Nail In Treatment Research Articles

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

Improving dust capture efficiency with local exhaust hoods in manicure shops

As a prerequisite for our goal of studying the entrainment of dust particles released by nail filing in nail salons we have identified their physical and mechanical properties that were previously unknown: density, particle-size distribution, dynamic shape coefficient and dust concentration in the manicurist's working zone. It was proven using a computational experiment a lateral exhaust would capture dust particles effectively. Using the discrete vortex method and numerical integration of the dust particle motion equation, a mathematical simulation was developed for the flow of dust-laden air around a flanged lateral hood. Relationships behind the dust particle capture range for an exhaust hood mounted on a horizontal table were identified in connection to the terminal velocity of dust particles, quantity and inclination angle of the initial escape velocity vector, velocity inside the duct, flange length, and duct inlet edge shaping along the identified vortex zone boundaries. Dust released by nail treatment can be trapped effectively with a tabletop-mounted lateral exhaust duct with a semicircular flange having a length of 2–4 times gauge (pipe radius). As a means of reducing drag, it is proposed to shape duct inlet edges along the identified boundaries of vortex zones occurring at duct inlet. For a local exhaust hood, such shaping will render the added benefit of reducing noise generated in vortex zones along with preventing contaminant release from these zones. Patterns in dust particle capture range identified by us can be used to determine the required performance of local exhaust ventilation.

The prophylactic use of antibiotic coated intramedullary nail in treatment of open tibia fractures

Introduction: Open tibia fractures are the most common type of all open injuries and are more prone to infection than other long bones. To control infection various surgical techniques and antibiotic therapy are used. Local delivery of antibiotics at the tissue-implant interface using Gentamicin-coated implants is one of the methods which provide mechanical stability, effectively prevent infection and promote bony union by simple one stage procedure. Materials and Methods: Thirty patients were selected with open fracture of shaft tibia, treated operatively with antibiotic coated intramedullary interlocking nail and were followed up for a minimum of six months duration. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Result: In this study of 30 patients, time taken in wound healing in 15 patients is 5 weeks. RUST score at 6 months in 16 patients is 8. Infection found in 2 patients and 1 patient undergone non-union. 29 patients can bear weight without pain after 6 months of surgery. 16 patients have fair outcome. Conclusion: The use of the antibiotic coated nail has good clinical and radiological outcome at six months and preliminary results support the use of antibiotic coated implants as a new potential treatment option for prevention of infection in open tibia fractures. Keywords: Open fracture, Intra medullary nail, Antibiotic coated.

Effective multi-functional biotechnological applications of protease/keratinase enzyme produced by new Egyptian isolate (Laceyella sacchari YNDH)

BackgroundDue to a multitude of industrial applications of keratinolytic proteases, their demands are increasing. The present investigation studied the production and monitoring of the most possible multi-functional applications of YNDH thermoalkaline keratin-degrading enzyme. ResultsThis work is considered the first that reported YNDH strain closely related to Laceyella sacchari strain; YNDH is a producer of protease/keratinase enzyme and able to degrade natural keratin such as feathers, wool, human hairs, and nails. Experimental design Plackett-Burman (PBD) was applied to evaluate culture conditions affecting the production of thermoalkaline protease/keratinase. Afterwards, Box-Behnken design (BBD) was applied to find out the optimum level of significant variables namely, NH4Cl, yeast extract, and NaNO3 with a predicted activity of 1324.7 U/ml. Accordingly, the following medium composition and parameters were calculated to be optimum (%w/v): NH4Cl, 0.08; feather, 1; yeast extract, 0.04; MgSO4.7H2O, 0.02; NaNO3, 0.016; KH2PO4, 0.01; K2HPO4, 0.01; pH, 8; inoculum size; 5%, cultivation temperature (Temp.) 45 °C and incubation time 48 h. The studied enzyme can degrade keratin-azure, remove proteinaceous materials, and is able to remove hairs from goat hides. These interesting characteristics make this enzyme a good candidate in many applications especially in detergent (Det.), in leather industries, and in pharmaceuticals particularly in nail treatment. ConclusionThe promising properties of the newly keratin-degrading protease enzyme from Laceyella sacchari strain YNDH would underpin its efficient exploitation in several industries to cope with the demands of worldwide enzyme markets.

Visualisation of penetration of topical antifungal drug substances through mycosis-infected nails by matrix-assisted laser desorption ionisation mass spectrometry imaging.

Matrix-assisted laser desorption ionisation mass spectrometry imaging (MALDI-MSI) is a mass spectrometry-based technique, which can be applied for compound-specific imaging of pharmaceuticals in tissues samples. MALDI-MSI technology is widely used to visualise penetration and distribution profile through different tissues but has never been used with nail tissue. This study used MALDI-MSI technology to visualise distribution profile and penetration into ex vivo human mycosis-infected toenails of three antifungal active ingredients amorolfine, ciclopirox and naftifine contained in topical onychomycosis nail treatment preparations, marketed as Loceryl® , Ciclopoli® and Exoderil® . Three mycosis-infected toenails were used for each treatment condition. Six and twenty-four hours after one single topical application of antifungal drugs, excess of formulation was removed, nails were cryo-sectioned at a thickness of 20μm, and MALDI matrix was deposited on each nail slice. Penetration and distribution profile of amorolfine, ciclopirox and naftifine in the nails were analysed by MALDI-MSI. All antifungal actives have been visualised in the nail by MALDI-MSI. Ciclopirox and naftifine molecules showed a highly localised distribution in the uppermost layer of the nail plate. In comparison, amorolfine diffuses through the nail plate to the deep layers already 6hours after application and keeps diffusing towards the lowest nail layers within 24hours. This study shows for the first-time distribution and penetration of certain antifungal actives into human nails using MALDI-MSI analysis. The results showed a more homogeneous distribution of amorolfine to nail and a better penetration through the infected nails than ciclopirox and naftifine.

Minimally invasive technique with intramedullary nail for treatment of severe hallux valgus

Objective: The purpose of the study was to evaluate early clinical and radiological results with a novel minimally invasive surgery (MIS) technique for Lapidus arthrodesis using intramedullary nail. Methods: Retrospective review of patients with hallux valgus surgery during an 18-month period. Patients with a procedure other than MIS Lapidus nail fixation were excluded. We describe surgical technique with a percutaneous joint preparation and fixation with an intramedullary nail through a MIS approach. Demographic variables, early complications and radiographic parameters were measured. Results: Ten feet in 8 patients with severe HV underwent a Lapidus procedure performed with a minimal invasive technique using intramedullary nail for fixation. No soft tissue complications and 1 patient required screw removal after bone healing. Mean HVA decreased from 31,4 degrees (range 17 to 47) SD (±9,3) to 10,3 degrees (range, -8,8 to 31,5) SD (±8,4), mean IMA decreased from 17,91 degrees (range, -17 to 20) SD (±0,9) to 5,46 degrees (range, –7,3 to 15.3) SD (±2,9) and mean DMAA decreased from 20,36 (range, 10-40) SD (±8,4) to 7,67 (range, -5 to 30) SD (±8,0). Conclusion: Intramedullary nail for Lapidus arthrodesis with minimally invasive technique showed satisfactory radiographic correction and minimal complications, but further follow up is needed to analyze clinical-radiographic results. Level of Evidence IV; Therapeutic Study; Case Series.

The Treatment of Ingrown Nail: Chemical Matricectomy With Phenol Versus Aesthetic Reconstruction. A Single Blinded Randomized Clinical Trial.

Background: In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. Objective: To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. Methods: A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients’ recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.

Immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures reduces the nonunion rate compared with traditional weight-bearing protocol: A cohort study.

To investigate whether immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures could avoid secondary replacement. We prospectively included 167 patients receiving intramedullary nailing in treatment of distal tibial fractures. All these patients were encouraged to bear weight as tolerated postoperatively. One hundred and fifty-five patients who did not bear weight immediately after surgery were retrospectively included as historical control. The mean immediate lateral and anterior DTA were 88.9±3.9 and 85.2±3.5° for historical control and 88.7±3.6 and 84.9±3.8° for immediate weight bearing group (lateral DTA: P=0.715; anterior DTA: P=0.734). The mean final lateral and anterior DTA were 88.1±3.3 and 84.1±4.3° for historical control and 87.9±5.0 and 84.5±5.1° for the immediate weightbearing group (lateral DTA: P=0.857; anterior DTA: P=0.788). Strikingly, the immediate weightbearing resulted in accelerated healing (3.5±1.2 versus 4.9±1.3 months, P=0.023) and decreased nonunion rate (2.4% versus 7.1%, P=0.027). The rates of infection and soft-tissue necrosis were similar between the two groups. Immediate weightbearing after IMN fixation of extra-articular distal tibial fractures led to a similar change in alignment compared with our historical control without immediate weightbearing. Immediate weightbearing appears to be safe for most patients and might be able to accelerate fracture healing and decrease nonunion rate.

Use of Custom-Made Antibiotic Coated Intra-Medullary Nail in Treatment of Infected Non-Union of Long Bones

Introduction: In cases of infected Nonunion of long bones Antibiotic coated nail provides mechanical support for the affected bone with delivery of high concentration of antibiotics for infection control and a conclusive environment for fracture healing. The aim of the study was to observe and study the treatment of infected non-union of long bones with antibiotic coated nailing in infection control and bony union. Material and Method: The study was conducted on 30 patients (male and female between the age of 18‑70 years). All patient on admission were subjected to detailed history, relevant investigations and thorough clinical examinations. Minimum follow-up period was 6 months. Radiological and blood investigations were done for infection control and bony union. Result: In the current study of 30 patients with mean age of 43.67 years, Infection control and bony union was achieved in 27 patients without any need for subsequent procedures. Current study provides an alternative to external fixation alone as a means of stabilizing non-unions while providing a high concentration of antibiotic locally for combating this difficult problem. Conclusion: The clinical results and final outcome after antibiotic coated I.M. nailing in infected nonunion of long bones are both satisfactory and reproducible as evident by the comparison of this present study with the previous literature available.

THE COMPARISON OF FIXATION AND CUT-OUT OF PROXIMAL INTRAMEDULLARY NAIL AND DYNAMIC HIP SCREW THERAPY IN THE TREATMENT OF STABLE INTERTROCHANTERIC FRACTURES OF THE FEMUR: A RETROSPECTIVE STUDY

Introduction: Intertrochanteric fractures, among the osteoporotic fractures, have higher mortality and important complications, and are more prevalent among the elderly. There are several methods for fixing these fractures that have different advantages and disadvantages. The purpose of this study was to compare the proximal intramedullary nail (PIN) and dynamic hip screw (DHS) treatments. Material and Methods: This retrospective study, investigated the cases of 300 between 2015 and 2018 patients who complained of intertrochanteric fracture were referred to Kowsar Medical Center clinic of Semnan, Iran or admitted to orthopedic section of this center have been treated either PIN or DHS method. Patients were divided into two groups of 150 and after examining the age and sex of the patients, the rate of cut-out and fixation was compared between the two groups. Results: The mean age of the patients was 640.8 years in the PIN group and 631.1 years in the DHS group, respectively. The rate of cut-out and implant fixation in this study were 2% and 98% in patients treated with PIN and 6.66% and 93.4% in patients treated with DHS, respectively. As well as in terms of gender in implant cut-out in PIN and DHS group 66.66% and 70% of them were women, 33.33% and 30% men, respectively. Conclusion: According to the results of this study, proximal intramedullary nail treatment in comparison to dynamic hip screw treatment, in the treatment of intertrochanteric fractures, has more fixation and less cut-out.

Comparative study between intramedullary nailing and plating for extra articular distal tibia fractures

Background: Distal third tibial fractures remain challenging due to peculiar soft tissue features and myriad treatment options. Tibia is not only the most common long bone of body to get fractured but also offers many challenges to Orthopaedic surgeons in managing its fractures. The surgical treatment itself has controversies such as difficulty in achieving and retaining good reduction by nailing methods, propensity to infection and nonunion due to dissecting the fracture site during the procedure of inserting the plate. There are various options available for the surgical management of distal 1/3rd tibial shaft fractures and each of these treatment options is associated with certain challenges. Method: We studied the 60 patients of distal 1/3rd tibial shaft fractures operated with closed reduction and internal fixation with reamed intramedullary interlocking nailing or open reduction internal fixation with plating. The patient selection was done by randomisation. Radiological outcomes and clinical outcomes using Olerud-Molander score were assessed at 6 weeks, 3 months, 6 months and 1 year intervals Result: Mean for surgery duration in minutes was 68 and 75 in patients who underwent interlocking nailing and plate osteosynthesis respectively. Mean time of union was found to be 14.2 weeks in patients treated with interlocking nail and 18.1 in patients treated with plate osteosynthesis. We found out that 20% patients had good & 80% patients had excellent outcome treated with interlocking nail according to Olerud-Molander Score in comparison with patients who underwent plate osteosynthesis had good outcome in 36.7% patients and excellent outcome in 63.34% of patients. Complications were seen mostly in plate osteosynthesis group of patients that included superficial infection and hardware impingement in 2 patients each and wound dehiscence was seen in 1 patient. Hardware impingement was seen in one case on patient who underwent interlocking nail. Conclusion: Our results have shown that both closed intramedullary nailing and locking plating can be used safely to treat fractures of the tibia. Closed nailing has the advantage of shortened operating time, decreased wound problems, early union of the fracture, decreased implant related problems & overall reduced morbidity, therefore we prefer closed intramedullary interlocking nailing in treatment of extra-articular distal tibia fractures.

Terbinafine-induced lichenoid drug eruption: case report and review of terbinafine-associated cutaneous adverse events

Terbinafine is an antifungal agent used in the treatment of hair, nail, and skin dermatophyte infections. Skin side effects to terbinafine are not common. Lichenoid drug eruption is a medication-related adverse cutaneous event; the lesion morphology and pathology mimic lichen planus. A woman with onychomycosis developed a lichenoid drug eruption one week after starting terbinafine. The features of her dermatosis and the characteristics of two additional men who also experienced terbinafine-induced lichenoid drug eruption are discussed. They were receiving a daily terbinafine dosage of either 125mg or 250mg to treat onychomycosis or tinea cruris. The lichenoid drug eruption presented as diffuse or symmetric lesions within one to two weeks after starting terbinafine treatment. The extremities, chest, abdomen, and/or trunk were common sites. Less frequent locations were the lips, nails, palms, soles, and suprapubic region; lesions did not occur on the oral or genital mucosa. The eruption resolved after discontinuation of the medication (with or without treatment using topical corticosteroids, systemic corticosteroids, or both). In addition, more frequently occurring terbinafine-associated cutaneous adverse events (such as urticaria, erythematous eruptions, pruritus, acute generalized exanthematous pustulosis, subacute cutaneous lupus erythematosus, and papulosquamous conditions) are reviewed.

Simple and Aesthetic Treatment for Pincer Nail

Simple and Aesthetic Treatment for Pincer Nail

Inverted T Incision with Osteophyte Removal in The Treatment of Pincer Nail

Inverted T Incision with Osteophyte Removal in The Treatment of Pincer Nail

Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report

ABSTRACT Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.

Clinical and Instrumental Objective Evidence of the Efficacy of a New Water-Based Nail-Strengthening Solution Containing Pistacia lentiscus and Hyaluronic Acid Applied for Up to 6 Months to Improve the Appearance of Weak, Brittle Nails.

IntroductionBrittle nails are fragile or split nails; they affect 20% of the population and may be primary or secondary to different conditions. The aim of our studies was to evaluate the efficacy and tolerability of a new water-based nail-strengthening treatment containing hyaluronic acid and Pistacia lentiscus with daily application for a period of 1–3 months for one study (n = 30) and up to 6 months for a second study (n = 30).MethodsIn total, we enrolled 60 patients of both sexes with brittle and weak nails due to primary or secondary causes and evaluated the efficacy of this new product using subjective and objective methods: clinical evaluation, assessment of photographs, onychoscopy evaluation, investigator and patient global assessment, dynamic optical coherence tomography (D-OCT) and reflectance confocal microscopy (RCM).ResultsStudies subjects presented a statistically significant improvement in global assessment scale (GAS) scores at 14 days (GAS = 1.7 ± 0.6), 1 month (GAS = 1.4 ± 0.7) and at 3 months (GAS = 1±0.7) versus the GAS score obtained before treatment (1.9 ± 0.5) (p < 0.0001). From the Italian study at 6 months (n = 30) 76% of the patients had an improvement in their nail appearance. Reduction in nail plate roughness with improved nail resistance and decreased distal breakage were the most evident benefits, demonstrated on clinical and instrumental evaluations. No side effects were reported. All patients reported an improvement in nail appearance after using the product for 1 month, 3 months and 6 months, and had a positive opinion on the product.ConclusionsThis new product is an effective, safe, and easy-to-use option for topical treatment of brittle nails and primary nail fragility and an adjuvant therapy in secondary nail fragility. Moreover, its ease of application and cosmetic qualities allow good compliance.FundingISDIN.

Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia

PurposeThe goal of this study is to evaluate the treatment outcomes of anterolateral bowing and residual deformities of distal tibia in patients with CPT using circular external fixation and hydroxyapatite coated flexible intramedullary nailing without excision of affected part of tibia. Patients and methodsSix patients (4 boys and 2 girls, mean age 12.4 ± 4.1 years) were included in the study. Mean follow-up is 2.1 years. In 4 patients with early onset of disease initial surgical treatment (at age of 5–8 years) was dysplastic zone or pseudarthrosis resection with proximal metaphyseal osteotomy for bone transport. Children with unbroken bowed tibia (2 cases of type II according to Crawford classification) had no previous surgery. Neurofibromatosis type I was diagnosed in 4 cases. Surgical technique for residual deformity correction consisted of percutaneous osteotomy, application of circular external frame and composite hydroxyapatite-coated intramedullary nailing. ResultsMean external fixation time was 95.3 ± 17.5 days. All patients never get fractured after frame removal. At the present time, they are considered to be healed, in 2.1 years, in average, without fractures or deformity recurrence. Mean lower limb length discrepancy varied from 2 to 10 mm at the latest follow-up control. After realignment procedure, patients didn't require additional surgery but one. Intramedullary nails were removed in two years after deformity correction for individual reason. ConclusionCorrection of anterolateral bowing or residual deformity in children with CPT is indicated. Association of external fixation with intramedullary nailing/rodding left in situ after frame removal ensure stability and accuracy of deformity correction. Biological methods of stimulation of bone formation in dysplastic zone are obligatory to ensure bone union. Intramedullary nailing with composite hydroxyapatite-coated surface provides mechanical and biological advantages in patients with CPT.

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

IntroductionThe OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes.MethodsFrom one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years).ResultsCephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion.ConclusionIntramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.

Comparison of Third Generation Proximal Femoral Nails in Treatment of Reverse Oblique Intertrochanteric Fractures

Comparison of Third Generation Proximal Femoral Nails in Treatment of Reverse Oblique Intertrochanteric Fractures

Descriptive study of outcome of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of weight bearing long bones

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infected non-union of tibia and femur is a debilitating disorder for patient as well as challenging task for treating surgeon. Conventionally treatment of infected non-union is a two staged procedure. But antibiotic cement-impregnated intramedullary nailing (ACIINs) is a single staged and cost-effective procedure. Hence we intended to study the outcome of ACIIN use in infected non-union of tibia and femur.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a hospital based prospective case series type of descriptive study conducted in Department of Orthopedics, SMS Medical College and Hospital, Jaipur. We studied 35 cases of infected non-union of femur and tibia fracture with interlock nail in situ. All patients were treated with interlock nail removal, debridement and freshening of sclerosed bony ends and fixation with ACIIN. All were followed for at least 6 months for infection control and bony union and final results were evaluated by Paley’s bony criteria and functional criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Infection was controlled in 94.28% cases. Bony union was achieved in 88.57% cases (19 femur and 12 tibia). Average duration for bony union was 7.3 months for femur and 8 months for tibia. According to Paley’s criteria for bony outcome and functional outcome 65.71% and 51.43% had shown excellent outcome respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ACIIN is a good modality for treatment of infected non union of tibia and femur in terms of infection control and bony union and has a good functional outcome when bone gap is less.&lt;/p&gt;