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Casciato D, Wynes J. The Navicular Cuneiform Joint: Updates on Avoiding and Managing a Nonunion. Clin Podiatr Med Surg 2023; 40:613-621. [PMID: 37716740 DOI: 10.1016/j.cpm.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the surgical treatment of progressive collapsing foot deformity, can develop nonunion. Addressing this condition hinges on the assessment of various parameters such as patient/host factors and recognition of the etiology of the nonunion. In this article, methods of optimizing this surgical intervention through anatomic and physiologic considerations are highlighted. Further, information is provided to assist foot and ankle surgeons in performing a comprehensive work-up to allow for successful reconstruction and optimal patient outcomes.
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Affiliation(s)
- Dominick Casciato
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob Wynes
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA.
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Zhang W, Chen H, Tang P. [Recent advances in treatment of aseptic femoral shaft nonunion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:519-525. [PMID: 29806336 DOI: 10.7507/1002-1892.201712089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.
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Affiliation(s)
- Wei Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Hua Chen
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,
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Aliakbar A, Witwit I, Al-Algawy AAH. Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country. J Clin Diagn Res 2017; 11:RC04-RC06. [PMID: 28969222 DOI: 10.7860/jcdr/2017/27437.10382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. AIM To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. MATERIALS AND METHODS A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. RESULTS Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. CONCLUSION Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources.
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Affiliation(s)
- Adil Aliakbar
- Assistant Professor, Department of Orthopaedic Surgery, Babylon University, Al-hilla, Babil, Iraq
| | - Ibrahim Witwit
- Assistant Professor, Department of Orthopaedic Surgery, Babylon University, Al-hilla, Babil, Iraq
| | - Alaa A Hussein Al-Algawy
- Assistant Professor, Department of Orthopaedic Surgery, Babylon University, Al-hilla, Babil, Iraq
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Lui TH. Arthroscopic revision arthrodesis for non-union of the naviculocuneiform joint: a case report. J Orthop Surg (Hong Kong) 2015; 23:267-9. [PMID: 26321567 DOI: 10.1177/230949901502300234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Naviculocuneiform arthrodesis is a viable treatment for symptomatic flatfoot with sag of the naviculocuneiform joint. Nonetheless, non-union is a common complication, and revision arthrodesis is indicated. This study reports arthroscopic revision arthrodesis for non-union of the naviculocuneiform. Accurate debridement and bone grafting of the nonunion site was performed arthroscopically.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong
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The use of core track endoscopy to document accurate decompression of the femoral head. Hip Int 2015; 24:284-9. [PMID: 24500830 DOI: 10.5301/hipint.5000118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 02/04/2023]
Abstract
The aim of this study is to evaluate the role of endoscopy as diagnostic and prognostic method for Ficat and Steinberg stage IIIA and IIIB lesions by assessing the efficacy, risks and complications of this method. In a prospective study from January 2008 until September 2013, nine patients (13 hips) were assessed. In nine hips the disease was stage II, in three hips stage III and in one hip stage IV. Evaluation included x-rays, magnetic resonance and bone scintigraphy. After femoral head decompression, the borders of the removed necrotic area were investigated under direct visualisation by means of endoscopy in order to assess the vitality status of the surrounding bone. Endoscopic evaluation was successful in nine hips. The visualisation of healthy bone borders after removing the necrotic bone was not possible in four cases. The preoperative MRI findings were in correlation to our endoscopic findings in five out of nine cases. There were no cases of cartilage perforation, femoral neck fracture and other intra and postoperative complications. Endoscopic evaluation of the removed necrotic bone can greatly improve the therapeutic effect by visualising the borders of the decompressed bone area and provide information regarding the necessity for bone graft and the type of graft required.
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Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury 2015; 46:1102-7. [PMID: 25712702 DOI: 10.1016/j.injury.2015.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of femoral shaft nonunion still remains a challenge in orthopaedic surgery. It represents a serious postoperative problem for the patient, associated with plate breakage and loosening, bone defect, shortening deformity and infection. A double plate fixation combined with bone grafting may become a promising therapeutic strategy for the treatment of patients with femoral shaft nonunion. In this study, our goal was to evaluate the clinical outcome of a novel approach for 14 consecutive patients with femoral shaft nonunion using double plate fixation with bone grafting. METHODS Retrospective data from June 2010 to August 2012 were obtained from records for 14 consecutive femoral shaft aseptic nonunion patients treated with double plate fixation combined with bone grafting. Nine patients were men and five patients were woman and average age of the patients was 26 years (range from 22 to 32 years). The mean time since injury was 26.2 months. The nonunion had resulted from repeated internal fixation failure (including plate or intramedullary nail fixation) in nine cases and primary internal fixation in five cases. RESULTS All the 14 patients were followed up for an average of 14.8 (10-25) months. All cases achieved bony union without wound infection or fixation failure and the mean time to union was 5.2 months (range 4-7 months). CONCLUSION Double plate fixation and bone grafting are a promising method for femoral shaft nonunion. In addition, this strategy is useful for such a nonunion caused by a repeated plate or intramedullary nail fixation failure with bone defect due to its strong stability with three-dimensional fixation and fully bone graft availability.
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Oberst M, Konrad G, Herget GW, El Tayeh A, Suedkamp NP. Novel endoscopic sacroiliac screw removal technique: reduction of intraoperative radiation exposure. Arch Orthop Trauma Surg 2014; 134:1557-60. [PMID: 25209231 DOI: 10.1007/s00402-014-2076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Indexed: 02/09/2023]
Abstract
OBJECTIVE We report in the following on our technique of endoscopic sacroiliacal screw removal as a new extra-articular endoscopic method in soft tissue surgery, aimed at the reduction of radiation exposure for both the patient and the surgical teams. Patients who underwent endoscopic implant removal from the dorsal pelvic ring (Group A) were retrospectively compared with a control group, in which the screws were removed via the conventional approach (Group B). The parameters of interest were the extent of x-ray exposure in seconds and surgical duration in minutes as well as approach related peri- and postoperative complications. RESULTS 34 screws were removed endoscopically from 28 patients in group A and 35 screws from 29 patients in group B. The mean skin-to-skin time in group A was 36.1 (15-111) min and 32.7 (12-114) min in group B. The difference was not statistically significant (p > 0.05). The average radiation time in group A was 5.7 ± 3.2 s (range, 0-101 s), while in group B the radiation time was significantly longer (52.6 ± 23 s (range, 0-239 s); p = 0.005). CONCLUSIONS Endoscopic screw removal from the posterior pelvic ring reduces the intraoperative radiation time whereas the skin-to-skin times do not differ from the conventional procedure. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Michael Oberst
- Clinic of Orthopaedics, Trauma and Spine Surgery, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany,
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Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. Injury 2014; 45:560-7. [PMID: 24342368 DOI: 10.1016/j.injury.2013.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 11/16/2013] [Accepted: 11/17/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of nonunion has remained a constant challenge. The associated bone defect, shortening, deformity and infection complicate the management. A mono-lateral external fixator may minimise some of the problems frequently encountered in these patients. We report our results of prospectively evaluated 37 consecutive patients regarding nonunion of lower-extremity long bones managed using a mono-lateral external fixator. PATIENTS AND METHODS A total of 37 patients (7 femurs and 30 tibias), mean age 36 years, were stabilised using a mono-lateral fixator for nonunion of long bones. The mean time since injury was 8 months. Fifteen cases were infected and they received debridement and antibiotic treatment as per culture and sensitivity reports. In cases where the bone gap or shortening was >3 cm in the tibia and >5 cm in the femur, corticotomy and bone transport (bifocal procedure) was done and in the remaining cases, only compression-distraction (monofocal procedure) was done. The bone and functional results were assessed at the end of treatment according to the criteria described by Paley et al. RESULTS Union was achieved in 34 cases (91.9%). The average time for union was 5 months. Five cases were treated with the bifocal method and 32 cases were treated with the monofocal method. The average length gain in the bifocal method was 5.7 cm, mean duration of treatment was 8.2 months and bone healing index (BHI) was 1.44 months cm(-1). In six cases, the monofocal treatment was used for limb lengthening. The average length gain was 1.9 cm, mean duration of treatment was 4.83 months and BHI was 2.5 months cm(-1). Bone grafting was required in two cases at the docking site. The bone results were excellent in 24 cases, good in nine cases, fair in one case and poor in three cases. The functional results were excellent in 27 cases, good in six cases, fair in one case and poor in three cases. The most common complication in this series was pin-tract infection (11.5%). CONCLUSIONS A mono-lateral external fixator is an effective method for treating nonunion in the lower extremity with or without bone loss. The nonunion site can be carefully controlled with simultaneous correction of angulation and length.
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Lui TH. Arthroscopic revision of nonunion of calcaneocuboid distraction arthrodesis. Foot (Edinb) 2013; 23:172-5. [PMID: 24252400 DOI: 10.1016/j.foot.2013.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 02/04/2023]
Abstract
Calcaneocuboid distraction arthrodesis is one of the common surgical procedures for correction of flatfoot deformity. Nonunion of the arthrodesis site is a significantly well-known complication of this procedure. Revision arthrodesis is indicated especially if the nonunion is symptomatic. Classically, this is performed openly with removal of the implants, refreshment of the fusion sites, bone grafting and revision fixation. We reported, a case of nonunion of the calcaneocuboid arthrodesis, which was successfully treated with arthroscopic revision arthrodesis. Removal of the implant and revision fixation was not needed.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Gelalis ID, Politis AN, Arnaoutoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karageorgos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury 2012; 43:980-8. [PMID: 21741650 DOI: 10.1016/j.injury.2011.06.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/28/2011] [Accepted: 06/15/2011] [Indexed: 02/02/2023]
Abstract
Nonunions of the femoral shaft represent a treatment challenge for the orthopaedic surgeon and a serious socioeconomic problem for the patient. Inadequate fracture stability, insufficient blood supply, bone loss or presence of infection are the main reasons for the development of a nonunion. Careful classification and exclusion of infection are crucial for the choice of the proper treatment alternative. Nail dynamization, primary intramedullary nailing or nail exchange, plate osteosynthesis and external fixation along with bone grafting, usage of bone substitutes and electrical stimulation can stimulate osseous union. A review of the aetiology, classification and treatment should prove helpful managing this serious complication.
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Affiliation(s)
- Ioannis D Gelalis
- Department of Orthopaedic Surgery and Traumatology, University of Ioannina, School of Medicine, Ioannina, Greece.
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Oberst M, Herget G, Riede U, Kreim SY, Konrad G, Suedkamp NP, Haberstroh J. Fat marrow embolism during intramedullary bone endoscopy: an experimental study in sheep. J Orthop Res 2009; 27:1060-6. [PMID: 19170095 DOI: 10.1002/jor.20841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We present a study designed to investigate whether the intramedullary bone endoscopy (IBE) procedure within the cavity of an intact long bone will create embolic loads on the lungs similar to that of other orthopedic procedures (e.g., stem implantation in total hip arthroplasty [THA]). In a sheep model, 10 animals underwent the IBE procedure with complete perioperative anesthesiology monitoring. The lungs were harvested postoperatively and examined for fat embolisms. One animal showed evidence of intraoperative fat embolism with temporary increases in mean pulmonary arterial pressure (MPAD) and the mean CO(2)-gradient. The histological examination in this animal revealed fat embolism with a 2% surface area of the investigated fields covered with fat vacuoles. All peri- and postoperative data on the other nine animals were normal. Our findings indicate that, as with other intramedullary manipulation in intact long bones, there is a potential risk for systemic fat excavation during IBE. However, the embolic load is much lower than the rates reported for other orthopedic interventions.
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Affiliation(s)
- Michael Oberst
- Department of Orthopaedics and Traumatology, University Hospital of Freiburg, Freiburg, Germany.
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Lui TH. Endoscopic bone grafting for management of nonunion of the tuberosity avulsion fracture of the fifth metatarsal. Arch Orthop Trauma Surg 2008; 128:1305-7. [PMID: 18175130 DOI: 10.1007/s00402-007-0556-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Indexed: 11/24/2022]
Abstract
The most common fracture of the proximal fifth metatarsal is the tuberosity avulsion fracture. Most of the time, the fracture is relatively undisplaced and it can be treated conservatively with a hard-soled shoe or walking cast. For painful intra-articular nonunion, internal fixation with or without bone graft is the treatment of choice. We describe an endoscopic approach to treat nonunions of the tuberosity avulsion fracture. Under endoscopic guidance, the nonunion site can be debrided thoroughly and bone grafted without the need of extensive soft tissue dissection. Moreover, the condition of the fifth metatarsal cuboid articulation can be assessed and intra-articular pathology can be dealed with arthroscopically. Finally, the desired position of the screw can be guided by the arthroscopic aiming device.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Oberst M, Bosse A, Holz U. Intramedullary fracture reduction of long bone under visual control: experimental results of an endoscopic technique. Arthroscopy 2006; 22:686.e1-5. [PMID: 16762718 DOI: 10.1016/j.arthro.2006.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In controlling the closed reduction of a shaft fracture of long bone during an operation, intraoperative radiography is essential. The amount of imaging needed depends on the patient, the fracture, and the surgeon. This article documents our first experimental results of closed fracture reduction performed under direct visual control with the endoscopic technique of intramedullary bone endoscopy (IBE), which eliminates the need for fluoroscopy. On 3 human tibial cadaveric bones, an artificial shaft fracture was set. The lower leg was fixed on a brace, and the endoscope was inserted at the standard entry point for intramedullary nailing. The endoscope was gently pushed distally to prepare the medullary canal under visual control with the use of endoscopic instruments. At the level of fracture, surgeons achieved a closed reduction by "looking around" for the distal part of the fracture by using the stiff endoscope similarly to a "joystick." Thus, the proximal fragment was automatically guided into the correct position, and the fracture was reduced. The endoscopic tool was pushed down the medullary canal into the distal fragment in the way that a guidewire would be placed. Through this technique, it has been possible in all patients to reduce fractures under visual control. Fluoroscopy can be eliminated in these cases.
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Affiliation(s)
- Michael Oberst
- Department of Othopaedics and Traumatology, University Hospital, Freiburg, Germany.
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Abstract
The treatment of diaphyseal nonunion of long bones is difficult and controversial. We retrospectively reviewed 113 patients with diaphyseal nonunion treated by various modalities, during 15 years at one institution. There were 36 cases of nonunion of the tibia, 23 nonunions of the femur, 21 nonunions of the humerus, 13 nonunions of the radius, 18 nonunions of the ulna and two nonunions of the clavicle. The minimum followup was 24 months (average, 40 months, range 2-15 years). The nonunions were classified as aseptic (84) and septic (29) and additionally classified as hypertrophic (61) and atrophic (52) in order to determine the treatment. The treatment was individualized based on the stability at the nonunion site, need for bone grafting, and control of infection. All fractures healed and every patient in the study regained functional use of the limb without pain or instability and functional range of movements that they had at the time of presentation with nonunion. Residual problems seen in some patients were joint stiffness, limb length discrepancy, and angular deformity. Twenty-six patients required repeat surgery using bone grafting because no satisfactory progress of fracture healing was seen in 4 months. Complications were related to the iliac crest donor site and persistent infection at the nonunion site.
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Affiliation(s)
- Sudhir Babhulkar
- Sushrut Hospital, Research Centre and Postgraduate Institute of Orthopaedics, Central Bazar Road, Ramdaspeth, Nagpur 440-010, India.
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Abstract
Femoral diaphyseal fractures usually result after trauma of high magnitude and because of this, can be life-threatening injuries or may result in considerable physical disability if not treated with care and caution. Nonoperative treatment of these fractures continues to be popular among the patient population in the Indian subcontinent, which in majority of cases, leads to healing in malalignment, shortening of the limb, chondromalacia patellae, and loss of knee motion. Although the majority of these fractures are being treated by operative methods today, success of the treatment depends largely on the surgeon's familiarity with the procedure or the type of fracture pattern (comminuted or segmental) particularly in a polytraumatized patient. Delayed union and nonunion of femoral-diaphyseal fractures and implant failures usually result after these procedures or the type of injury. The purpose of this study is to discuss various types of neglected femoral diaphyseal fractures and to review the literature on their treatment.
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Affiliation(s)
- S K Mukherjee
- Department of Orthopaedics, Pt. J. N. M. Medical College and Dr. B. R. Ambedkar Memorial Hospital, 11 Vivekanand Nagar, Raipur 492-001, India. subeer
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Abstract
After successfully testing the new technique of IBE (intramedullary bone endoscopy) in vitro, we present the first clinical applications of the new endoscopic method. In two selected cases (cement removal in revision joint arthroplasty/complication management after intramedullary loss of a reamer) the technique of IBE was performed in vivo for the first time. Removal of cement under endoscopic guidance and salvage of the lost reamer was easily possible using the special endoscopic tools. With the new technique of IBE, endoscopic intramedullary manipulation is easily possible in vivo.
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Affiliation(s)
- M Oberst
- Klinik für Unfall- und Wiederherstellungschirurgie, Katharinenhospital, Stuttgart.
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Oberst M, Bosse A, Holz U. Intramedullary pressure during endoscopy of the long bone: experimental results of a new endoscopic technique. Arthroscopy 2004; 20:552-5. [PMID: 15122150 DOI: 10.1016/j.arthro.2004.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study shows the local changes in intramedullary pressure during a new endoscopic technique for the medullary canal of the long bone. The procedure of intramedullary bone endoscopy (IBE) was performed on 4 tibial amputations. By slowly pushing the endoscope distally under visual control and endoscopic preparation of the medullary canal, a "neocavum" for endoscopy was created. During the procedure, the intramedullary pressure was continuously measured: Highest peak pressure was 125 mm Hg. We therefore conclude that the procedure of IBE is a safe intervention within the medullary canal of the long bone. Local or systemic side effects, common to intramedullary reaming in fracture treatment (fat-embolism, local bone necrosis, reduction in cortical blood flow) should not be expected.
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Affiliation(s)
- Michael Oberst
- Department of Trauma and Reconstructive Surgery, Katharinenhospital, Stuttgart, Germany.
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