scholarly journals Management of Infection After Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes

2013 ◽  
Vol 7 (1) ◽  
pp. 219-226 ◽  
Author(s):  
Kostas G Makridis ◽  
Theodoros Tosounidis ◽  
Peter V Giannoudis
Keyword(s):  
Bone Fractures ◽  
Stage Iii ◽  
Long Bone ◽  
Unusual Complication ◽  
Antibiotic Administration ◽  
Treatment Protocols ◽  
Long Bone Fractures ◽  
Ilizarov Frame ◽  
Exchange Nailing ◽  
Im Nailing

Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.

The 2+2 Rule in the Management of Long Bone Fractures in Patients with Severe Multiple Trauma

2009 ◽  
Vol 81 (11) ◽  
Author(s):  
Leszek Brongel ◽  
Wiesław Jarzynowski ◽  
Piotr Budzyński ◽  
Waldemar Hładki ◽  
Jacek Lorkowski ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Bone Fractures ◽  
Long Bone ◽  
Severe Multiple Trauma ◽  
Long Bone Fractures

Advances in the management of long bone fractures

2016 ◽  
Vol 2016 (2) ◽  
pp. 12-14
Author(s):  
Toby Gemmill ◽  
Dylan Clements
Keyword(s):  
Bone Fractures ◽  
Long Bone ◽  
Long Bone Fractures

No racial or ethnic disparity in treatment of long-bone fractures

2008 ◽  
Vol 26 (3) ◽  
pp. 270-274 ◽  
Author(s):  
Polly Bijur ◽  
Anick Bérard ◽  
Jordan Nestor ◽  
Yvette Calderon ◽  
Michelle Davitt ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Ethnic Disparity ◽  
Long Bone ◽  
Long Bone Fractures

scholarly journals Percutaneous administration of allogeneic bone-forming cells for the treatment of delayed unions of fractures: a pilot study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Marc Jayankura ◽  
Arndt Peter Schulz ◽  
Olivier Delahaut ◽  
Richard Witvrouw ◽  
Lothar Seefried ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Phase I ◽  
Bone Fractures ◽  
Fracture Site ◽  
Post Treatment ◽  
Long Bone ◽  
Allogeneic Bone ◽  
Hla Antibodies ◽  
Long Bone Fractures

Abstract Background Overall, 5–10% of fractures result in delayed unions or non-unions, causing major disabilities and a huge socioeconomic burden. Since rescue surgery with autologous bone grafts can cause additional challenges, alternative treatment options have been developed to stimulate a deficient healing process. This study assessed the technical feasibility, safety and preliminary efficacy of local percutaneous implantation of allogeneic bone-forming cells in delayed unions of long bone fractures. Methods In this phase I/IIA open-label pilot trial, 22 adult patients with non-infected delayed unions of long bone fractures, which failed to consolidate after 3 to 7 months, received a percutaneous implantation of allogeneic bone-forming cells derived from bone marrow mesenchymal stem cells (ALLOB; Bone Therapeutics) into the fracture site (50 × 106 to 100 × 106 cells). Patients were monitored for adverse events and need for rescue surgery for 30 months. Fracture healing was monitored by Tomographic Union Score (TUS) and modified Radiographic Union Score. The health status was evaluated using the Global Disease Evaluation (GDE) score and pain at palpation using a visual analogue scale. The presence of reactive anti-human leukocyte antigen (HLA) antibodies was evaluated. Results During the 6-month follow-up, three serious treatment-emergent adverse events were reported in two patients, of which two were considered as possibly treatment-related. None of the 21 patients in the per-protocol efficacy population needed rescue surgery within 6 months, but 2/21 (9.5%) patients had rescue surgery within 30 months post-treatment. At 6 months post-treatment, an improvement of at least 2 points in TUS was reached in 76.2% of patients, the GDE score improved by a mean of 48%, and pain at palpation at the fracture site was reduced by an average of 61% compared to baseline. The proportion of blood samples containing donor-specific anti-HLA antibodies increased from 8/22 (36.4%) before treatment to 13/22 (59.1%) at 6 months post-treatment, but no treatment-mediated allogeneic immune reactions were observed. Conclusion This pilot study showed that the percutaneous implantation of allogeneic bone-forming cells was technically feasible and well tolerated in patients with delayed unions of long bone fractures. Preliminary efficacy evidence is supporting the further development of this treatment. Trial registration NCT02020590. Registered on 25 December 2013. ALLOB-DU1, A pilot Phase I/IIa, multicentre, open proof-of-concept study on the efficacy and safetyof allogeneic osteoblastic cells (ALLOB®) implantation in non-infected delayed-union fractures.

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