TIBIAL BONE NONUNION PLASTIC WITH THE USE OF MONOLOCAL OSTEOSYNTHESIS BY RING FIXATORS

Actuality. Monolocal extrafocal osteosynthesis by ring fixators (RF) of tibial nonunion is not a generally accepted method, there are no systematic guidelines for its implementation. These issues need to be further studied. Task. Formulate situational predominant properties of RF; features of application in different condi-tions. To offer a method of nonunion plastics and features of monolocal osteosynthesis of RF and to study its efficiency. Materials and methods. The data of treatment of 16 patients with aseptic nonunion of tibia, who required complex comprehensive specialized medical care with a possible positive result (scores from 51 to 75 according to the evaluation system Non-Union Scoring System - NUSS). Implementation of monolocal extrafocal osteosynthesis of RF nonunion of shin bones after fractures was performed by us taking into account the features that distinguished it from that by fractures. The principal requirement of surgical intervention was the need to treat the center of nonunion, local stimulation of repara-tive processes. The technical features of all components of the intervention in the future were of great im-portance. The so-called blood-saving tactics were used, which were carried out using squeezing and hemostatic tourniquets, tranexamic acid. The results obtained. The results of treatment of victims with nonunion of the tibia with the use of RF in monolocal mode were as follows. Taking in consideration the severity of the lesion, we consider this result to be good. Given the insufficient number of observations, it is necessary to continue the use of the proposed method of treatment and to investigate its effectiveness. Conclusions. 1. The use of monolocal RF in patients with nonunion of tibia after fractures has the advantage of use in cases with episodes of septic inflammation in the past, extensive scarring of soft tissues, short distal fragment and osteoporosis. 2. The peculiarities of monolocal osteosynthesis of RF were the use of thick Ilizarov needles Ø 2.0 mm with their conduction at an angle of two planes. The obtained results of treatment of victims with nonunion of the tibia with the use of RF in the monolocal mode should be considered encouraging.

Novel Technique for the Treatment of a Tongue-Type Calcaneal Fracture in the Setting of Chronic Osteomyelitis

Osteomyelitis of the calcaneus combined with a pathologic fracture is a rare and difficult presentation for any practicing foot and ankle surgeon. Treatment for achieving an aseptic nonunion involves a variety of steps, including surgical debridement, antibiotic administration, and fracture stabilization. In this case series, we report a novel technique for the treatment of a tongue-type calcaneal fracture in the setting of chronic osteomyelitis using the Biomet JuggerLoc bone-to-bone system for fixation.

Pediatric aseptic lower leg fracture nonunion

Purpose Lower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion. Methods Thirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated. Results The mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well. Conclusion If treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient’s age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment.

Bone marrow concentrate efficacy in treatment of chronic aseptic nonunion

<p class="abstract"><strong>Background:</strong> Bone marrow is a rich source of osteoprogenitor cells that proliferate and differentiate into osteoblasts. Traditionally, autologous iliac bone grafts have been used in treatment of nonunion. This technique has its associated morbidity, which include donor site pain, infection, scarring, and nerve injury. The use of percutaneous bone marrow stem cells (BMSC) avoids these morbidities with comparable clinical results.</p><p class="abstract"><strong>Methods:</strong> We studied twenty patients of aseptic nonunion where bone marrow was aspirated from the anterior iliac crest, concentrated on a cell separator, and then injected into the nonunion site under c-arm guidance. Each nonunion received a relatively same amount of concentrated bone marrow. The volume of callus was calculated by dimensions obtained from RISPACS software in our institution.</p><p class="abstract"><strong>Results:</strong> There was an average of 29,418 mm3 of callus formation with a minimum of 4,455 mm³ and maximum of 68,460. The average time of union was 12 weeks with minimum of 6 weeks and maximum of 24 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The percutaneous bone marrow concentrate injection provides an effective and a safe alternative method for the treatment of a chronic long standing non-union.</p>