scholarly journals Treatment of Femoral Non-Union with the Gene-Activated Osteoplastic Material: А Case Report

2021 ◽  
Vol 27 (1) ◽  
pp. 66-74
Author(s):  
V. V. Khominets ◽  
R. V. Deev ◽  
A. L. Kudyashev ◽  
S. V. Mikhailov ◽  
D. A. Shakun ◽  
...  
Keyword(s):  
Case Report ◽  
Bone Defect ◽  
Individual Treatment ◽  
Non Union ◽  
Group Iii ◽  
Femur Fractures ◽  
Plate Fracture ◽  
Diamond Concept ◽  
Osteoplastic Material ◽  
Bone Autograft

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

scholarly journals A Case Report of Post-traumatic Osteomyelitis with Gap Non-union of Humerus with Segmental Bone Defect and Scarred Skin Treated with Open Reduction Internal Fixation with Osteomyocutaneous Fibula

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Prakash K. George ◽  
Bibhas Dasgupta ◽  
Bhanuprakash Reddy ◽  
P. V. Shubhanshu Bhaladhare
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Bone Loss ◽  
Bone Defect ◽  
Treatment Options ◽  
Bone Union ◽  
Soft Tissue Coverage ◽  
Segmental Bone Defect ◽  
Non Union ◽  
Segmental Bone

Introduction: Non-union of closed humerus fractures is estimated to be about 5.5% and this figure is even higher in open fractures. In cases of non-union of the humerus with segmental bone defect, if a conventional treatment has failed, free fibular transfer is often considered for satisfactory bone union. In some cases, where there is severe scarring due to multiple previous surgeries. In such cases, skin cover may not be adequate and tight closures often lead to necrosis and failure excision. Segmental bone defects of the upper limb that is >6 cm with soft-tissue coverage defects have limited options for reconstruction. Osteomyocutaneous fibula may provide to be a valuable option in such cases. Case Report: This is a report a case of a 27-year-old male presented with a history of road traffic accident with Gustilo-Anderson Grade 3 B open fracture of humerus midshaft. He developed humerus osteomyelitis, for which he underwent surgical debridement. He presented to us with gap non-union with segmental bone loss. The overlying skin was scarred and had significant limb shortening. Treatment options for such a case are reconstruction or amputation. Challenges for reconstruction were to deal with the segmental bone loss and the soft-tissue defect following scar excision. We tackled both these challenges with an osteomyocutaneous fibula flap. At 1-year follow-up, the humerus showed union and flap uptake was good. Conclusion: Osteomyocutaneous fibula flap is a valuable treatment options in such complicated cases allowing for both bone union and soft-tissue coverage with a single surgical procedure. Keywords: Osteomyocutaneous flap, humerus gap nonunion, osteomyelitis humerus.

scholarly journals Reconstruction of Juxta-Articular Bone Defect in an Infected Fracture Distal Right Femur Using Autologous Fibular Strut and Iliac Crest Graft

2021 ◽  
Vol 10 (39) ◽  
pp. 3501-3504
Author(s):  
Nareshkumar Satyanarayan Dhaniwala ◽  
Khizar Khusrau Khan ◽  
Salahuddin Ahmed
Keyword(s):  
Bone Defect ◽  
Iliac Crest ◽  
Distal Femur ◽  
Fracture Site ◽  
Open Fractures ◽  
Iliac Crest Graft ◽  
Strut Graft ◽  
Non Union ◽  
Femur Fractures ◽  
Fibular Strut

Distal femur fractures are about 7 % of all femur fractures.1 Being complex in nature management of these fractures is difficult; management is still a challenge in this technically advanced era. Fibular strut graft is one of the useful and simple options to manage defects in distal femur fractures. High velocity injuries causing open fractures may lead to infection and non-union of fracture if proper debridement and antibiotics are not used as per established protocol. Antibiotics can be given mixed with polymethyl-methacrylate (PMMA) cement formed in beads at the open fracture site or coated over a nail.2 This causes slow release of antibiotics and helps in control of infection. Local infection, damaged soft tissue, ischemia over fracture site, stabilisation of fracture, the hardware used and patient’s co morbidities all play a role in union and infection control of open fractures. Early detection of infection is important to avoid non-union and related complications. Distal femur juxta-articular fracture may develop infection due to fractures and unstable fixation more commonly. This may result in cavity formation and complications like osteomyelitis often leading to bone destruction and sequestrum formation. Its management becomes a challenging task for an orthopaedic surgeon.3- 9 The reconstructive methods are autogenous cortical bone, cancellous bone, allograft, bone substitutes like synthetic bone blocks and bone granules. Free bone transfer is crucial in reconstructing massive defects in distal femur fracture due to properties of rapid healing and being hypertrophic.7-13 Fibula is the best available option for grafting in massive defects of femur due to its characteristics like mechanical strength, length, minimum morbidity, and resistance to infection.3,11,13 A single fibula strut graft can give up to 26 cm of graft. The case reported here is of a patient of juxta-articular bone defect in an infected previously operated fracture distal femur using autologous fibular strut and iliac crest graft

ULNAR-SIDED WRIST PAIN AFTER FOUR-CORNER FUSION IN A PREVIOUSLY-ASYMPTOMATIC ULNAR POSITIVE WRIST: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 49-51 ◽  
Author(s):  
Hyun Sik Gong ◽  
Su Ha Jeon ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Wrist Pain ◽  
Stage Ii ◽  
Treatment Choices ◽  
Non Union ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Post Traumatic ◽  
Snac Wrist

Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis.

Correction of Dorsi-Flexed Intercalated Segment Instability after Restoration of Scaphoid Height in a Cadaver Model of Scaphoid Non-Union

1995 ◽  
Vol 20 (5) ◽  
pp. 596-602 ◽  
Author(s):  
M. YASUDA ◽  
M. KUSUNOKI ◽  
K. KAZUKI ◽  
Y. YAMANO
Keyword(s):  
Mechanical Loading ◽  
Bone Defect ◽  
Carpal Instability ◽  
Rigid Fixation ◽  
Anatomical Reduction ◽  
Non Union ◽  
Herbert Screw ◽  
Palmar Approach ◽  
Wrist Joints

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

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