Cases Of Nonunion Research Articles

Anterior screw fixation for type II odontoid process fractures: A single-center experience with the double Herbert screw fixation technique (Retrospective cohort study)

BackgroundIn type II odontoid fractures with intact transverse ligament as classified by the Anderson and D'Alonzo system, anterior screw fixation offers the best anatomical and functional results. The goal of this study is to review the results of the double screw technique in anterior odontoid surgery using a headless 3.0-mm.-diameter cannulated Herbert screw on patients with odontoid process fractures. MethodsFrom January 2015 through March 2019, 12 cases of acute traumatic type II odontoid fractures were treated with double anterior screw fixation using 3.0-mm Herbert screws, slightly smaller than the standard size for Caucasian populations. The data collected included radiographic measurements, postoperative complications, union rate and clinical outcomes in follow-up examinations over an average of 24-months. ResultsThe age of the 12 patients, 8 males and 4 females, ranged from 17 to 68 years (mean, 38.42 ± 20.14). The fracture type was type IIa in 4 patients (33.33%) and type IIb in 8 patients (66.67%). The period of follow-up was 15–64 months (mean, 31.42 ± 17.37). All the patients had good clinical results after surgery with no postoperative complications. Eleven cases (92%) had achieved bone union with 1 case (8%) of nonunion. In the nonunion case, the patient was a chronic smoker who continued smoking both during treatment and follow-up. ConclusionsThis series of satisfactory clinical results demonstrates that double anterior screw fixation of type II odontoid process fractures using 3.0-mm screws is highly effective in the Thai population. Headless cannulated cancellous screws provide significant biomechanical strength which is not inferior to the traditional screws

Хірургічне лікування хворих із позасуглобовими переломами дистального відділу плечової кістки

У статті розглядаються позасуглобові переломи дистального відділу плечової кістки згідно з класифікацією АО/ASIF, до яких залежно від площини зламу та характеру зміщення уламків відносять типи 12А–С. Мета: вивчити особливості переломів плечової кістки в нижній третині і провести порівняльний аналіз результатів хірургічного лікування. Матеріали та методи. Під наглядом перебували 127 пацієнтів із позасуглобовими дистальними переломами плечової кістки. Для ретроспективного аналізу пацієнти були розподілені на групу порівняння (92 особи), в якій був виконаний традиційний накістковий остеосинтез, і групу дослідження (35 осіб), в якій застосовували розроблений нами пристрій зовнішньої фіксації стрижневого типу. Найближчі та віддалені функціональні результати вивчені з використанням шкали MEPS. Результати. Проаналізовані різні показники, встановлені нами для порівняння, і результати лікування в 101 пацієнта (група порівняння— 68 осіб, група дослідження — 33 особи). Більшість значень цих показників були цілком порівнянними за віком, статтю, термінами госпіталізації, тривалістю операцій тощо, але виявлені відмінності показників все ж таки не досягали рівня статистичної вірогідності (p > 0,05). Оцінка клінічного застосування запропонованого нами пристрою показала цілком порівнянне з накістковим остеосинтезом відновлення анатомії плечової кістки і досягнення кінцевого результату лікування. Однак число ускладнень за видом і загальною кількістю було вірогідно (p < 0,001) вищим у 4,5 раза у групі порівняння, де на їх частку припадала найбільша кількість випадків нейропатій (16,18 %), незрощень (8,82 %), конт-рактур ліктьового суглоба (8,82%) і гетеротопічної осифікації (4,42 %). Підсумкові значення за шкалою MEPS серед обстежених хворих у групі порівняння становили 84,9 ± 10,2 бала, у групі дослідження — 92,6 ± 3,7 бала. При цьому сумарна оцінка позитивних результатів лікування після накісткового остеосинтезу становила 66,18 %, після черезкісткового остеосинтезу— 81,82 %. Висновки. Аналіз отриманих даних дозволяє рекомендувати спосіб малоінвазивного остеосинтезу стрижневим пристроєм зовнішньої керованої фіксації як метод вибору для більш широкого клінічного використання при лікуванні пацієнтів із переломами плечової кістки на рівні нижньої третини.

Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up

BackgroundThe use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures.MethodsWe retrospectively assessed 32 patients (17 males, 15 females; 23–88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups.ResultsThe mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8).ConclusionTreatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.

Clinical application of new three-dimensional honeycomb guide in percutaneous cannulated screw fixation of femoral neck fracture

To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups ( P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group ( t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group ( P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group ( P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups ( t=-0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups ( P>0.05). The new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.

Teriparatide in fracture healing: Case series and review of literature

Teriparatide (TPTD) (recombinant Parathyroid Hormone 1-34) is one of the pioneer osteo-anabolic agents approved for management of osteoporosis. Being an anabolic agent, it increases bone mineral density by inducing formation of new bone by the action on osteoblasts. As new bone formation is an important aspect of fracture healing as well, Teriparatide has long been a product of interest with respect to its effect on the process of fracture healing. Though fracture healing is not an approved indication for Teriparatide, there is quite a substantial amount of published data related to its effectiveness in fracture healing. With an intent to better understand the role of teriparatide in fracture, we share few case reports of successful fracture healing after giving Teriparatide and also review the published evidences of union taking place in difficult delayed union and non-union cases secondary to mechanical instability, inadequate fixation support or other reasons. This article thus, intended to summarize the accumulating preclinical and clinical evidence for role of TPTD in accelerating fracture healing in various conditions like conservative management of fractures, vertebral fractures, non-unions, delayed unions and atypical femoral fractures.

Outcomes of Arthroscopic Latarjet Procedure for Anterior Glenohumeral Instability in Patients With Epilepsy: A Case-Control Study

Background: Unacceptably high rates of redislocation, reoperation, osteoarthritis, and coracoid nonunion have been reported in patients with a seizure disorder after surgery for shoulder instabilitiy. Purpose: To evaluate the objective and subjective functional and radiologic results of the arthroscopic Latarjet procedure for anterior shoulder instability in patients with epilepsy and compare them with the results of patients without epilepsy. Study design: Cohort study; Level of evidence, 3. Methods: A retrospective and comparative case-control analysis of patients operated for shoulder instability with arthroscopic Latarjet was conducted. Nineteen patients (21 unstable shoulders) with a seizure disorder (epilepsy group) were matched with 21 patients without a history of seizure (control group). Demographics, surgical indications, and imaging data were collected. Clinical outcomes at a minimum 2 years of follow-up (range, 2-9 years) postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE). The incidence of complications, recurrent instability, redislocation, revision surgery, repeated seizure(s), and presence of osteoarthritis, coracoid nonunion, and osteolysis were also examined. Results: After a mean follow-up of 4.5 years, no significant differences in functional results were found between patients with and without epilepsy on the average Rowe (P = .917), WOSI (P = .621), CMSO (P = .600), and SANE (P = .859) scores. A total of 5 patients (7 shoulders) continued to have seizures postoperatively, but no seizure-related glenohumeral instability was documented. One dislocation and 1 subluxation were documented while participating in sports in each study group, comprising a recurrence rate of 9.5%, but no significant differences were found at comparison (P = .605). A bone defect did not influence the results, as no significant difference was found between the 2 groups. Osteoarthritic changes of the glenohumeral joint were observed in 5 shoulders (23.8%) in the epilepsy group and in 3 (14.3%) in the control group (P = .451). No case of coracoid nonunion or osteolysis was recorded. There was no statistically significant difference in postoperative athletic activity (P = .660). However, patients with epilepsy had significantly lower pre- and postoperative sports participation (P < .001). Conclusion: Arthroscopic Latarjet stabilization can lead to improved functional and subjective outcomes and should be considered in patients with epilepsy with recurrent anterior glenohumeral instability. These results can be achieved regardless of the presence of bone defect and the postoperative control of seizures and are similar to those in patients without epilepsy.

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures.

BackgroundThe best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures.MethodsForty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12–144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV).ResultsOf the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference (p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference (p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression.ConclusionsAlthough a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.

Two cases of nonunion after proximal humeral fracture treated with bone graft and intramedullary nail

Two cases of nonunion after proximal humeral fracture treated with bone graft and intramedullary nail

The Novel Hooked Kirschner Wire Technique for Ulna Coronoid Process Fractures.

The aim of this study was to introduce a novel technique to improve the ease of fixing of even small fragments of the coronoid process and report the clinical outcomes of this method. Forty-nine patients with ulnar coronoid process fractures fixed using the hooked Kirschner wire (K-wire) technique at our hospital from 2007 to 2019 were reviewed. Radiological features and fracture union were assessed using simple radiographs. Functional outcomes of the treated elbows were evaluated at the final follow-up visit using the Mayo Elbow Performance Score (MEPS). All patients were examined at a mean follow-up of 17.7 months (range, 6-62 months). We observed bony union in patients at a mean of 10.9 weeks (range, 6-22 weeks). The mean flexion and extension ranges of the elbow were 132.0° (range, 106° -151°) and 4.5° (range, -20° to 30°), respectively. The mean pronation and supination ranges of the forearm were 81.1° (range, 60°-90°) and 88.3° (range, 60°-120°), respectively. The mean arc of the elbow was 127.4° (range, 78°-160°). All patients were evaluated using the MEPS at the final follow-up visit, with a mean score of 96.9 points (range, 80-100 points). One case of coronoid nonunion was observed and re-fixation was performed. One case of infection was observed and also treated with additional surgery. Three patients complained of ulnar nerve symptoms and 1 patient underwent surgical release for tardy ulnar nerve palsy. Despite its limitations, the hooked K-wire technique was a useful method for even smaller coronoid process fractures. K-wires were also a useful temporary intraoperative fixation method and could provide permanent fixation.

Open Fractures of Limbs by the Bite of Domestic Donkeys: An Unusual Aetiology

Introduction: The aim of this study is to describe the epidemiological, lesional, therapeutic and evolutionary profile of open fractures of limbs by bites of domestic donkeys. Patients and Methods: This is a prospective descriptive study over 28 months made in the Orthopedics-Traumatology department of the Tambacounda Regional Hospital in Senegal, concerning patients bitten by donkeys, resulting in an open fracture of the thoracic and pelvic limbs. Results: Twelve male patients were included. The average age was 10.50 years ± 2.60. The most common circumstance was the bite when two donkeys were separated. The thoracic limbs were the most affected by the occurrence of the arm. Cauchoix-Duparc type II and AO A2 and B2 were predominant. The essential trimming/osteosynthesis was carried out within 24 hours of the bite. Serovaccination was systematic, but on the other hand, a single dose of anti-rabies serum was administered. Pinning was the most commonly used bone synthesis. Complications were mainly infectious, followed by a case of radial nerve palsy and non-union on pins. Conclusion: The typical profile of an open donkey bite fracture is a male child/adolescent who is bitten during the separation of two fighting donkeys. The lesions are most often found in the thoracic limbs with a predominance of Cauchoix-Duparc type II and type A2 and B2 fractures of the AO, whose treatment consisted of trimming and pinning. The infectious complications of the soft tissues marked the evolution.

Clinical outcomes of dual fixation of femoral shaft fracture nonunion: synchronous nailing and plate augmentation

Background The key to success in femoral shaft nonunion cases is the achievement of mechanical stability. We aimed to provide the clinical outcome of dual-fixation femoral shaft fracture nonunion using intramedullary nailing and plate augmentation in the same setting. Patients and methods This was a retrospective study of 12 patients with femoral shaft fracture aseptic nonunion operated at our university hospital between January 2017 and June 2021. All patients underwent revision surgery with synchronous nailing and plate augmentation. Demographics, comorbidities, history of previous trauma, fracture healing, and complications were recorded. We also reviewed radiological images. Results Twelve patients (nine males and three females) with a mean age of 31.1±9.8 years were included. Six patients had a previous fixation with an intramedullary nail, five with a plate, and one with an external fixator. Ten patients had atrophic nonunion, and two patients had hypertrophic nonunion. Patients achieved fracture healing after the surgical intervention, except two patients required another surgical intervention for delayed union as bone grafting (at 6 and 8 months, respectively). At the end of the study, they achieved fracture healing in all patients. The mean healing time was 6.1±2.4 months. Conclusion s Good mechanical stability and hence union can be achieved with synchronous nailing and plate augmentation as a treatment option for femoral shaft fracture aseptic nonunion.

Hardware Choice and Risk Factors of Talonavicular Arthrodesis Non-Union

Category:Midfoot/Forefoot; AnkleIntroduction/Purpose:Talonavicular arthrodesis is a commonly performed procedure in orthopedic foot and ankle surgery, for conditions including osteoarthritis, instability, and others. The surgery is frequently performed as part of a double or triple arthrodesis. Multiple surgical constructs have been described, including screws, plate/screw constructs, and staple/screw constructs. Few studies exist that specifically focus on the talonavicular joint, and those that do are often limited by low patient volumes. Studies that do examine non-union of the talonavicular joint do not offer comparative data on non-union rates between the different methods of fixation. The purpose of this study was to determine the rate of arthrodesis in talonavicular fusion surgery among different fixation techniques and determine if hardware has a significant effect on union rate among patient factors.Methods:This is a retrospective single institution, multi-surgeon study evaluating arthrodesis rates in the talonavicular joint. Adult patients undergoing primary talonavicular fusion (isolated or as part of double/triple arthrodesis) from 2015-2018 with a minimum of 3-month radiographic follow-up were studied. Patients undergoing revision talonavicular fusion or fusion as part of Charcot reconstruction were excluded. Patient radiographic and chart notes were reviewed to assess fixation type (single screw, 2-hole compression plate, or screw + staple), the status of the arthrodesis at >=3 months and any hardware complications or reoperations following the index procedure. Descriptive statistics were generated for standard patient demographics and co- morbidities. Non-union rates were calculated for the cohort as a whole and for each fixation technique utilized along with the frequency of hardware complications/removal. Univariate analysis was performed to determine risk factors for increased non- union rate, including patient demographics, co-morbidities, and fixation technique.Results:A total of 198 patients were included. Hardware included 131 double straight screws, 42 two-hole compression plates, and 25 screw + staple constructs. Seventeen patients (8.59%) had a nonunion of the talonavicular joint at >3 months, while 18 patients (9.09%) had hardware complications of breakage or prominence and 11 (5.56%) required eventual removal. Hardware type was not a significant predictor of nonunion, as 11 patients had straight screw hardware (8.40%), while 3 had a two-hole plate (7.14%) and 3 had screw + staple (12%) (p=0.801). Hardware breakage or backing out occurred in 6/131 patients with straight screws (4.58%), 5/42 with 2-hole plates (11.90%), and 7/25 with staple + screw (28%) (p=0.001). Hardware removal was necessary in 5 (3.82%) straight screw patients, 3 (7.14%) two-hole plate patients, and 3 (12%) screw + staple patients (p=0.186). Patient age, sex, diabetic and smoking status were not significant for nonunion or hardware complication.Conclusion:The type of hardware used in talonavicular arthrodesis is not a significant factor in achieving union. Staple + screw constructs may be more susceptible to hardware breakage or migration, but was not significant for the necessity of hardware removal, as a number of patients remain painless and achieve the intended union. The authors recommend that physicians can make decisions of which to utilize based on familiarity and preference. Further study is indicated on even larger patient cohorts with increased population of nonunion cases so that further significant patient risk factors for nonunion of the joint can be identified.

Radiographic Evaluation of Isolated Continuous Compression Staples for Midfoot and Chopart Arthrodesis

Category:Midfoot/Forefoot; HindfootIntroduction/Purpose:The use of continuous compression implants (nitinol staples) in orthopaedic surgery has increased secondary to advances in metal alloy engineering. Biomechanical studies provide useful data supporting the theoretical use of nitinol staples in the foot and ankle; however, clinical data is limited. There are several advantages of nitinol staples, including a lower profile when compared to traditional fixation methods. They are easy to apply and take up a smaller footprint than most plating techniques, thus decreasing surgical time and dissection. Additionally, continuous compression across the fusion site is maintained, as opposed to lag screw fixation. The purpose of this study was to determine the overall effectiveness, clinically and radiographically, of continuous compression implants (nitinol staples) to achieve stable arthrodesis in the midfoot and Chopart joints.Methods:A retrospective chart review was performed on 18 patients (37 joints) who underwent arthrodesis of the midfoot or Chopart joints utilizing isolated continuous compression implants between January 2017-December 2019. The primary outcome variable was radiographic evidence of arthrodesis on x-ray. X-rays were independently reviewed by three board-certified foot and ankle surgeons. All investigators were blinded towards the x-rays, and x-rays were randomized in terms of timing from surgery. Each investigator reviewed digital radiographs independently and recorded their radiographic finding responses. Joints were deemed fused if greater than 50% of the joint contained bridging bone radiographically. A partial fusion was defined as some bridging bone, but less than 50% of the joint involved, and nonunion was defined as no arthrodesis seen radiographically, broken hardware, or loss of reduction. Smokers and diabetics represented 22% and 11% of the patient population, respectively.Results:Radiographic union was seen in 88.8% of TMT joints (16/18) and 83.3% of midfoot joints overall (20/24). Nonunion rates were 11.2% (2/18) and 16.6% (4/24) respectively. Diabetes was associated for 50% (3/6) of nonunions. Mean time-to-fusion for TMT joints was 60 days. In Chopart joint fusions, nonunion rate was 46% (6/13), 2/6 (33%) were smokers. Overall, diabetes and smoking was associated with 40% (4/10) of all nonunion cases. TMT joint fusions had a significantly lower proportion of nonunion rates than hindfoot fusions (p=0.043). Radiographic Interobserver reliability was moderately strong between reviewers. Clinically, Chopart joint fusion patients had a significantly longer time course to weight bearing (p = 0.028). 8% (4/50) had broken hardware, all in nonunions, 75% (3/4) occurring in Chopart joints.Conclusion:Isolated nitinol staples are a viable option for midfoot arthrodesis, especially TMT joints, and offer multiple advantages when compared to traditional fixation methods. Staples are lower profile, eliminating hardware irritation and potential secondary surgeries, are technically less demanding, and time of application is decreased when compared to other methods. They offer the benefit of continuous compression of the fusion site, as well, and are rigid enough to maintain reduction. However, Chopart joints may require a more rigid fixation than CCI staples can provide, given the higher nonunion rate, and caution should be exercised in diabetics and smokers.

Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Anchor and Krackow-"8" Suture for the Fixation of Distal Pole Fractures of the Patella: Comparison to Kirschner Wire.

ObjectiveThe study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow‐“8” suture fixation (AS) and K‐wire fixation in patients with distal pole patellar fractures.MethodsTwenty‐eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow‐“8” suture fixation (AS group) was applied in 10 patients and 18 patients underwent K‐wire fixation (K‐wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K‐wire group, with comparable demographic characteristics. All patients underwent regular follow‐up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture.ResultsA total of 28 eligible patients were included in this study. The mean follow‐up was similar for the AS and the K‐wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The final follow‐up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion–extension angle was slightly better in the AS group than in the K‐wire group. The Bostman patella fracture functional score of AS group were better than K‐wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K‐wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re‐operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation.ConclusionsAnchor and Krackow‐“8” suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures.

Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

&lt;p class="abstract"&gt;Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.&lt;/p&gt;

Metatarsophalangeal arthrodesis of the hallux using a minimally invasive technique

Objective: To evaluate the outcomes of the metatarsophalangeal arthrodesis (MTPA) of the hallux using a percutaneous technique. Methods: The MTPA of the hallux was performed in a total of 27 feet: 20 patients diagnosed with hallux rigidus and 7 with rheumatoid arthritis. The mean postoperative follow-up time was 30.7 months. The results were evaluated using the visual analogue scale (VAS) for pain, the American Orthopaedic Foot &amp; Ankle Society (AOFAS) forefoot score, and regards to union rate. Results: All 27 patients were operated percutaneously and noticed relief of the pain, with a mean increase of 50.9 points in AOFAS scores and a mean decrease of 7.4 points in the VAS. The mean union time was 10 weeks. There were no cases of nonunion. Conclusion: Percutaneous first MTP arthrodesis proved effective for treating hallux rigidus and degenerative rheumatic pathologies. Level of Evidence IV; Therapeutic Studies; Cases Series.

The efficacy of augmentative anti-rotational plating plus decortication and autogenic bone grafting for aseptic nonunion after intramedullary nailing of femoral shaft fracture

Abstract Background: Femoral interlocking intramedullary (IM) nailing fixation is an effective method for the treatment of femoral shaft fractures. Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon. Currently, the treatment for aseptic femoral shaft nonunion is controversial. The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure. Methods: A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019. All patients were treated by leaving the nail in situ, debridement of nonunion sites, decortication, autogenous iliac bone grafting, and augmentative antirotational plating fixation. The time to fracture union and complications were recorded. Results: All patients were followed up for 12–18 months. The union rate after revision surgery was 100%. The average union time was 5.5 months (range, 4-10). Subjective pain symptoms had disappeared in all patients. There were no incision infections or internal fixator fatigue fractures. Average scores of the physical function and bodily pain components of the SF-36 were 95.5 (range, 91-98) and 94.1 (range, 90-97), respectively. No other obvious complications occurred postoperatively. Conclusion: Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing; this approach has an overall high union rate and few complications.

Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report

BackgroundTransverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge.Case presentationWe present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient’s complete recovery.ConclusionWe believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.

The use of a free vascularized osteocuteanous flap from the medial femoral condyle for two separate cases of ulnar shaft nonunions in a single patient: A case report

Abstract The free vascularized osteocutaneous flap from the medial femoral condyle is an attractive option for limb salvage given its low donor morbidity site and reliable vascular supply. Its use was originally described for the use of nonunions with small bony defects and has shown reliable results for a variety of reconstructive needs. We present a case of a female patient who underwent two free vascularized corticoperiosteal medial femoral condyle grafts to her right ulna during two separate surgeries for treatment of consecutive ulnar shaft nonunions. The patient had a prior malignant soft tissue tumor resection of her forearm followed by chemotheraphy and radiation, which presented unique challenges during their course of limb salvage. Six months after the most recent procedure, the patient has a functional limb and no evidence of nonunion on imaging.