◽

2012 ◽

Vol 45 (03) ◽

pp. 468-477 ◽

Cited By ~ 5

Author(s):

Guru Dayal Singh Kalra ◽

Amit Agarwal

Keyword(s):

Weight Bearing ◽

Treatment Options ◽

Bony Union ◽

Non Union ◽

Fibula Graft ◽

Congenital Pseudarthrosis ◽

Free Fibula ◽

Paediatric Orthopaedic ◽

Primary Modality

ABSTRACTBackground: Congenital pseudarthrosis is one of the greatest challenges of paediatric orthopaedic practice. Treatment options and literature addressing this condition are numerous, reflecting the difficulty in management. We aimed to study the effectiveness of free fibula transfer as a primary modality of treatment in children with this condition in terms of achieving length, union, and normal axis of the involved leg. Materials and Methods: During the period of 2001 to 2010, 26 children with congenital pseudarthrosis of tibia between age group of 2-8 years were evaluated and were reconstructed using contra-lateral free fibula graft, and then patients were followed up for 5 years subsequently. Patients were examined and time of bony union, weight bearing ability and walking without support were noted. Any complication directly or indirectly related to surgery with any complication seen in the due course of follow up of 5 years was also taken care of. Results: In our experience with treatment of congenital pseudarthrosis over a span of 10 years with free fibula transfer, the results have been gratifying with no flap loss. All our patients had UNEVENTFUL post-op recovery. Only 2 patients out of 26 had non-union, for which cancellous bone grafting was done (7.6%). Most of the patients were ambulatory with support by 3-6 months and continued to walk without support after a span of 18-24 months. The incidence of stress fracture in our study over the follow-up period was 4 out of 26 pts (15.3%). None of them had any deformity in the donor leg. Conclusion: When compared to other surgical modalities of treatment of the problem in question, vascularised free fibula transfer has emerged as a real saviour with good patient compliance and less complication rate in our study. It achieves the desired target with no residual deformities and near normal to normal gait with no stigma of bone removal from other leg.

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Descriptive study of functional outcome and complication of fracture calcaneum treated with locking calcaneum plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191791 ◽

2019 ◽

Vol 5 (3) ◽

pp. 498

Author(s):

Amit Jain ◽

R. C. Meena ◽

Laxman Choudhary ◽

Jitesh Jain ◽

Abhishek Chandra ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Weight Bearing ◽

Descriptive Study ◽

Calcaneal Fracture ◽

Lateral Approach ◽

Soft Tissue Envelope ◽

Medical College ◽

Type Iv

Background: Fracture of calcaneum accounts for about 2% of all fractures and 75% of all calcaneum fractures are intra-articular. Numerous controversies existed regarding optimal treatment of displaced intraarticular calcaneum fractures. In this study evaluate post-operative functional outcome and complication of fracture calcaneum treated with locking calcaneum plate.Methods: This hospital based prospective descriptive study was conducted on 108 patients (120 calcaneum fracture) operated between July 2016 to December 2018 by open reduction and internal fixation with locking calcaneum plate through extensive lateral approach at Department of Orthopaedics, SMS Medical college and hospital, Jaipur. All close displaced intraarticular calcaneal fracture was included in the study.Results: Average duration between injury and surgery was 8.3±2.97 days. Out of 120 calcaneum fracture 52 fractures (43.33%) were Sander’s type II, 52 fractures (43.33%) were Sander’s type III, and 16 fractures (13.33%) were Sander’s type IV. Pain on weight bearing was noted in 20 patients (16.66%) implant prominence was noted in 8 patients and delayed wound healing was seen in 4 patients. Maryland foot score was excellent in 44 fracture (36.67%), good in 56 fractures (46.67%), fair in 8 fractures (6.67%), and poor in 12 fractures (10%).Conclusions: Open reduction and internal ﬁxation (ORIF) with locking calcaneum plate in an indicated case, with respect to soft tissue envelope and early rehabilitation, leads to better therapeutic results as compared to other operative technique.

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A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194821 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1150

Author(s):

Parag M. Tank ◽

Yash S. Shah ◽

Rutvik D. Dave ◽

Vijay J. Patel

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Functional Outcomes ◽

Bone Fractures ◽

Case Series ◽

Functional Results ◽

Dash Score ◽

Retrospective Case ◽

Non Union ◽

Case Series Study

Background: The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.Methods: This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.Results: Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.Conclusions: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

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Highly Cancellous Titanium Alloy (TiAl6V4) Surfaces on Three-Dimensionally Printed, Custom-Made Intercalary Tibia Prostheses: Promising Short- to Intermediate-Term Results

Journal of Personalized Medicine ◽

10.3390/jpm11050351 ◽

2021 ◽

Vol 11 (5) ◽

pp. 351

Author(s):

Wiebke K. Guder ◽

Jendrik Hardes ◽

Markus Nottrott ◽

Lars E. Podleska ◽

Arne Streitbürger

Keyword(s):

Titanium Alloy ◽

Limb Salvage ◽

Soft Tissues ◽

Weight Bearing ◽

Distal Tibia ◽

Case Series ◽

Complication Rates ◽

Non Union ◽

Custom Made ◽

3D Printed

Custom-made, three-dimensionally-printed (3D) bone prostheses gain increasing importance in the reconstruction of bone defects after musculoskeletal tumor resections. They may allow preservation of little remaining bone stock and ensure joint or limb salvage. However, we believe that by constructing anatomy-imitating implants with highly cancellous titanium alloy (TiAl6V4) surfaces using 3D printing technology, further benefits such as functional enhancement and reduction of complications may be achieved. We present a case series of four patients reconstructed using custom-made, 3D-printed intercalary monobloc tibia prostheses treated between 2016 and 2020. The mean patient age at operation was 30 years. Tumor resections were performed for Ewing sarcoma (n = 2), high-grade undifferentiated pleomorphic bone sarcoma (n = 1) and adamantinoma (n = 1). Mean resection length was 17.5 cm and mean operation time 147 min. All patients achieved full weight-bearing and limb salvage at a mean follow-up of 21.25 months. One patient developed a non-union at the proximal bone-implant interface. Alteration of implant design prevented non-union in later patients. Mean MSTS and TESS scores were 23.5 and 88. 3D-printed, custom-made intercalary tibia prostheses achieved joint and limb salvage in this case series despite high, published complication rates for biological and endoprosthetic reconstructions of the diaphyseal and distal tibia. Ingrowth of soft tissues into the highly cancellous implant surface structure reduces dead space, enhances function, and appears promising in reducing complication rates.

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Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00312 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0031

Author(s):

Leonardo V. M. Moraes ◽

Stéfani C. Kelly ◽

James R. Jones ◽

Haley McKissack ◽

Aaradhana J. Jha ◽

...

Keyword(s):

Postoperative Complications ◽

Weight Bearing ◽

Case Series ◽

Wound Dehiscence ◽

Fracture Treatment ◽

Retrospective Case ◽

Early Weight Bearing ◽

Non Union ◽

Jones Fracture ◽

Radiographic Union

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.

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