Cases Of Nonunion Research Articles

Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique

IntroductionSeveral alternatives are now available when treating posttraumatic acute bone defects. Masquelet's technique represents a safe procedure to treat lower limb open fractures associated with significant bone defects and allows surgeons to try to reduce complications incidence. Material and MethodsRetrospective study based on patients´ record files and images (2015-2017). Twelve patients suffering acute bone defect, treated using Masquelet technique, were evaluated. A total of ten patients were finally included after exclusion criteria were applied. ResultsAverage time from injury to first stage surgery was 11 days. Free flaps were required in three cases (two latissimus dorsi and one anterolateral thigh flap). Time to second stage surgery was 115 days on average. As bone graft, reaming irrigation-aspiration system was associated to this technique. Consolidation was achieved in all patients but one after an average time of 8.4 months. There was only one case of limb shortening of 20 mm. There was no case of nonunion or infection, and patients could perform daily basic activities independently. VAS mean score was one point one year after final surgery. ConclusionsMasquelet's technique achieves encouraging results when treating lower limb acute bone defects. Using this technique, surgeons could decrease infection incidence in open fractures with severe bone loss. On the other hand, it is a two-stage surgery process, which makes the process longer.

External Fixation using external Fixation plate in proximal tibial fracture

Abstract Background: Proximal tibial fractures with compromised soft tissue envelop may lead to significant complications .The optimal management of these injuries remains controversial . The aim: The purpose of this study was to evaluate the results of external fixation using the external fixation plate in proximal fractures of the tibia. Patients and Methods : We prospectively evaluated 50 patients, with a mean age of 34.9 years ,who presented with proximal tibial fractures .According to the (AO/OTA) classification, type41-A2 in 35 cases and type 41-A3 in 15 cases. The state of the soft tissue were classified according to Tscherne classification : (O 1 in 10 cases , O 2 in 20 cases . C 0 in 5 cases and C 1 in 15 cases). The external fixation plate was used to fix these fractures.Which was placed on the tibia as an external fixator. The mean follow up was 9.2 months . Results : All fractures healed in a mean time of 27.9 weeks. There were no cases of deep infection, nonunion and loosening of the plates and screws. According to the modified Ramussen Criteria knee scoring system the mean score was 26.2 and (AOFAS) ankle scoring system , the mean score was 96.2. Conclusion : For proximal fractures of the tibia, external fixation using the external fixation plate is a safe and reliable technique with minimal complications and excellent outcomes.Its advantages include ease of performing surgery and ease of removing plate after fracture healing. Keywords: Locked plate,external fixator, tibia .

Metallosis after using distal fibular locking plate for lateral malleolar fractures: a retrospective study.

Studiesregarding the development of metallosis following open reduction and internal fixation (ORIF) of fractures are rarely found in orthopedic literature. Theaim of the current study was to assess metallosis following ORIF using distal fibular locking plates to treat distal fibular fractures. 69 patients who underwent surgery using locking compression plates to treat lateral malleolar fractures, with a minimum 1-year follow-up period and subsequent hardware removal were enrolled in our study. We divided the patients into 2 groups, to compare the complications and demographics: 38 patients, treated with ZPLP plate; 31 patients, treated with other plates. During 1year of postoperative follow-up, 20 complications developed: 6 superficial infections at the operative site, 1 case of nonunion, 3 cases of osteitis, 4 cases of hypaesthesia, 2 cases of peripheral neuropathy, and 4 cases of metallosis. No statistical difference was found in the rate of complications when comparing the treatment groups (Mann-Whitney U test, p < .05) except for metallosis. All 4 patients who developed metallosis were treated using a ZPLP plate, and metallosis did not develop at all in patients who underwent surgery using other plates. In our study, metallosis developed more than was previously known, particularly after using LCPs to treat lateral malleolar fractures. Our findings and those in recent publications support the possibility that metallosis can occur not only in patients with arthroplasties, but also in patients with open reduction and internal fixation with LCPs. Surgeons should be aware of such risk of metallosis and be careful to select proper plates for internal fixation.

Ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage in the treatment of 18 cases of chronic osteomyelitis.

ObjectiveOzone is a colorless gas used as a disinfectant and to treat diseases by limiting the effects of bacteria, viruses, fungi, yeast, and protozoa. In this study, we investigated the clinical efficacy of ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage (VSD) in the treatment of chronic osteomyelitis.MethodsEighteen patients (14 men and 4 women) with chronic osteomyelitis in the limbs (tibia: 13 cases; femur: 4 cases; humerus: 1 case) admitted to our hospital between April 2012 and October 2018 were selected. The patients were aged 9 to 52 years, with a mean age of 31 years. All patients underwent ozonated water lavage and physiological saline irrigation combined with VSD negative pressure closed drainage during hospitalization. The patients were followed up for 18 to 84 months, with a mean of 31 months.ResultsOsteomyelitis recurred in only one case of nonunion. The length of hospitalization was 18 to 29 days, with a mean of 21 days.ConclusionsA combination of ozonated water lavage, physiological saline irrigation, and VSD provided good clinical effects in the treatment of chronic osteomyelitis, and thus, is recommended for such treatment.

Upper Limb Lengthening in Achondroplasia Using Unilateral External Fixation.

The purpose of this study was to analyze the long-term results of humeral lengthening in achondroplastic patients and make suggestions on the most appropriate surgical technique to improve patient outcomes. Fifty-four humeral lengthening procedures performed in 27 achondroplastic patients were reviewed. Elongations were performed by means of callotasis with unilateral external fixation. Inclusion criteria were: achondroplastic patients under 17 years without prior arm operations and minimum follow-up of 36 months. Fifty humeri in 25 patients (13 men and 12 women), aged between 9 and 17 years, met the inclusion criteria. Mean humeral lengthening was 8.82 cm (range: 5 to 10.5 cm), which represented an elongation of 54.80% (range: 46% to 63%) of the original length. The healing index was 0.91 months (range: 0.72 to 1.4 mo) per centimeter gained. Shoulder and elbow range of motion and stability were preserved in 47 limbs. Noncomplicated cases consistently experienced a significant functional improvement in the performance of activities of daily living such as putting on footwear and personal hygiene. Short-term complications included 11 pin-tract infections, 1 radial nerve neuropraxia, and 1 failure of the regenerated bone formation. None of these complications prevented from completion of treatment. Long-term complications included 2 cases of nonunion, 3 elbow flexion contractures, and 2 cases of psychological dissatisfaction, all of them in 4 patients. Factors associated with long-term complications were intraoperative fragment displacement and distal humeral osteotomy. No fractures of the regenerated bone were identified in the long term. Callotasis with unilateral external fixation is a reliable and well-tolerated procedure for humeral lengthening in achondroplastic patients, with an acceptable complication rate. Guided fixator placement and a proximal humeral osteotomy are strongly recommended technical tips as they may help prevent complications and improve outcomes. Level IV-case series.

Non-vascularized fibular autograft for resistant humeral diaphyseal nonunion: Retrospective case series

IntroductionThere is a great surgical challenge when humeral diaphyseal fractures are initially open, complex, or associated with segmental bone loss. The challenge becomes even greater with previous multiple unsuccessful surgeries. The question of this study was: Does combining locked compression plating with non-vascularized fibular autograft in cases of resistant humeral diaphyseal nonunion yield reliable bony union and satisfactory functional outcome? HypothesisThe use of non-vascularized fibular autograft in conjunction with locked compression plating will provide stable construct, enhance bony union and improve functional outcome in cases of resistant humeral diaphyseal nonunion. Materials and methodsThirty-three patients with resistant humeral diaphyseal nonunion who were surgically managed combining non-vascularized fibular autograft fixed with locked compression plating in the period from January 2011 to June 2017, were retrospectively studied. All patients were followed-up for a minimum of 24 months. The time to union, the postoperative disability of arm, shoulder and hand (DASH) score, in addition to the possible complications including infection or nonunion were reported and analyzed. ResultsTwenty-nine patients have achieved union at the final follow-up with a mean time to radiological union of 7.5±2.6 months (range: 3–12). The mean postoperative DASH score was 7.7±8.9 (range: 0–38.8) which was significantly better than the preoperative value (p<0.001) and superior in the patients of aseptic nonunion (p=0.04). Eight patients showed complications in the form of infection (four), nonunion (two cases), transient radial nerve palsy (one case) and one case of septic nonunion that was managed by two-stage reconstruction using vascularized fibular autograft. There were comparable results in patients with either open or closed fractures. However, patients with septic nonunion experienced more significant complications (p=0.02). DiscussionThe use of non-vascularized fibula autograft in cases of resistant humeral diaphyseal nonunion provides adequate fracture stability, quadrilateral screw purchase, enhances bony union in addition to promoting satisfactory functional outcome particularly in aseptic nonunion. Level of evidenceIV; retrospective case series.

The Clinical and Economic Impact of High Value External Fixation Utilization at a Level II Trauma Center

Introduction: In the current climate of cost containment and fiscal responsibility, high value implant alternatives represent a substantial opportunity for the treatment of orthopedic trauma patients. As patents have expired on many commonly used trauma implants, high value alternatives have become available. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, low cost external fixation components for temporary spanning constructs in the treatment of tibial plateau and pilon fractures. Methods: 62 patients with tibial plateau and pilon fractures treated with temporary high value external fixation devices were compared to 62 patients treated with conventional brand external fixation devices over the same time period. The groups were analyzed for differences in intraoperative and post-operative outcomes in order to analyze the clinical efficacy of high value devices. Operative records were analyzed to identify intraoperative complications, operative time and estimated blood loss. Cases of infection, malunion, nonunion or need for repeat surgery were recorded. Hospital financial records were appraised to determine implant costs. Results: There were no significant differences in age, sex, presence of diabetes, smoking or fracture type between the high value and conventional groups. No difference in operative time was noted. No intraoperative or postoperative complications occurred in either group from the time of external fixation to the time of external fixator removal and conversion to definitive fixation. Overall the hospital realized a 58% reduction in implant costs, an average of $2,200 savings per case and a total savings of $136,400 during the study period. Conclusions: Use of high value external fixation implant constructs has been a very successful endeavor at our institution providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on this data the use of high value implants has the potential to markedly reduce operative costs as long as quality products are utilized.

Good clinical outcomes in nonunion cases after facet fusion with a percutaneous pedicle screw system for degenerative lumbar spondylolisthesis.

There are many satisfactory long-term outcomes after posterolateral fusion (PLF) for degenerative lumbar spondylolisthesis (DLS); nonunion cases have also achieved good clinical outcomes. Facet fusion (FF), a minimally invasive evolution of PLF, also resulted in good clinical outcomes. We aimed to assess the course of nonunion cases after FF and determine whether thenonunion cases achieved good clinical outcomes. We retrospectively reviewed the records of 136 patients who underwent FF for DLS. Range of motion (ROM) at the fused level was measured using a flexion-extension lateral radiograph preoperatively and 1 year postoperatively. Patients were classified into the Fusion or Unconfirmed Fusion group by computed tomography (CT) 1 year postoperatively. Furthermore, patients in the Unconfirmed Fusion group were classified into the Delayed Union or Nonunion group depending on the confirmation status of FF upon the following CT. The average preoperative ROM and clinical outcomes were compared between the three groups. The Fusion, Delayed Union, and Nonunion groups had 109, 14, and 13 patients, respectively. In the Nonunion group, the average ROM significantly decreased from 13.0° preoperatively to 4.9° postoperatively. There was a significant difference in the average preoperative ROM between the groups. The larger the preoperative ROM, the fewer facets fused. There was no significant difference in clinical outcomes between the groups. Five patients (3.7%) required revision surgery for adjacent segment disease 1-5.5 years after FF. Even nonunion cases after FF achieved good clinical outcomes, likely because the unstable spondylolisthesis was stabilized. FF did not require revision surgery for nonunion itself.

Patient-Reported and Radiographic Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformities

Background: Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA. Methods: This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point. Results: Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p &lt; 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p &lt; 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%. Conclusions: Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Open Reduction and Internal Fixation with Plate and Titanium Elastic Intramedullary Nail in Treating Pediatric Humeral Fracture

ObjectiveTo investigate the therapeutic efficacy of titanium elastic intramedullary nail (TEN) and open reduction and internal fixation with plate (ORIF) in the treatment of humeral fracture in children.MethodsA retrospective study was carried out in a total of 69 patients who were admitted to the hospital from January 2013 to December 2018. These patients, including 41 males and 28 females, were aged from 6 to 12 years old with a median of 8 years. These patients were diagnosed with humeral fracture and underwent the surgery of ORIF (n = 22) or TEN (n = 47). The intraoperative bleeding, operation time, length of stay (LOS), and fracture healing time were compared between the two groups. The therapeutic effect was assessed by the shoulder range of motion, the elbow range of motion, the UCLA shoulder function score, and the Mayo elbow performance score (MEPS) 6 months after the surgery.ResultsThe intraoperative bleeding (97.20 ± 27.83 mL vs 185.60 ± 37.50 mL, P < 0.05), the operation time (53.70 ± 11.87 min vs 73.50 ± 13.33 min, P < 0.05), and the fracture healing time (9.30 ± 4.23 weeks vs 13.45 ± 3.67 weeks, P < 0.05) in the TEN group was significantly decreased than those in the ORIF group. There was no significant difference in the LOS between the two groups. The length of follow‐up is 3 and 6 months. The shoulder range of motion (110.88° ± 15.82° vs 98.37° ± 16.22° at 3 months and 162.88° ± 17.29° vs 117.65° ± 19.38° at 6 months, both P < 0.05), the elbow range of motion (105.23° ± 2.81° vs 87.12° ± 4.73° at 3 months and 137.47° ± 4.82° vs 109.67° ± 5.83° at 6 months, both P < 0.05), and the UCLA shoulder function score (28.58 ± 4.74 vs 21.64 ± 7.23 at 3 months and 33.05 ± 3.27 vs 25.78 ± 3.87 at 6 months, both P < 0.05), and the MEPS (80.76 ± 3.53 vs 65.33 ± 9.43 at 3 months and 97.48 ± 1.23 vs 88.22 ± 3.65 at 6 months, both P < 0.05) in the TEN group were greater than those in the ORIF group. In the TEN group, complications occurred in three of 47 cases (6.38%), including one case (2.13%) of bone nonunion and two cases (4.25%) of irritation response around the nail. In the ORIF group, complications occurred in four of 22 cases (18.18%), including one case (4.55%) of delayed healing, one case (4.55%) of deep infection, and two cases (9.08%) of radial nerve injury. The complication rate was not significantly different between the two groups.ConclusionTEN can be a good technique for the treatment of humeral fracture in children, with the advantages of less intraoperative bleeding, shorter operative time, quicker healing, and better recovery of shoulder range of motion and elbow range of motion.

Subtalar distraction arthrodesis for calcaneal malunion - comparison of structural freeze-dried versus autologous iliac bone graft.

This study aims to analyze the outcomes of subtalar distraction arthrodesis (SDA) for calcaneal malunion using structural freeze-dried iliac allograft (FDIA) compared to using autologous iliac bone (AIB). We retrospectively evaluated 57 consecutive cases (51 patients) of calcaneal malunion between March 2006 and December 2017. All patients were followed for an average of 22.8 months. All cases were treated by SDA using structural FDIA (17 cases, group 1), or AIB (40 cases, group 2). The outcome measures included the American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, visual analog scale (VAS) pain scores, and radiographic measurements. The mean postoperative 3, 6, and 12 months of AOFAS scores and VAS pain score were significantly better in group 2 than those in group 1 (p < 0.05, for all). There were 3 cases (17.6%) of nonunion in the group 1, whereas the group 2 had 2 cases (5.0%), which did not shown significant difference between two groups (p=0.492). Although the mean pre-, postoperative, and final follow-up radiologic parameters in both groups were similar, (p > 0.05, for all) the difference of talocalcaneal height, talocalcaneal angle, and talar declination angle from postoperative to final follow-up were significantly bigger in the group 1. (p < 0.05, for all). Although union rate was not significantly different between the two groups, we obtained more favorable clinical and radiologic outcomes in the autologous iliac bone group. Using FDIA without any orthobiological agent for SDA, there were significant more loss of radiological parameters due to inferior incorporation and biomechanical properties. When considering the SDA for calcaneal malunion, routine use of FDIA without any orthobiological agents as an interpositional graft for SDA is not recommended.

Medial Malleolus Fracture Fixation in Weber Type B and C Ankle Injuries

Introduction: Medial malleolus fractures are commonly encountered by orthopaedic surgeons in their daily practice. Medial malleolus fractures are articular fractures and hence need anatomical reduction to prevent the potential complications. Many methods of fixation are in practice for fixing medial malleolus with the aim to achieve stable fixation and union of the fracture site. Aim: To evaluate the outcome of medial malleolus fracture fixation by three different methods- two partially threaded screws, one partially threaded screw and one k-wire and tension band wiring, in Weber type B and C ankle injuries. Materials and Methods: This prospective interventional study was conducted from August 2017 to September 2020 in a tertiary care orthopaedics hospital in Srinagar, Jammu and Kashmir, India. A total of 40 patients (aged 18 years or greater) of Weber B and C types medial malleolus fracture, were included in the present study. The medial malleolus was fixed with two partially threaded screws in 16 patients (Group A), one partially threaded screw and one Kirschner wire (K)-wire in 14 patients (Group B) and tension band wiring was done in 10 patients (Group C). The fixation was decided on intraoperative finding of fragment size and comminution as well as quality of bone. The parameters assessed were time of union, delayed union, non union, ankle range of motion and symptomatic hardware. One-way Analysis of Variance (ANOVA) test was used to compare parametric data of the three groups. The p-value &lt;0.05 was considered statistically significant. Results: The mean age of the patients was 40.20 years with range 18-65 years. 22 patients were females and 18 were males and the male to female ratio was 0.81. The mean time of healing of fracture was 10.25 weeks in group A, 11.14 weeks in group B and 10.80 weeks in group C. There were two cases of delayed union, one each in group B and C. Symptomatic hardware was mostly seen in group C. There was no case of non union in the present study. Conclusion: It can be concluded that all the three fixation methods used in this study achieved the union in comparable time duration with no case of non union. A particular method of fixation should be used by taking into consideration the type of fracture, size of the fragment, comminution and quality of the bone.

Functional outcome of extra-articular proximal tibia fractures treated by MIPPO

Introduction: Increased incidence of road traffic accidents, natural disasters, and industrial accidents claim most of human mortality and morbidity. These injuries commonly involve long bones, especially the tibia due to its subcutaneous location. Tibial diaphyseal fractures are the most common, followed by proximal tibial fractures. The treatment of proximal tibial fractures changed dramatically in 1969 following the study by Reudi and Ailgower (1) where 75% patients after internal fixation of tibia fractures were pain free and had good functional outcome at 4 years follow up. The following widespread use of internal fixation led to an increase in major complications like malunions (42%), superficial infections (20%), nonunion (18%), and osteomyelitis (17%). This led to a search for newer techniques which led to lesser soft tissue damage and yielded better results. Amongst these techniques was biological minimally invasive percutaneous plate osteosynthesis (MIPPO). In the 1990’s Krettek et al popularized the Minimally Invasive Percuntaneous Plate Osteosynthesis (MIPPO) technique in which conventional plates were placed through a small incision and slid through a subcutaneous tunnel. Biologically friendly plating and minimally invasive plating continues to remain popular today. This study compares MIPPO in extra articular proximal tibia fractures, in terms of functional outcome, union rate and time and the various complications associated with each group. Aims and objectives 1. To evaluate the clinical and functional outcome in Extra-articular Proximal tibial fracture treated with Minimally Invasive percutaneous plate osteosynthesis. 2. To study range of motion at the knee joint postoperatively. 3. To study the complications, if any with Proximal tibia fracture fixation. Inclusion criteria 1. Patients with closed extra-articular proximal tibia fractures with age of more than 18 years. 2. Both male and female patients. The exclusion criteria 1. Fracture associated with knee dislocation 2. Pathological fractures 3. More than 6 weeks Old untreated fractures 4. No other associated lower limb fracture 5. Age more than 80 years Results and observation: In this study we have taken follow up data of 30 patients with 25 males and 5 females. Most patients were males between 31-50 years of age. RTA was the highest reason for incidence of these fractures. Majority of patients were discharged within 10 post-operative days. Five patients developed infections which increased their hospital stay upto 16 days. On 6 weeks follow up there was only one case of nonunion out of the 30 patients, all of the 29 other fractures united within 6 weeks radiologically and clinically. Total 30 patients were evaluated postoperatively thoroughly for functional outcome using The Knee. Society Score which showed 24 patients (80%) had excellent and 6 patients (20%) had good objective knee society score. 23 patients (76.6%) had excellent, 5 patients (16.66%) had good and 2 patient (6.66%) were each of poor and fair functional knee society score. Conclusion: In this study, we found that extra-articular proximal tibia fractures treated with MIPPO plating gave an excellent functional outcome with minimal soft tissue stripping and better healing of the surgical site wound. There was only one case of delayed union and this directly tells us how superior a MIPPO plating technique is in comparison to long incisions.

Fracture patella: Fixation with cancellous screws and anterior cerclage wiring

Patella is the largest sesamoid bone. It is a triangular bone that lies within quadriceps tendon. Fractures of patella constitute approximately 1% of all skeletal injuries and occur in all age groups. There is always a need to salvage the fracture as it is an important functional structure in extensor mechanism of knee. Its report to evaluate the effectiveness and safety of anterior cerclage wire/tension band wiring technique using two or more cannulated cancellous screws in patients with transverse or transverse with comminuted patellar fractures. Material and Methods: This is a prospective study of 28 patients with transverse or transverse with comminuted fractures. All patients were treated with open reduction and internal fixation using multiple cancellous screws (more than two) and 18G stainless steel wire except two cases with TBW with k wire as per tension band principle. Result-There were 28 patients, 24(85.71%) males and 4(14.28%) females. The age group ranged from 22-60 years with mean age 38 years. The mode of injury was either direct or indirect trauma, fall (74%) followed by RTA (18%) and violent quadriceps contraction (8%). Transverse fractures were present in 60% patients and transverse fracture with comminution in 40% patients. Mean time to achieve union was 10.7 weeks (Range 8-12 weeks). Cases were followed up for 3 months, then at 6 months, thereafter 6 monthly and assessed for recovery of knee function. Study continued up to 12 months to 18 months. Mean ROM at the end of 3 months was 113.8° (90-130) and at final follow up this movement improved up to 125.4° (ROM 100-150). There was loss of reduction in one case, one case of infection and one case of nonunion. No case of implant failure was observed. The study was conducted in Department of Orthopaedics, Hi Tech Medical College, Rourkela and SB Medical College, Hazaribag. The results were graded according to the criteria given by Gaur et al. IJO May 1997. Conclusion: The criteria for surgery, open reduction and internal fixation with multiple cannulated cancellous screws with anterior cerclage was if ˃ 3mm displacement and ˃ 2mm articular step off was present. The screws provide rotation control of fragment and anchorage of cerclage wire. It provides additional compression across the fracture site. Open reduction and internal fixation with cannulated cancellous screws with anterior cerclage /TBW is a safe, reliable and reproducible method in the management of transverse or transverse with comminuted fractures, with less chances of implant failure and less soft tissue irritation.

Results of flexible nails for fixation of tibial diaphysis fractures in children

Background: Fracture tibia is one of the most common fractures in the pediatric age group. It accounts about 15% of cases. In majority of cases, close reduction and plaster application is the mainstay of treatment. Objectives: The objective was to assess the outcome of flexible nails in the treatment of tibial diaphysis fractures in children and to evaluate the results regarding the union rate and complications including limb length discrepancy, angular deformities, and pain. Materials and Methods: This prospective descriptive case–control study which included 30 children with 30 unilateral tibial diaphysis fractures in which the physis were open, all were closed, and open (type 1 and type 2) fractures, and with displaced transverse, short oblique, and spiral fractures, in which the trial of close reduction was failed. All patients are admitted and operated at West Erbil Emergency Hospital. Alignment of fractures, any infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, time of complete union, and skin irritation were assessed with minimum follow-up period of 6 months. Results: In the current study, the complete union was achieved in 9–11 weeks in 20 (66.7%) patients, while in 6 (20%) patients, achieved in 12 weeks, and in 4 (13.3) patients, achieved in 13–16 weeks that were regarded as a delayed union. In 6 (20%) patients, there were nail protrusion and skin irritation, no shortening more than 0.5 cm was recorded, shortening <0.5 cm recorded in 12 (40%) patients, and no lengthening was recorded. In 3 (10%) patients, the angulations in coronal and sagittal views were 5°–10°. There was no case of nonunion. Conclusion: Elastic nails are an effective way for the treatment of the pediatric tibial diaphysis fractures. It is a simple and easy method but with radiation risk, although elastic nails have complications, all are avoidable and minor that will be managed with minimal intervention.

Evaluation of outcomes of distal femoral fractures treated by retrograde nailing technique

Background: Distal femur fractures are less common injuries accounting for approximately 1% of fractures in the elderly. They occur due to high-velocity injury in adults and simple fall in the elderly. Management of these type injuries in the elderly is more challenging because of osteoporosis. Retrograde nailing represents an established fixation method for fractures of the distal femur and offers an alternative to the existing technique of antegrade nailing. Materials and Methods: Prospective study of 70 patients, aged between 16 and 85 years, whose distal femoral fractures were treated with a retrograde femoral nail from December 2016 to November 2018 in the department of orthopedics of a tertiary care centre in North India were followed to assess the outcome of treatment. The fracture was caused by a motor-vehicle accident in 58 patients (82.85 percent) and a fall on the ground in 12 (17.14%). 26 (37.14%) of the fractures were open. All the patients were followed up at about 3 weeks, 6 weeks, 3 months, 6 months, and 1 year. On each visit pain, functional range of movements was noted and the union was assessed clinically and radiologically at regular intervals. Results: Out of 70 patients, 60 patients were males and the remaining patients were female. Twenty-six patients had open fractures and 44 patients had closed fractures. All the patients in our study united without any case of nonunion and knee infection. The mean time required to achieve union was 5.42 ± 2.48 months in closed fractures, while in open fractures, it was 5.7 ± 1.65 months. The mean range of knee movement in open fractures was from 15.0° ± 12.57° to 113.75° ± 14.69 °, while in closed fractures, it was from 5.38° ± 6.43° to 122.18° ± 15.0°. Five patients had loosening of the distal interlocking screws impinging on the skin. Based on the criteria recommended by Schatzker the outcome was assessed as excellent in 33 (47.14%) cases, good in 27 (38.57%) cases, and fair in 7 (10%) cases. The outcome in 3 (04.29%) cases was graded as poor. Conclusions: Retrograde intramedullary nailing makes possible a biological osteosynthesis of distal femoral fractures. It also produces good functional results even in elderly patients.

Evaluation of diaphyseal femoral fractures in children treated with tens nailing: A clinical study

Femur fracture is very common fracture in children. Femur shaft fracture around 2% pediatrics age group fracture. Various methods are used to treatment in femur fracture. Like hip Spica, plating, nailing with tens or Enders nailing. Enders and tens are commonly used methods. Purpose of study: The know of outcome of elastic tens nailing in pediatrics shaft fracture. Material and Method: We study’s 24 children’s of fracture shaft of femur between age group 5 to 14. Result: The minimum fellow up to 8 month. The average time taken to full weight bearing and clinical union is 6 week to 8 week. In 3 cases there is superficial infection present in 2nd week of post-surgery. Which is cure by antibiotics and wound washing. No case of nonunion, out of 24 cases 12 cases have limb length discrepancy. 6 cases had lighting 6 cases had shorting. On the Flynn criteria 22 cases have excellent result 2 have satisfactory result. No cases show any unsatisfactory results. Conclusion: Cases which treated by tens elastic nailing achieved primary healing. The advantage of treating patient with enders nail had early weight bearing, reduced hospital stay, less bedridden and early to start to study. Overall tens elastic nailing is have many benefits either then conservation treatment.

Patient oriented outcome of surgical fixation of clavicle fractures in a rural tertiary care centre

Clavicle fracture is one of the most common bony injuries. They account for 2.6% to 4% of adult fractures and 35% of injuries to the shoulder girdle. Clavicular fractures have traditionally been treated non-operatively. Surgical treatment of acute midshaft fractures was not favored due to relatively frequent and serious complications. However, the prevalence of non-union or malunion in displaced midshaft clavicular fractures after conservative treatment is higher than previously presumed. Twenty-four patients with displaced clavicle fractures were treated with locking compression plate between October 2018 to September 2020 at Kamineni Institute of Medical Sciences, Narketpally. The duration of radiological union ranged from 12-16 weeks with the majority having union at 12 weeks (66.7%). The remaining (33.4%) had union at 16 weeks. Delayed union and nonunion cases were not observed in our study. The functional outcome assessment according to Constant Murley Scoring system showed excellent functional outcome in 75% and good functional outcome in 25% of the patients.

Tibial Tubercle Osteotomy With Distalization Is a Safe and Effective Procedure for Patients With Patella Alta and Patellar Instability.

Background:Tibial tubercle osteotomy with concomitant distalization for the treatment of patellar instability remains controversial, as it may cause anterior knee pain and chondral degeneration.Purpose:To evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction.Study Design:Case series; Level of evidence, 4.Methods:Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle–trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score.Results:The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range, 7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02 (0.9-1.12) postoperatively (P = .001); and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral release (22 cases; 71.0%), medialization of tibial tubercle (17 cases; 54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other associated procedures. The J-sign improved in 30 cases (96.8%; P = .001), and there was a complete resolution of anterior knee pain in 22 cases (71.0%; P = .001). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain (P = .005). The apprehension test became negative in all cases (P = .001). The median Kujala score increased from 52 to 77 (P = .001), and the median Tegner activity level improved from 3 to 4 (P = .001). No cases of osteotomy nonunion were reported. One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed.Conclusion:TTO-d resulted in good radiographic, clinical, and functional outcomes providing proper patellar stability to patients with patella alta. TTO-d appears to be a safe and efficient procedure with low complication rates, providing an additional tool for the personalized treatment of patellar instability.

A case of infectious nonunion with skin defect of distal lower leg open fracture treated with Ilizarov external fixator

A case of infectious nonunion with skin defect of distal lower leg open fracture treated with Ilizarov external fixator