scholarly journals Vascularised fibular graft in the management of non-union of fracture shaft of radius: a less ventured entity

2020 ◽  
Vol 54 (4) ◽  
pp. 284-286
Author(s):  
Tapas K. Panigrahi ◽  
Ramesh C. Maharaj ◽  
Debi P. Nanda
Keyword(s):  
Donor Site ◽  
Major Complication ◽  
Fibular Graft ◽  
Dash Score ◽  
Forearm Fractures ◽  
Non Union ◽  
Fibula Graft ◽  
Excellent Functional Outcome ◽  
Both Bones

Introduction: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft. Case Report: We describe a case of 45yr old lady with closed fracture of both bones of left forearm. She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity. Conclusion: In management of gap non-union of Shaft radius with gap (>6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications.

scholarly journals Functional outcome of non-vascularized fibula in gap non union

2019 ◽  
Vol 6 (1) ◽  
pp. 205
Author(s):  
Amit Kumar Yadav ◽  
Eknath Pawar ◽  
Prasanna Kumar G. S. ◽  
Akash Mane ◽  
Abhishek Harssor ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Donor Site ◽  
Fibular Graft ◽  
Effective Treatment Option ◽  
Non Union ◽  
Special Skill ◽  
Vascularized Fibula

<p class="abstract"><strong>Background:</strong> Gap non-union is one of the most perplexing problems facing the orthopedic surgeon today. Fibula is the preferred site of non-vascularized bone graft due to its easy accessibility to surgical resection and minimal donor site complications.</p><p class="abstract"><strong>Methods:</strong> The study comprised 11 patients of gap non-union between 13 to 80 years (mean=34.9 years). The fibular graft was harvested from the mid shaft and cortico-cancellous bone graft taken from the iliac crest was applied at both ends of the fibular graft to aid in union.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average bone gap was 7 cm (4-13 cm). 64% of the patients achieved bone union after the first procedure, of the remaining 4 patients, 1 patient showed union after secondary cortico-cancellous bone grafting, while two are planned for the same. The remaining one patient has only completed 16 weeks follow-up at present and is not showing signs of union at present. Functional range of motion was achieved in both the proximal and distal joints in all cases.</p><p class="abstract"><strong>Conclusions:</strong> Non-vascularized fibular bone grafting is a simple and effective treatment option which does not require any special skill, has a very low complication rate and has very high patient compliance.</p>

scholarly journals Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures: a pilot study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Dong Li ◽  
Jiao Jiao Li ◽  
Yuanyuan Zhu ◽  
Fushan Hou ◽  
Yuan Li ◽  
...  
Keyword(s):  
Donor Site ◽  
Outcome Analysis ◽  
Pilon Fracture ◽  
Implant Fixation ◽  
Level Of Evidence ◽  
Tibiotalar Joint ◽  
Non Union ◽  
Joint Reconstruction ◽  
Pilon Fractures

Abstract Background Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods Twenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis. Results Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3–36). Conclusions Large autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up. Level of evidence Level III, retrospective cohort study.

scholarly journals 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

2012 ◽  
Vol 45 (03) ◽  
pp. 468-477 ◽  
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.

scholarly journals Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures. A pilot study

2020 ◽  
Author(s):  
Dong Li ◽  
Jiao Jiao Li ◽  
Yuanyuan Zhu ◽  
Fushan Hou ◽  
Yuan Li ◽  
...  
Keyword(s):  
Donor Site ◽  
Outcome Analysis ◽  
Pilon Fracture ◽  
Implant Fixation ◽  
Level Of Evidence ◽  
Tibiotalar Joint ◽  
Non Union ◽  
Joint Reconstruction ◽  
Pilon Fractures

Abstract Background: Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis. Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36). Conclusions: Large autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up.Level of Evidence: Level III, retrospective cohort study

Four-Corner Arthrodesis Using the Quad Memory Staple

2009 ◽  
Vol 34 (2) ◽  
pp. 252-255 ◽  
Author(s):  
E. A. VAN AMERONGEN ◽  
A. H. SCHUURMAN
Keyword(s):  
Range Of Motion ◽  
Compressive Property ◽  
Dash Score ◽  
Ulnar Deviation ◽  
Non Union ◽  
Radial Deviation ◽  
Pin Fixation ◽  
The Mean ◽  
Simple Fixation

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50° extension, 62° flexion, 9° radial deviation and 24° ulnar deviation. The postoperative range of motion was similar to previous studies at 32° extension, 31° flexion, 15° radial deviation and 20° ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

scholarly journals Outcome of Surgical Treatment of Stress Fracture Neck of Femur in Military Recruits

2020 ◽  
Vol 19 (2) ◽  
pp. 90-96
Author(s):  
Sushil Rana Magar ◽  
Pankaj Chand ◽  
Bishnu Babu Thapa ◽  
Ritesh Sinha ◽  
Rajesh Pratap Shah ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Stress Fracture ◽  
Harris Hip Score ◽  
Fibular Graft ◽  
Neck Of Femur ◽  
Non Union ◽  
Military Recruits ◽  
Necrosis Of Femoral Head

Introduction: Stress fracture of neck of femur is known to occur in athletes and soldiers. From treatment perspective, this is still an unsolved fracture. The purpose of this study is to critically analyse the functional outcome of surgical treatment of stress fracture of neck of femur in military recruits performed by the same surgical team. Methods: This is a retrospective study of surgically treated femoral neck stress fracture from 1st December 2012 to 1st December 2013. All fractures were fixed with three 6.5 mm cancellous lag screws with washers. For failure of primary fixation or non-union, osteosynthesis with fibular strut graft was performed. Patients were evaluated at six weeks, 12 weeks, six months, 12 months and then yearly for three years. Functional outcome was evaluated by using Harris Hip Score at six months and at final follow-up. The outcome was followed up for six years up to Dec 2019. Results: There were eight males and one female patient. Mean age of patient was 20.7 years (Range, 19-23 years). Average follow-up period was 67.6 months (range 6-81). Lag screw fixation was done in five cases after closed reduction and in four cases after open reduction. Osteosynthesis with fibular graft was done in two cases. In six cases, fracture united at a mean duration of 9.8 months (Range 6-20). In three cases there was non-union of the fracture with added  infection in one case. Avascular necrosis of femoral head developed in two cases. Conclusions: Successful surgical treatment of stress fracture of neck of femur requires anatomical reduction and stable interfragmentary compression with lag screws.

scholarly journals Intramedullary nail fixation for the treatment of simple forearm fractures in military combatants

2020 ◽  
Author(s):  
Hao Wang ◽  
Huayong Zheng ◽  
Hongying He ◽  
Jianzheng Zhang ◽  
ZHI Liu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intramedullary Nail ◽  
Forearm Fracture ◽  
Dash Score ◽  
Forearm Fractures ◽  
Fracture Union ◽  
Extensor Pollicis Longus ◽  
Post Operation ◽  
Simple Fracture

Abstract Background: Most of forearm fracture in military combatants are simple fracture. The traditational procedure for adult forearm fracture is open reduction and plate osteosynthesis. However, plate fixation do have the defect of nonunion, stress shielding, skin irritation. Intramedullary nail is believed to be an alternative treatment of adult forearm fractures. However, whether simple forearm fractures in military combatants could be successfully treated by intramedullary nail is not clear.Methods: Patients of military combatants with diagnosis of simple forearm fracture treated by intramedullary nail fixation were identified from 1st January 2016 to 31st November 2018 in this retrospective study. General information of the patients, time of follow-up, time of fracture union post-operation, complications, rotation activity and DASH score 12 month post-operation were recorded to figure out the clinical outcome of simple forearm fracture treated by intramedullary nail in military combatants.Outcome: Twenty male patients were identified in this retrospective study, with average age of 26.5 years old (range 18-36).Fourteen forearm fracture happened in right side and the rest six happened in left side. Single ulna fracture happened in 11 cases, single radius fracture happened in 4 cases , both forearm fracture happened in 5 cases. Classifications of the 20 patients were all OTA type A. All 20 patients got followed, with mean follow-up time of 15.8 months（range 12-18). All patients got fracture union successfully. Average time of fracture union was 2.6 months（range 2-4months）. Partially rupture of extensor pollicis longus tendon happened during operation in one patient and 3 months post-operation in another patient. One patient with both forearm fractures showed linear ossification of interosseous membranes. Average pronation activity 12 months post-operation was 86.9 degrees (range 80-90), average supination activity 12 months post-operation was 86.3 degrees (range 60-90). Average DASH score 12 months post-operation was 6.5（range 0-37).Conclusion: This respective study demonstrated that intramedullary nail achieved excellent results in the treatment of simple fracture of forearm in military combatants.Trial Registration : Not applicable

Complex clavicle fractures in children: Kids are not little adults

Trauma ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 35-39
Author(s):  
Hayk Stepanyan ◽  
William Hennrikus ◽  
Derek Flynn ◽  
David Gendelberg
Keyword(s):  
Pediatric Patients ◽  
Adult Population ◽  
Clavicle Fracture ◽  
The Body ◽  
Bony Union ◽  
Dash Score ◽  
Non Union ◽  
Fractures In Children ◽  
Clavicle Fractures

Background The clavicle is the most commonly fractured bone in the body and accounts for 10–15% of all pediatric fractures. Adult patients with complete midshaft clavicle fractures often undergo surgical management. Pediatric patients have a thicker periosteum, more robust blood supply and a greater healing potential. Controversy exists as to whether to treat adolescents with surgery similar to adults versus with a sling as children are treated. Some orthopaedic surgeons are now operating on adolescent clavicle fractures. Objective The objective of the study was to evaluate the outcomes of displaced midshaft clavicle fractures in adolescent who were treated conservatively with a sling. Methods We performed a retrospective chart review of 25 pediatric patients aged 12–16 with complete midshaft clavicle fracture. The outcomes of the study were bony union and functional outcomes such as pain, problems with ADL measured by the modified Disability of Arm, Shoulder, and Hand (DASH) score. Results All patients in our cohort had excellent outcomes at follow-up visits with no complaints of pain or limitations of activities of daily living. Mean follow-up time was 12 months. All patients had perfect modified DASH score of 18. Injury radiographs demonstrated an average of 13 mm shortening initially and 8 mm shortening in final follow-up. Average fracture angulation at final follow-up was 15°. Normal clavicle angulation at the mid shaft is 8°. All clavicles healed completely with no case of malunion or non-union reported. Conclusion Clavicle fractures are common. Although operative treatment of clavicle fractures in the adult population is gaining popularity due to issues in adults with non-union and malunion, the adolescent population is different. The adolescent clavicle fracture demonstrates robust healing and remodeling and complete return to full function. We therefore recommend that adolescent patients aged 12–16 with complete clavicle fracture be treated conservatively with a sling.

Clinical Outcomes and Complications after Open Reduction and Internal Fixation Utilizing Conventional Plates in 65 Distal Radial and Ulnar Fractures of Miniature- and Toy-Breed Dogs

2018 ◽  
Vol 31 (03) ◽  
pp. 214-217 ◽  
Author(s):  
Yuta Miyazaki ◽  
Taichi Shimatsu ◽  
Kyoko Iizuka ◽  
Masaaki Nishimura ◽  
Takeshi Aikawa
Keyword(s):  
Internal Fixation ◽  
Clinical Outcomes ◽  
Open Reduction ◽  
Plate Fixation ◽  
Effective Means ◽  
Major Complication ◽  
Normal Function ◽  
Non Union ◽  
Normal Functional

Objective This article aims to evaluate clinical outcomes and complications of distal radial and ulnar fractures in miniature- and toy-breed dogs treated with conventional bone plate fixation. Methods Medical records (2001–2010) of miniature- and toy-breed dogs with distal radial and ulnar fractures repaired with open reduction and internal fixation utilizing conventional plates were reviewed. The inclusion criteria were body weight of <7 kg, fracture located in the distal antebrachium (distal-to-total radial length ratio < 0.4) and follow-up radiographs available. Results All 65 fractures healed without developing non-union, and had a successful return to normal function (median follow-up: 73 months; range: 2–149 months). Minor complication in seven fractures and major complication in four fractures were identified. Clinical Significance Open reduction and conventional plate fixation of distal radial and ulnar fractures in miniature- and toy-breed dogs are effective means of fixation that result in normal functional outcome without developing non-union.

scholarly journals Non-Vascularised Fibular Graft as an Intramedullary Strut for Infected Non-Union of the Humerus

2011 ◽  
Vol 19 (3) ◽  
pp. 341-345 ◽  
Author(s):  
G Gopisankar ◽  
Arockiaraj SV Justin ◽  
Manasseh Nithyananth ◽  
Vinoo M Cherian ◽  
VN Lee
Keyword(s):  
Donor Site ◽  
Activity Level ◽  
Implant Removal ◽  
Fibular Graft ◽  
Tissue Cultures ◽  
Infected Nonunion ◽  
No Donor ◽  
Non Union ◽  
Compression Plate ◽  
The Mean

Purpose. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. Methods. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected nonunion who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2–4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3–10) months. Results. The mean length of the fibulae harvested was 13 (range, 12–15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4–8) months. The mean follow-up period was 15 (range, 13–24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. Conclusion. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.

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