Femoral Nonunion Research Articles

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

ObjectiveFemoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation.MethodsRetrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference.ResultsA total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05).ConclusionBoth positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

A study on the management of non-union of fracture distal femur with locking plates

Background: US FDA defines non-union as fracture bone that has not completely healed in 9 months since injury and which has not shown any signs of healing over 3 consecutive months on serial x-rays. The operative treatment depends on the type of non-union. There are one-step or two-step procedures according to the principles of the ‘diamond concept’. This involves the improvement of the mechanical situation (in most cases with a re osteosynthesis) and vascularization, local application of osteoconductive carriers e.g. tricalcium phosphate, vial cells from autologous bone and osteoinductive substances like bone morphogenic proteins (BMP-2 or BMP-7). Aim: To study the principles and method of fixation of non-union of distal femur with lock plates. Material and Methods: It was a prospective study including patients with non-union of distal femur admitted and examined according to protocol after obtaining informed consent from the patient and permission from the institutional ethics committee. 40 cases satisfying the inclusion criteria admitted in tertiary healthcare centre of Navi Mumbai since May 2018 to March 2020 with minimum 1 year of follow up were included in the study.Results: Patients were also evaluated as per non-union scores. The average non-union score was 19 (range 11 to 27). All of the non-unions united, at an average of 19 weeks. The average arc of knee motion improved from 85° preoperatively to 114° postoperatively. The average Neer’s score improved from an average of 60.4 points (range 16 to 44 points) preoperatively to 89 points post operatively. The knee society score (Part 1) improved from an average of 51.87 points (range 36 to 68) preoperatively to 81.725 points (range 74 to 93) post-operatively. Conclusion: The operative technique respecting the biology and biomechanical principles has shown the influence of success of treating these fractures with locking plates.

Augmented Plating and Bone Grafting in Treatment of Tibial and Femoral Shaft Nonunion

Background: Tibial and femoral nonunion is not unusual after intramedullary fixation and might lead to multiple surgical procedures and long-term disabilities. Different surgical techniques have been described for management of lower limb long bone nonunion primarily treated with intramedullary nailing. Despite the use of various procedures, the success rate of most of them are suboptimal, increases the risk of related complications and costs. Objectives: Augmented plating concomitant with autologous bone grafting technique make it possible to improve healing in a single operation. Methods: In this study, 19 patients with lower limb long bone nonunion were primarily fixed with intramedullary nails, were treated with augmented plating and autologous bone grafting and followed for one year. Results: The union rate was 94.7% with a mean union time of 4.75 months, 18 patients healed completely with solid union and only one case of femoral shaft nonunion remained. Infection and other surgical-related complications were not detected. After one year follow up, Visual Analog Scale was 31 ± 18.8, and decrement in active knee range of motion was more than 20% compared with opposite side in 47.4% of the patients. Conclusion: According to the results, the single stage augmented plating with locking plates combined with autologous bone grafting can be used as a useful method in treatment of femoral or tibial nonunion.

Exchange nailing with Uni-cortical plate augmentation +/- bone grafting for proximal 2/3rd distal 1/3rd junction shaft non-union femur

The femur is prone to fracture when struck by strong external forces, such as in motor vehicle accidents, falling from height. Intramedullary nailing (IMN) has achieved good results in the treatment of adult femoral shaft fractures. However, poor blood supply and severe soft tissue damage often result from inappropriate surgical operations or deep infection, leading to delayed union or bone non-union. The incidence of non-union of femoral fractures after trauma is 5%–10%. The treatment options available to deal with NON-UNION include Exchange Nailing, removal of the nail, and Re-osteosynthesis with plating +/- Bone grafting, or Ilizarov fixation. We present our experience of plate augmentation with Exchange nailing +/- bone grafting for non-union at junction of proximal 2/3rd and distal 3rd of femoral fractures. It is an efficient technique, which provides additional rotational stability at the non-union site, the additional advantages of this technique are that it can be done with minimally invasive technique, allows early rehabilitation of the patient, and carries lesser morbidity.

Surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture

BackgroundInfra-isthmal femoral fracture has been known as one of the risk factors for femoral nonunion. Retrograde intramedullary nailing can provide reliable stability of the distal fragment in infra-isthmal femoral fracture, but adequate reduction is required to achieve a successful outcome. This study aimed to evaluate the surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture. MethodsBetween March 2013 and July 2017, 15 patients with infra-isthmal fractures treated with retrograde nailing and minimally invasive cerclage cable fixation were included in this study. Cerclage cable was applied for reduction aid (reduction cable) or prevention of further displacement in non-displaced extension of the distal spiral fracture (prevention cable). Number and function of cerclage cables, operation time, additional surgery, and complications were assessed. Further displacement of the wedge after nailing, coronal and sagittal alignment, displacement of the main fragment, and time from injury to union were evaluated as radiologic outcomes. ResultsOf the 15 patients in this study, 14 were treated with reduction cables. Average postoperative coronal and sagittal angulation was 1.7° (1° varus to 4° valgus) and 1.6° (2° flexion to 11° extension). Mean displacement between the main fragments was 3.5 mm (range 0–22 mm). Four of the 14 cases used additional prevention cables combined with reduction cable. Only one case was treated solely with a prevention cable. A total of five prevention cables were maintained without further displacement. All patients achieved bone union, and the average time to union was 22.7 weeks (range 9–44 weeks). There were no complications as a result of surgery, such as infection or major neurovascular injury. ConclusionsThe minimally invasive cerclage cable technique could be a useful and safe enhancement in retrograde nailing for infra-isthmal femoral fracture in order to prevent further displacement and to reduce the main fracture.

Modular prosthesis fracture in a patient with developmental dysplasia of the hip: a case report and literature review

BackgroundModular prosthesis fracture, especially distal femoral fracture, is a rare complication of total hip arthroplasty (THA). However, it is catastrophic, and may have a serious impact on the patients. A distal femoral prosthesis fracture in a patient with developmental dysplasia of the hip (DDH) with nonunion at the subtrochanteric osteotomy site has not yet been reported in any literature. This report presents the first such case, with a purpose of analyzing the causes of modular prosthesis fractures and nonunion of the osteotomy area, so as to provide orthopedic surgeons with experience and lessons.Case presentationWe report the case of a 52-year-old woman with the distal femoral prosthesis fracture after THA and subtrochanteric osteotomy for Crowe type IV DDH. The patient had severe pain in the left thigh and her activities were limited. Plain radiographs revealed fracture of the left distal femoral prosthesis and nonunion in the subtrochanteric osteotomy region of the left femur. After a revision of the THA, the patient’s symptoms were resolved.ConclusionsA prosthesis fracture combined with nonunion at the subtrochanteric osteotomy site is a rare complication. Modular THA combined with a subtrochanteric osteotomy in the treatment of Crowe type IV DDH should reduce the damage to blood supply and avoid further nonunion of the osteotomy area, which may otherwise lead to modular prosthesis fractures. A detailed preoperative plan and suitable rehabilitation program may help minimize the occurrence of subtrochanteric osteotomy nonunion and reduce complications, including femoral prosthesis fractures, in patients with DDH.

An assessment of the C-reactive protein, erythrocyte sedimentation rate and white blood cell count, values during the post-operative period of infected tibial nonunions treated with antibiotic- loaded PMMA-coated nails

&lt;p&gt;In this study, our aim was to assess the changes in the serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) values during the follow-up period of infected tibial pseudoarthrosis treated using antibiotic-loaded nails. Three patients with infected femoral nonunions and 11 patients with infected tibial nonunions were included in the study. All patients were treated with intramedullary nails coated with antibiotic-loaded PMMA after local extensive debridement. Postoperatively, parenteral antibiotic therapy was administered. The CRP, ESR and WBC values were noted preoperatively and on the first day, and then on the second, sixth, and 12&lt;sup&gt;th&lt;/sup&gt; weeks postoperatively. The changes in these values over time were analyzed comparatively. The preoperative CRP level was found to be significantly lower than the early postoperative period (1&lt;sup&gt;st&lt;/sup&gt; day), while no significant differences were detected during the follow-up period. The CRP level constantly decreased between the first postoperative control (1&lt;sup&gt;st&lt;/sup&gt; day) and the final follow-up time (12&lt;sup&gt;th&lt;/sup&gt; week). The postoperative ESR showed a significant difference when compared to the preoperative value, and also showed a decreasing trend in the postoperative period, having its highest value on the first day. The WBC did not exhibit a significant difference when comparing the preoperative and postoperative values. C-reactive protein level and ESR can be used to monitor the adequacy of the treatment after antibiotic-loaded nail application, whereas WBC may be insufficient in the diagnosis and follow-up of osteomyelitis treated with antibiotic-loaded nails.&lt;/p&gt;

Poller (blocking) screw with intramedullary femoral nailing for subtrochanteric femoral non-unions: clinical outcome and review of concepts.

Surgery to treat nonunion resulted from malalignment is challenging since correction and bone union should be achieved simultaneously. To report the clinical outcomes achieved through reconstruction of sub-trochanteric femoral fractures by femoral nailing using a poller screw and to review the current concepts. Fourteen patients (11 men and 3 women; mean age 56.4years) who were diagnosed with non-union of subtrochanteric femoral fractures and who underwent intramedullary nailing with blocking screws between August 2013 and March 2019, with at least 1year follow-up, were analyzed retrospectively. The preoperative and postoperative Centrum-Collum-Diaphyseal angle and anterior angulation angle were measured. Bone union time, position and number of poller screws used, and complications were analyzed. Functional assessment was performed by evaluating the Harris hip score. The related literature was searched, and 14 clinical studies on the treatment of sub-trochanteric non-union were analyzed. Bone union was achieved in 12/14 cases (85.7%) at the final follow-up within a mean of 6.52 (3-12)months. Bone union was also achieved in two patients lacking bone union at the final follow-up through bone grafting and augmented plating. No cases developed complications, including infection and bone necrosis, and the varus deformity and anterior angulation significantly improved from a preoperative mean of 12.4° and 9.4° to postoperative mean 3.8° and 2.4°, respectively. The mean Harris hip score at the final follow-up was 87.07 (73-98) points. Analysis of published literature revealed high rates of bone union (78-100%) through various fixation methods. Correction with blocking screws and rigid fixation with intramedullary nailing to treat sub-trochanteric-non-union-caused malalignment can yield good clinical and radiological outcomes.

Treatment of Femoral Non-Union with the Gene-Activated Osteoplastic Material: А Case Report

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

Effect of double plate technique combined with autogenous iliac bone graft in the treatment of femoral nonunion after intramedullary nailing

To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing. From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation. All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening). It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.

Nanohydroxyapatite/polyamide 66 crosslinked with QK and BMP-2-derived peptide prevented femur nonunion in rats.

Active interventions should be made to avoid delayed bone union and nonunion during fracture treatment. Nanohydroxyapatite/polyamide 66 (nHA/PA66), a simulated bioactive bone substitute with great biocompatibility and mechanical properties, has been widely used in bone regeneration. However, the limited bioactivity of nHA/PA66 has impeded its further application in tissue engineering. In this study, BMP-2-derived peptide and QK (a VEGF mimetic peptide) were dually grafted to PA66 polymer chains to prepare peptide-decorated HA/PA66-BMP-2-QK scaffolds to enhance bone formation after severe femoral fracture (periosteum scraped off) in SD rats. Fourier transform infrared spectroscopy (FTIR) confirmed that the BMP-2-derived peptide and QK were covalently bonded onto the surface of nHA/PA66. In vitro, BMP-2- and QK-modified scaffolds promoted the adhesion and proliferation ability of rBMSCs. After loading onto peptide-modified scaffolds, both BMP2-derived peptide and QK showed sustainable release and preserved bioactivity, improving the osteogenic differentiation ability of BMSCs. The combined ability of these factors to promote osteogenicity was better than that of a single peptide. Furthermore, the QK released from nHA/PA66-BMP-2-QK scaffolds improved the proliferation and tube formation ability of HUVECs. In vivo, femur nonunion in SD rats was successfully prevented by implanting HA/PA66-BMP-2-QK scaffolds into the fracture gap: the fracture line disappeared, the cortical bone showed continuity, the scaffolds were completely embedded and more vessels formed in the nonunion area than observed in other groups. Overall, the nHA/PA66-BMP-2-QK scaffolds simultaneously facilitated angiogenesis and osteogenesis, providing a promising method for reinforcing bone regeneration in nonunion treatment.

Presentation and outcome of femoral infected non-unions in children and adolescents.

Objectives:To document the presentation of infected non-unions of femur in pediatric and adolescent population and evaluate the outcome of segmental bone transport with the Ilizarov method.Methods:This prospective case series study was carried out over a period of five years, from January 01, 2015 to December 31, 2019. The study included all children and adolescent patients who presented with femoral infected non unions. The study excluded patients above the age of 16 years and those who had pathological fractures secondary to bone pathologies such as cysts, tumors or metabolic bone diseases.Results:Out of 31 patients, 27(87.09%) were males and 4(12.90%) were females. The mean age was 13.48±1.98 years. The underlying mechanisms that lead to the causation of fractures included road traffic accidents (n=23;74.19%), fall from height (n=7;22.58%) and firearm injuries (n=1;3.22%). The bone gaps ranged from 3-5 cm with a mean of 4.00± 0.856 cm. Bone union was achieved among 28(90.32%) patients. Infection was eradicated among 27(87.09%) patients whereas the remaining patients continued to suffer persistent infection. The most common complications included pin tract inflammation/ infection among (n=31;100%) patients and stiffness of knee joint among (n=19;61.29%) patients.Conclusion:Majority of the patients were males, aged 9-16 years. Road traffic accidents were the commonest cause of the fractures. The Ilizarov method of segmental bone transport was effective in treating the majority of infected non-unions.

Microvascular hip rotationplasty in a severe femoral radionecrosis

The overall prognosis of soft-tissue sarcomas of the extremities has improved with recent advances in medical, radiation and surgical treatments. An increasing number of patients are adult long-term survivors that may suffer the sequelae of radiation therapy during childhood, particularly radiation-induced bone growth arrest and osteonecrosis with complex nonunions. The orthoplastic approach, meaning the combination of skeletal and soft-tissue advanced reconstructive techniques as an integrated comprehensive treatment scheme, has proved particularly useful in these complex cases. A case of severe radiation–induced femoral hypoplasia with radiation necrosis and nonunion of the proximal femur and hip joint in a young patient treated with a microvascular rotationplasty is described herein.

Advantage of antibiotic cement-coated interlocking intramedullary nail (tibia nail/femur nail) over conventionally used antibiotic cement-coated Kuntscher nail in infected nonunion

Background: Open fracture are very prone to chronic infection. The infection of long bones during its process of fracture healing not only delay but may completely abort the fracture healing and leads to nonunion. Infection along with its nonunion is very difficult to treat and a debilitating disorder which bother both the patients and surgeon. However in many studies, this situation is usually managed with multiple steps first to cure the infection before dealing with nonunion. But this is a single step procedure to cure both infection and nonunion simultaneously with intramedullary nail that coated with antibiotic cement. It is difficult to achieves axial and rotational stability along with controlling infection by antibiotic cement-coated Kuntscher nail. This study we have compare the outcome in term of control the infection and treating nonunion and copmplication associated with these. And also the advantage of antibiotic cementcoated interlocking intramedullary nail (tibia nail / femur nail) for achieving good stability. Materials and Methods: In our study we included 20 adult patients all have stablisted infective nonunion and divided into two group according to types of intramedullary nail used. In group A 12 adult patients with infective nonunion of tibia & femur (9 tibia and 3 femur) were managed using antibiotic cementcoated interlocking intramedullary nail (group A)(tibia nail / femure nail) with proximal and distal locking screws. And in group B 8 adult patients with stablised infective nonunion of tibia & femur (7 tibia and 1 femur) were treated using antibiotic cement-coated K-nail. Combination of Antibiotics used are 4gm vancomycin and 3gm clindamycin in 40gm bone cement package. Results: Controlled of infection is 90% (18 out of 20 patients) similar in both. Bony union achieved in 83% (10 out of 12 patients) in group A with average time of union is 6 months. Bony union 62.5% (5 out of 8 patients) in group B with average time of union 8 months. The ad

Outcomes of free vascularized fibular flaps for the treatment of radiation-associated femoral nonunions

Nonunion is a known complication following fracture in the setting of radiotherapy. Free vascularized fibular (FVF) flaps have been used successfully in the treatment of segmental bone defects; however, their efficacy in the treatment of radiated nonunions is limited. The purpose of the study was to evaluate the outcome following FVFG for radiation-associated femoral fracture nonunions. 23 (11 male and 12 female; mean age 60 ± 12 years) patients underwent FVF for radiation-associated femoral fracture nonunions. The most common indication for radiotherapy was soft tissue sarcomas (n = 16). The mean follow-up was 5 ± 4 years. Mean radiation dose was 51 ± 14 Gy at a mean of 11 ± 3 years prior to FVF. The mean FVF length was 17 ± 4 cm and placed commonly with an intramedullary nail (n = 18). First time union was 52% (n = 12) following additional bone grafting, the overall union was 78% (n = 18) at a mean of 13 ± 6 months. Musculoskeletal Tumor Society scores improved from 30% preoperatively to 73% at latest follow-up (p < 0.0001). Five fractures failed to unite; 3 were converted to proximal femoral replacements. FVF are a reasonable treatment option for radiation-associated femoral fracture nonunions, providing a union rate of 78% and an improvement in functional outcome. Therapeutic Level IV.

Megaprosthesis as a treatment modality for persistent distal femoral nonunion in middle aged adults

Introduction:Managing distal femur non-union can be a struggle for any orthopedician as it brings along many perplexities which may not lead to satisfactory patient outcome. The target in these cases should be to reduce the morbidity and allow early rehabilitation of the patient and to accomplish this, megaprostheses can be a feasible option. The orthodox use of megaprostheses is in the musculo-skeletal oncologic surgeries but its use can be extended to traumatic etiologies. These can be offered as a single stage definite procedure in patients who have already undergone several previous surgeries. Here we report a series of four cases of persistent non-union of distal femur treated with megaprostheses and recommend this modality for achieving the desired goal but the indication should be meticulously selected.Hypotheses:Megaprosthesis as a definitive treatment option in persistent distal femur non-union and prevention of repeated surgical intervention.Methods:Four cases of persistent distal femur nonunion with failed osteosynthesis were selected who were initially treated with a distal femur locking plate. Results were assessed in terms of range of motion, limb length discrepancy, knee society score and osteointegration of the components.Results:The mean age of the patients at the time of DFEPR was 49 years (42-55).The mean follow up of patients was for approximately 2 years, with the longest follow up being 3.5 years for the first operated case of the series. The range of motion was from full extension to about 105 degrees of flexion with two patients having an extension lag of 10 degrees. Patients were ambulatory without support. Postoperatively, the mean knee society score was 83 (78–88) at last follow-up as compared to 29 (21-36) in the pre-operative period. No case of infection or loosening was reported. There was 1 cm of shortening in one patient in the operated limb which was compensated by giving shoe raise. Good osseointegration of the megaprosthesis was revealed on both anteroposterior and lateral radiographs.Conclusion:Although there are very limited studies on the use of megaprosthesis for traumatic cases, it can be considered as an alternative when we are left with only arthrodesis or amputation as the final option. Despite the operative challenges, there is marked improvement in pain and functional capacity as experienced by these severely limited patients, which are the hallmarks of a successful salvage. The use of distal femur mega-prosthesis is a novel acumen in cases, where bone stock at the fracture site at distal end of femur is so severely compromised that traditional revision osteosynthesis would not provide stable and durable fixation. The indications for this surgery must be rigorously selected and should only complement osteosynthesis procedures, which remain the reference treatment option.

Outcomes of Distal Femur Non-Union Following Lateral Locked Plating Treated withan Addition of A Medial Locking Plate and Autogenous Bone Graft

Fractures of the distal third of the femur account for 4% to 6% of femur fractures and are a treatment challenge...

A piezoelectric bone fixation plate for in vivo application and monitoring of mechanical loading during fracture healing

Fracture non-union, the failure of a bone fracture to bridge, occurs in roughly 5%–10% of treated fractures and requires lengthy and expensive follow-up interventions. A significant body of research has investigated the efficacy of low-magnitude, high-frequency (LMHF) vibration as a treatment for femoral non-unions through the use of whole-body vibration. This work presents a novel piezoelectric fixation plate for investigating the efficacy of LMHF treatment by applying loads directly to the fracture site, thus reducing undesired systemic effects such as hormonal up-regulation induced by whole-body vibration. The fixation plate can apply mechanical loading in the LMHF regime and monitor the mechanical environment at the fracture site during ambulation to quantify progressive changes in callus stiffness over time as an indication of healing. Mechanical testing demonstrated the ability of the plate to provide displacements of up to 10 µm, as well as to estimate the changing stiffness of the fracture environment.

Evaluation of result of plate augmentation and autogenous bone grafting for femoral shaft nonunion after locking nail

Evaluation of result of plate augmentation and autogenous bone grafting for femoral shaft nonunion after locking nail

REAMED INTRAMEDULLARY EXCHANGE NAILING FOR ASEPTIC NON- UNION OF ISTHMUS &amp; ENHANCED DISTAL FIXATION EXCHANGE NAILING FOR NON- UNION OF DISTAL THIRD SHAFT FEMUR FRACTURES.

Background: The aim of this study was to evaluate the role of exchange nailing in isthmus and exchange nailing with poller screw fixation &amp; multiplanar interlocking screws for Distal Third shaft femur aseptic non union. The evaluation was addressed by measuring the clinical, functional and radiological outcome of our treatment methods in both non union groups.&#x0D; Design: Retrospective study.&#x0D; Methods: Between 2006 to 2014, 55 patients with Non Union of shaft femur were operated using a standardised protocol at our institute and followed up for functional and radiological outcome.&#x0D; 5 patients were lost to follow up and thus were excluded from this study. Out of 50 patients, 29 were cases of Isthmus Non union and remaining 21 were cases of Distal Third Non union. Our approach in Isthmus group was closed Exchange nailing with 2mm larger nail with medullary reaming. Some needed isthmus when radiological signs of healing were delayed.&#x0D; In Distal Third group, poller screws were used in conjugation with reamed exchange nailing with a 2mm larger diameter nail and interlocking screws in different planes. Out of the 50 patients, 48 were men and 2 women. Their mean post surgical procedure period at presentation of non union was 11.60 months.&#x0D; Results: Out of a total 55, 5 were lost to follow up- all from isthmus group. In isthmus group, healing was observed in 25 out of 29 patients with union achieved in a mean of 7.60 months. Delayed union was seen in 3 patients and addressed with dynamisation of distal screws leading to union in all cases in a mean of 13 months without further intervention.1 patient had superficial infection which resolved with debridement at 4 months. 1 patient required additional bone grafting for persistent non union and healed at 18 months. Non union was encountered in 3 patients who refused further treatment and accepted functional limitations. Harris Hip Score for this group was 87.40. In Distal Third group, all 21 patients achieved union in a mean time of 10.30 months. No patients required further revisions however 4 patients had superficial infection which was treated with antibiotics and debridement. No further complications were encountered in this group of patients and bony union was uneventful otherwise. Harris Hip Score of this group was 92.40.&#x0D; Conclusion: Using exchange nailing for isthmus and poller screw augmentation for Distal Third Shaft Femur Non union yields excellent clinical, functional and radiological outcome. Exchange nailing with or without poller screw augmentation is a less invasive method to treat aseptic non union of shaft femur fractures without additional complications.&#x0D; Keywords: Nonunion, exchange nailing, poller screw, femoral non union, aseptic non union.