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

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

scholarly journals Quadriceps-splitting midline approach in the treatment of distal femur infected nonuinon with stiff knee and severely scarred soft tissues

2020 ◽  
Vol 6 (2) ◽  
pp. 276
Author(s):  
Jeremy Bliss ◽  
Dan Barnabas Inja ◽  
Manasseh Nithyananth ◽  
Vinoo Mathew Cherian
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Soft Tissues ◽  
Distal Femur ◽  
Bony Union ◽  
Infected Nonunion ◽  
Non Union ◽  
Knee Stiffness ◽  
Iliac Crest Bone Grafting ◽  
Stiff Knee

<p class="abstract"><strong>Background:</strong> Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.<strong></strong></p><p class="abstract"><strong>Results:</strong> 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant <em>in situ</em>. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.</p><p class="abstract"><strong>Conclusions:</strong> In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover.</p>

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

1993 ◽  
Vol 18 (2) ◽  
pp. 219-224 ◽  
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.

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

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

<p class="abstract">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.</p>

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

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.

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

2019 ◽  
Vol 5 (6) ◽  
pp. 1102
Author(s):  
Abhijit Sen ◽  
Chandan Kulkarni ◽  
Ashok Meena
Keyword(s):  
Infection Control ◽  
Functional Outcome ◽  
Weight Bearing ◽  
Case Series ◽  
Cost Effective ◽  
Descriptive Study ◽  
Bony Union ◽  
Non Union ◽  
Excellent Outcome ◽  
Antibiotic Cement

<p class="abstract"><strong>Background: </strong>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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan

2021 ◽  
Vol 10 (2) ◽  
pp. 76-82
Author(s):  
Waqas Raza ◽  
Raja Irfan Qadir ◽  
Shabir Awan ◽  
Muhammad Abu Bakar
Keyword(s):  
External Fixation ◽  
General Hospital ◽  
Bone Grafting ◽  
Single Stage ◽  
Bone Union ◽  
Autogenous Bone ◽  
Long Bones ◽  
Infected Nonunion ◽  
Non Union

Background: Infected nonunion of long bones after fractures is one of the most challenging complication to treat in clinical practice. It is commonly treated by a two-stage approach; controlling infection initially and then application of external fixator and bone graft. Treatment with Ilizarov had been the gold standard but is associated with few complications. The objective of the study was to evaluate the clinical, radiological and functional outcomes of infected non-union of long bones treated with single-stage bone grafting and external fixation.Material and Methods: This retrospective study was carried out at Orthopedics Department of Northwest General Hospital, Peshawar Pakistan from 2014 to 2019. Medical records of 17 patients, aged 32 years and treated with Single-stage bone grafting and external fixation were reviewed. Nonunion included 7 humerii, 5 femurs, 3 tibias and 2 radius/ulna. Preoperative plain radiographs for any sequestrum or sclerosed bone margins and baseline investigations (like CBC, ESR, CRP and Vitamin-D status) were reviewed. All patients underwent radical debridement, reaming of intramedullary canals, external fixation and autogenous bone grafting. The outcomes evaluated were union of the bone (clinically and radiologically), resolution of infection, complication rate and number of re-intervention surgeries.Results: Among 17 patients, 10 were males and 7 were females. After treatment, mean follow-up duration was 9.414.48 months (4–18 months). None of the patients were lost to follow-up, had recurrence of infection or required further surgery. The mean duration of bone union was 8.4  4.48 months (range 3 to 17 months) and all of the patients achieved infection free union with satisfactory functional outcome.Conclusions: Single-stage bone grafting and external fixation is an effective technique in terms of resolution of infection and satisfactory bone union without any complications and can be used as an alternative to Ilizarov for treating cases of infected nonunion of long bones.

scholarly journals Recent advances in understanding NRF2 as a druggable target: development of pro-electrophilic and non-covalent NRF2 activators to overcome systemic side effects of electrophilic drugs like dimethyl fumarate

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2138 ◽  
Author(s):  
Takumi Satoh ◽  
Stuart Lipton
Keyword(s):  
Side Effects ◽  
Specific Interaction ◽  
Dimethyl Fumarate ◽  
Carnosic Acid ◽  
European Medicines Agency ◽  
Related Factor ◽  
Inflammatory Phase ◽  
First Case ◽  
Systemic Side Effects ◽  
Transcriptional Pathway

Dimethyl fumarate (DMF) is an electrophilic compound previously called BG-12 and marketed under the name Tecfidera®. It was approved in 2013 by the US Food and Drug Administration and the European Medicines Agency for the treatment of relapsing multiple sclerosis. One mechanism of action of DMF is stimulation of the nuclear factor erythroid 2-related factor 2 (NRF2) transcriptional pathway that induces anti-oxidant and anti-inflammatory phase II enzymes to prevent chronic neurodegeneration. However, electrophiles such as DMF also produce severe systemic side effects, in part due to non-specific S-alkylation of cysteine thiols and resulting depletion of glutathione. This mini-review presents the present status and future strategy for NRF2 activators designed to avoid these side effects. Two modes of chemical reaction leading to NRF2 activation are considered here. The first mode is S-alkylation (covalent reaction) of thiols in Kelch-like ECH-associated protein 1 (KEAP1), which interacts with NRF2. The second mechanism involves non-covalent pharmacological inhibition of protein-protein interactions, in particular domain-specific interaction between NRF2 and KEAP1 or other repressor proteins involved in this transcriptional pathway. There have been significant advances in drug development using both of these mechanisms that can potentially avoid the systemic side effects of electrophilic compounds. In the first case concerning covalent reaction with KEAP1, monomethyl fumarate and monoethyl fumarate appear to represent safer derivatives of DMF. In a second approach, pro-electrophilic drugs, such as carnosic acid from the herb Rosmarinus officinalis, can be used as a safe pro-drug of an electrophilic compound. Concerning non-covalent activation of NRF2, drugs are being developed that interfere with the direct interaction of KEAP1-NRF2 or inhibit BTB domain and CNC homolog 1 (BACH1), which is a transcriptional repressor of the promoter where NRF2 binds.

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

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