Complications in Fracture Healing-A Review

Complications are a reality in healing fractures. Most can be stopped or reduced by being aware of their pathophysiology. Others, though, are inevitable, but their Early diagnosis and effective treatment can help recovery. Significant complications Are Osteomyelitis, delayed union, non-union, malunion, premature union, which were a result of fracture repair. Keeping these complications into consideration Presurgical patient assessment as well as postoperative treatment should be taken into account. The goal of fracture repair is to ascertain rigid fixation and perfect alignment of the bone to permit each timely and maximized come to perform in the affected space. The particular injury, species and breed conformation, age, general health, concomitant malady processes, nutrition, and medications all play a job in healing and, therefore, response to the repair. However, these factors don't seem to be the sole determinants of outcome. the strategy of repair and surgical technique each play a vital role within the outcome of fracture management. For this reason, it's vitally necessary that the practitioner be aware of potential complications of fracture repair and take steps to stop them. This review centers on how these complications can be prevented, understood and handled.

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Facilitation of fracture repair using low-intensity pulsed ultrasound

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632654 ◽

2000 ◽

Vol 13 (04) ◽

pp. 158-164 ◽

Cited By ~ 4

Author(s):

W. T. Wong ◽

K. L. Bennell ◽

J. M. McMeeken ◽

J. D. Wark ◽

S. J. Warden

Keyword(s):

Bone Fractures ◽

Delayed Union ◽

Fracture Repair ◽

Pulsed Ultrasound ◽

Non Union ◽

Veterinary Practice ◽

Low Intensity Pulsed Ultrasound ◽

Low Intensity ◽

Fresh Fracture ◽

Practical Implications

SummaryA recent application of ultrasound (US) therapy is to bone fractures. In two randomized controlled trials in humans, specific dosed US accelerated fresh tibial and radial fracture repair by 38%. When applied to delayed- and non-unions the same dosed US resulted in union in over 80% of cases. Similar US may augment fracture repair in veterinary practice. This paper reviews US dosages applied during fracture repair and their effect on bone healing. It concludes by discussing the clinical and practical implications of these findings to veterinary practice and the need for further research into this electrotherapeutic modality.Low-intensity pulsed ultrasound has been shown to facilitate fresh fracture repair, reduce the incidence of delayed-union and initiate healing of fractures displaying delayedand non-union. This paper discusses these findings and their implications to veterinary practice.

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Analysis of Centromedullary Nailing with Implant Failure

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.638.130 ◽

2015 ◽

Vol 638 ◽

pp. 130-134 ◽

Cited By ~ 3

Author(s):

Ioan Cristescu ◽

Iulian Vasile Antoniac ◽

Daniel Vilcioiu ◽

Florin Safta

Keyword(s):

Surgical Technique ◽

Intramedullary Nailing ◽

Delayed Union ◽

Fracture Pattern ◽

Fracture Site ◽

Implant Failure ◽

Implantation Technique ◽

Long Bones ◽

Metallic Implant ◽

Non Union

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

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Non-restricted weight-bearing after modified Lapidus arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000322 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Manuel Pellegrini ◽

Giovanni Carcuro ◽

Natalio Cuchacovic ◽

Gerardo Muñoz ◽

Marcelo Somarriva

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Clinical Results ◽

Delayed Union ◽

Rigid Fixation ◽

X Rays ◽

Non Union ◽

Fixation Methods ◽

First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

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Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632603 ◽

1998 ◽

Vol 11 (01) ◽

pp. 19-22 ◽

Cited By ~ 1

Author(s):

A. Steiner ◽

Gaby Hirsbrunner

Keyword(s):

Standard Treatment ◽

Delayed Union ◽

Surgical Debridement ◽

Rigid Fixation ◽

Skin Defect ◽

Long Time ◽

Metaphyseal Fracture ◽

External Stabilization ◽

Long Acting ◽

Local Antibiotic

SummaryA newborn calf was admitted for evaluation of a primarily closed comminuted metaphyseal fracture of metacarpus III/IV. Closed reduction and application of transfixation pins and a fibreglass cast were performed. Ten days after pin removal, radiographs revealed that the initially healed fracture had collapsed, and osteomyelitis was diagnosed. Bacteriological culture from the deep draining tract yielded Actinomyces pyogenes and Staphylococcus aureus. Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation, and long-time administration of antibiotics. In this case, we used surgical debridement, administration of a new long-acting local antibiotic (gentamicin- impregnated collagen sponges), and minimal external stabilization. At day 27 after initiation of this treatment, the skin defect had healed, and the fracture was stable on manual palpation.Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation and prolonged administration of antibiotics. In the case described, we used surgical debridement, administration of a long-acting local antibiotic (gentamicin-impregnated collagen sponges), and minimal external stabilization. The promising outcome of this case and the good results in human surgery warrant further investigation in the use of gentamicin-impregnated collagen sponges in veterinary orthopaedics.

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Creating Standardized Tools for the Pharmacist-Led Assessment and Pharmacologic Management of Adult Canadians Wishing to Quit Smoking: A Consensus-Based Approach

Pharmacy ◽

10.3390/pharmacy9020080 ◽

2021 ◽

Vol 9 (2) ◽

pp. 80

Author(s):

Kristi Butt ◽

Nardine Nakhla

Keyword(s):

Smoking Cessation ◽

Assessment Tool ◽

Treatment Plan ◽

Treatment Algorithm ◽

Vital Role ◽

Patient Assessment ◽

Stop Smoking ◽

Patient Consent ◽

Pharmacologic Management ◽

Documentation Form

Tobacco use continues to be recognized as the single most preventable cause of death worldwide. As the gatekeepers of and experts on pharmacotherapy, pharmacists play a vital role in facilitating smoking cessation. While existing frameworks have enabled pharmacists to provide smoking cessation services in Canada for many years, the way in which they are delivered vary considerably across the nation. The purpose of this initiative was to create standardized tools for the pharmacists providing cessation services to ensure all Canadians wishing to stop smoking have equal access to consistent, evidence-based care. An iterative process using repeated rounds of voting was employed to establish consensus among key opinion leaders on the most important items to include in tools for the pharmacist-led assessment and pharmacologic management of Canadian adults wishing to stop smoking. The results were used to create eight standardized documents for national use by pharmacists: a readiness to quit assessment tool, a patient consent form, a patient assessment form for past users of tobacco and/or tobacco-like products, a patient assessment form for current users of tobacco and/or tobacco-like products, a treatment algorithm, a treatment plan summary form, a prescribing documentation form, and a follow-up & monitoring documentation form. Although not described in detail in these documents, other strategies for smoking cessation (e.g., non-pharmacologic strategies (including quitting “cold turkey” and behavioural interventions), harm reduction strategies, etc.) should be considered when pharmacotherapy is inappropriate or undesired; care should be individualized based on a patient’s previous experiences and current motivation. No single approach to treatment is endorsed by the authors. The consensus-based approach described here provides a suggested framework for harmonizing the pharmacist-led management of other ailments to optimize patient care.

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Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

European Spine Journal ◽

10.1007/s00586-021-06897-y ◽

2021 ◽

Author(s):

Cesare Faldini ◽

Francesca Barile ◽

Fabrizio Perna ◽

Stefano Pasini ◽

Michele Fiore ◽

...

Keyword(s):

Surgical Technique ◽

Idiopathic Scoliosis ◽

Case Series ◽

Deformity Correction ◽

Pedicle Screws ◽

Mechanical Complication ◽

Non Union ◽

Implant Retention ◽

Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

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The application of rigid internal fixation to the treatment of non-union and delayed union using the AO technique

Injury ◽

10.1016/0020-1383(77)90131-0 ◽

1977 ◽

Vol 8 (3) ◽

pp. 188-198 ◽

Cited By ~ 12

Author(s):

A.G. Thompson ◽

R.L. Batten

Keyword(s):

Internal Fixation ◽

Delayed Union ◽

Rigid Internal Fixation ◽

Non Union

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

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80117-2 ◽

1995 ◽

Vol 20 (5) ◽

pp. 596-602 ◽

Cited By ~ 9

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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