STUDY ON OUTCOME OF TREATMENT OF NONUNION LONG BONE FRACTURE

2021 ◽  
pp. 12-14
Author(s):  
M. Ganesh Kumar ◽  
M. Sivakumar
Keyword(s):  
Long Bone ◽  
Long Bones ◽  
Infected Nonunion ◽  
Treatment Protocols ◽  
Limb Reconstruction ◽  
Long Bone Fracture ◽  
Lost To Follow Up ◽  
Age Range ◽  
Written Informed Consent

The aim of the study is to analyze the outcome of treatment of infected Nonunion of long bones using limb reconstruction system and to reveal its real usefulness Nonunion is diagnosed, until clinical or radiographic evidence shows healing has ceased and that union is highly improbable. Nonunion is dened as “established when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months This is a prospective and retrospective study which consists of 30 cases in the age range from 20 yrs to 65 yrs Patients who were lost to follow up were not included in this study. Our institution approved our treatment protocols and all patients gave written informed consent. ASAMI' criteria were used to analyze the results in our study. In this study we conducted, we could achieve a success rate of 80%, giving good encouraging results to most of our patients. Hence we conclude that the Indian version of the Limb reconstruction system is effective and convenient method for the treatment of infected nonunion of long bones. This can also be used to correct the limb length discrepancies simultaneously, which can arise during the course of the treatment.

scholarly journals Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes

2017 ◽  
Vol 3 (3) ◽  
pp. 557 ◽  
Author(s):  
Hrishikesh Pande ◽  
Chander Mohan Singh ◽  
Anjan Prabhakara ◽  
Vivek Mathew Philip ◽  
Mohd Shezan Iqbal ◽  
...  
Keyword(s):  
Lower Limb ◽  
Bone Fractures ◽  
Lower Limbs ◽  
Long Bone ◽  
Long Bones ◽  
Ilizarov Technique ◽  
Infected Nonunion ◽  
Ring Fixator ◽  
Long Bone Fractures ◽  
Ilizarov Ring Fixator

<p class="abstract"><strong>Background:</strong> Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.</p><p><strong>Conclusions:</strong> The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities. </p>

The Wide-Open Three-Legged Parallel Robot for Long-Bone Fracture Reduction

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Mohammad H. Abedinnasab ◽  
Farzam Farahmand ◽  
Jaime Gallardo-Alvarado
Keyword(s):  
Bone Fracture ◽  
Degrees Of Freedom ◽  
Experimental Tests ◽  
Parallel Robot ◽  
High Accuracy ◽  
Fracture Reduction ◽  
Long Bone ◽  
Long Bones ◽  
Six Degrees Of Freedom ◽  
Long Bone Fracture

Robotic reduction of long bones is associated with the need for considerable force and high precision. To balance the accuracy, payload, and workspace, we have designed a new six degrees-of-freedom three-legged wide-open robotic system for long-bone fracture reduction. Thanks to the low number of legs and their nonsymmetrical configuration, the mechanism enjoys a unique architecture with a frontally open half-plane. This facilitates positioning the leg inside the mechanism and provides a large workspace for surgical maneuvers, as shown and compared to the well-known Gough–Stewart platform. The experimental tests on a phantom reveal that the mechanism is well capable of applying the desired reduction steps against the large muscular payloads with high accuracy.

scholarly journals Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

2018 ◽  
Vol 4 (4) ◽  
pp. 556
Author(s):  
Srinivas Balagani
Keyword(s):  
Prospective Study ◽  
Bone Graft ◽  
Bone Fracture ◽  
Fracture Site ◽  
Long Bone ◽  
Segmental Defect ◽  
Long Bones ◽  
Non Union ◽  
Number Of Patients ◽  
Long Bone Fracture

<p class="abstract"><strong>Background:</strong> Increased road traffic accidents lead to increased incidence of fracture of long bones. It has a tendency of non-union. Infection is very common in these cases which are an important cause of nonunion of long bone fractures. The objective of the study was to study the incidence and patterns of non-union of long bone fracture.</p><p class="abstract"><strong>Methods:</strong> Hospital based prospective study was carried out at Department of Orthopedics, from June 2017 to March 2018. Patients admitted to wards of Department of Orthopedics with nonunion of long bones were included. During the study period a total of 20 cases were eligible for the present study as per the inclusion and exclusion criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Males were more affected than females. Most commonly affected age group was 41-50 years and 61-70 years (25% each). Most commonly affected long bone was femur in 35% of the cases. Most common type of non-union was hypertrophic (50%). Most common cause of non-union was broken implant in 35% of the cases. Maximum number of patients had union in 4-6 months in 60% of the cases after surgery of previous non-union of long bones. Only four patients developed complications like shortening of the limb or persistent non-union.</p><p class="abstract"><strong>Conclusions:</strong> Hypertrophic non unions doesn’t require bone graft, they require only stable fixation. For removal of broken implant in hypertrophic non-union if we open the fracture site, then even the gap after debridement of fracture site shows partial segmental defect it doesn’t require bone grafting.</p>

scholarly journals Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

2019 ◽  
pp. 1-7
Author(s):  
D. Aliyu ◽  
J. H. Solomon
Keyword(s):  
Histopathological Analysis ◽  
Recurrent Tonsillitis ◽  
Common Procedure ◽  
Female Ratio ◽  
Case File ◽  
Lost To Follow Up ◽  
Age Range ◽  
Male To Female ◽  
Adult Tonsillectomy

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region. Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed. Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4.  Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy). The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days. Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up. Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

Symptom Combinations Associated with Outcome and Therapeutic Effects in a Cohort of Cases with SARS

2006 ◽  
Vol 34 (06) ◽  
pp. 937-947 ◽  
Author(s):  
Shao Li ◽  
Ruiqin Wang ◽  
Yulong Zhang ◽  
Xuegong Zhang ◽  
A. Joseph Layon ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Therapeutic Effects ◽  
Treatment Protocols ◽  
Oxyhemoglobin Saturation ◽  
Treatment Groups ◽  
Lost To Follow Up

Severe acute respiratory syndrome (SARS) is an infectious disease and some of its symptoms were clinically indistinguishable of those from similar diseases. This study aimed to find the symptom combinations associated with adverse outcome and the therapeutic effects in a cohort of patients with probable SARS retrospectively. In 2003, 123 SARS cases in Beijing were subjected to a strictly western medicine (WM) treatment, or a combined treatment (WM plus Herba houttuyniae injection, addition of individualized herbal treatments when necessary), of which 115 were followed till death or discharge; 8 were transferred and lost to follow-up. In both treatment groups, clinical manifestations were evaluated daily; development of signs and symptoms, and their possible relationship with outcome, were assessed. The relationships between these sign/symptom complexes and outcome under two treatment protocols were evaluated and differences were noted. Dynamic symptom combinations, dividing into the early, the medium-term and the durational symptom clusters, were identified as likely being related to the adverse outcomes of SARS ( p < 0.05, p < 0.01). Compared with a strictly WM treatment, the combined treatment resulted in a longer hospital stay ( p = 0.028), a non-statistically significant mortality rate decrease (combined treatment: 9.6% versus WM: 11.1%), and a significant improvement of arthralgia and myalgia ( p < 0.05) in the early symptom cluster. Additionally, the combined protocol improved arterial oxyhemoglobin saturation significantly at day 22 ( p < 0.05). In conclusion, the progress and outcome of SARS may be associated with specific temporal patterns of development in combination of several non-specific signs and symptom complexes, which are also helpful for evaluating the therapeutic effects on SARS patients.

scholarly journals Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

2015 ◽  
Vol 9 (5-6) ◽  
pp. 256 ◽  
Author(s):  
Erich K. Lang ◽  
Kan Karl Zhang ◽  
Quan Nguyen ◽  
Leann Myers ◽  
Mahamed Allaf ◽  
...  
Keyword(s):  
Renal Cell ◽  
Older Patients ◽  
High Recurrence Rate ◽  
Low Grade ◽  
Medical Comorbidities ◽  
Percutaneous Cryoablation ◽  
Additional Surgery ◽  
Lost To Follow Up ◽  
Age Range

Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities.Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I–III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan.Results: Results were assessed on follow-up CTs (at 8–9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable.Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

scholarly journals Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Markus Rupp ◽  
Stefanie Kern ◽  
Tobias Weber ◽  
Tamina D. Menges ◽  
Reinhard Schnettler ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Descriptive Analysis ◽  
Polymicrobial Infection ◽  
Long Bone ◽  
Diagnostic Tools ◽  
Infected Nonunion ◽  
Tissue Samples ◽  
Microbiological Testing ◽  
Polymicrobial Infections

Abstract Background Frequencies of polymicrobial infection and pathogens evidenced in course of infected nonunion treatment are largely unknown. Therefore, this study aims at investigating microbial patterns in infected nonunions. Methods Surgically treated patients with long bone infected nonunion admitted between January 2010 and March 2018 were included in the study. Microbiological culture and polymerase-chain-reaction results of tissue samples of initial and follow-up revision surgeries were assessed and compared with patient and treatment characteristics. Results Forty two patients with a mean age of 53.9 ± 17.7 years were included. In six patients (14.3%) polymicrobial infection was evident. A change of pathogens evidenced in course of the treatment occurred in 21 patients (50%). In 16 patients (38.1%) previously detected bacteria could be determined by microbial testing after further revision surgery. Staphylococcus aureus was most often detected (n = 34, 30.6%), followed by Enterococcus spp. (n = 25, 22.5%) and Staphylococcus epidermidis (n = 18, 16.2%). Five Staphylococcus aureus were resistant to methicillin (MRSA). In patients without polymicrobial infection or further germ detection in course of the treatment, 86.4% of the infections were due to Staphylococcus spp.. Infections due to Streptococcus spp. and gram-negative bacteria were only present in patients with polymicrobial infection and germ-change in course of the treatment. Conclusion A low rate of polymicrobial infections was evidenced in the present study. Germ-change often occurs in course of revision surgeries. Prospective studies with more sensitive diagnostic tools are necessary to elucidate the therapeutical relevance of microbiological testing results for surgical as well as medical treatment in infected nonunions.

scholarly journals INTERLOCKED INTRAMEDULLARY NAILING OF LONG BONES

2008 ◽  
Vol 15 (04) ◽  
pp. 449-454
Author(s):  
MANSOOR ILYAS ◽  
MOHAMMAD IDRESS ◽  
SIAFUDDIN TAREEN
Keyword(s):  
Full Range ◽  
Long Bone ◽  
Long Bones ◽  
Distal Locking ◽  
Early Results ◽  
Good Healing ◽  
Long Bone Fracture ◽  
Orthopedic Hospital ◽  
Intervention Patient ◽  
Locking Screw

.. Intramedullary interlocking nailing is the recommended procedure of fixation of long bones fracture. This type of fixation allowthe patient to walk independently in few days time, but unlikely there are only few centers in our country which are doing this practice. InMansoor Orthopedic Hospital and Sandeman Civil Hospital Quetta we started this type of fixation from November 2001 and we have done 15femoral (13 closed and 2 open GII) and 15 tibial (11 closed and 4 open GI & GII). Interlocking nails up till now. Our early results revealed 0%infection rate, breakage of nail in one case and bending of one distal locking screw. Inspite this in both cases fracture healed with out anysurgical intervention. Patient had nearly full range of movements of both knee & hip joint. We recommend close Intramedullary in interlockingnailing is an excellent technique to treat long bone fracture regarding good healing minimum complication shorter hospital stay and earlyfunctional rehabilitation.

scholarly journals Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

2021 ◽  
Author(s):  
Markus Rupp ◽  
Stefanie Kern ◽  
Nike Walter ◽  
Lydia Anastasopoulou ◽  
Reinhard Schnettler ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inpatient Treatment ◽  
Retrospective Cohort ◽  
Long Bone ◽  
Treatment Concept ◽  
Infected Nonunion ◽  
Major Complications ◽  
Staged Treatment ◽  
Bony Consolidation

Abstract Purpose Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? Methods All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. Results Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. Conclusions Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.

Intramedullary Well-Differentiated Osteosarcoma: Imaging and Pathologic Findings in 17 Patients

2021 ◽  
Vol 18 ◽  
Author(s):  
Shu-Man Han ◽  
Yuan Wu ◽  
Jin-Xu Wen ◽  
Tian-Hao Wu ◽  
Tao Sun ◽  
...  
Keyword(s):  
Distal Femur ◽  
Correct Diagnosis ◽  
Long Bones ◽  
Endoprosthetic Replacement ◽  
Post Operation ◽  
Soft Tissue Masses ◽  
Bone Cortex ◽  
Well Differentiated ◽  
Age Range

Background: Intramedullary well-differentiated osteosarcoma (IMWDOS) is rare and may easily be misdiagnosed. Objective: This study was to investigate the clinical, imaging and pathological features of IMWDOS for correct diagnosis. Results: There were 13 males and 4 females with an age range of 19-55 years (mean 32). The lesion was located at long bones in 16 patients and at the second region of acetabulum in one patient. Except for three patients with limited areas of lesions, all the other patients had wide areas of disease, and the lesion in long bones all involved the metaphysis area with possible extension towards the diaphysis. In imaging, the lesion usually had an unclear boundary with destruction of bone cortex, uneven thickness of the bone cortex, thick and coarse trabecula in the lesion, but few periosteal reaction and soft tissue masses. The lesion was histologically composed of spindle cells with slight atypia. Follow-up was performed 2-101 months (mean 37.7) in 14 cases, 10 years in one case and 26 years in the remaining two. At follow-up, 12 patients (12/17 or 70.6%) who had complete resection including amputation (n=2), wide excision (n=8) and endoprosthetic replacement (n=2) had no recurrence or metastasis. Among five patients with curettage, three (3/17 or 17.6%) were recurrent with two deaths, and the third one died during post-operation chemotherapy. Conclusion: Intramedullary well-differentiated osteosarcoma tends to occur at the metaphysis of long bones, especially at the distal femur. Histological, clinical and imaging findings lack characteristics and should be closely combined to reach a correct diagnosis. The prognosis of patients with complete lesion resection is good while incomplete lesion curettage or resection will lead to recurrence and transformation into a highly malignant tumor.

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