Ununited Fractures Research Articles

Surgical repair of large segmental bone loss with the induced membrane technique: patient reported outcomes are comparable to nonunions without bone loss.

To compare the outcomes of patients with segmental bone loss who underwent repair with the induced membrane technique (IMT) with a matched cohort of nonunion fractures without bone loss. Retrospective analysis on prospectively collected data. Academic medical center. Two cohorts of patients, those with upper and lower extremity diaphyseal large segmental bone loss and those with ununited fractures, were enrolled prospectively between 2013 and 2020. Sixteen patients who underwent repair of 17 extremities with segmental diaphyseal or meta-diaphyseal bone defects treated with the induced membrane technique were identified, and matched with 17 patients who were treated for 17 fracture nonunions treated without an induced membrane. Sixteen of the bone defects treated with the induced membrane technique were due to acute bone loss, and the other was a chronic aseptic nonunion. Healing rate, time to union, functional outcome scores using the Short Musculoskeletal Functional Assessment (SMFA) and pain assessed by the Visual Analog Scale (VAS). The initial average defect size for patients treated with the induced membrane technique was 8.85cm. Mean follow-up times were similar with 17.06 ± 10.13months for patients treated with the IMT, and 20.35 ± 16.68. months for patients treated without the technique. Complete union was achieved in 15/17 (88.2%) of segmental bone loss cases treated with the IMT and 17/17 (100%) of cases repaired without the technique at the latest follow up visit. The average time to union for patients treated with the induced membrane technique was 13.0 ± 8.4months and 9.64 ± 4.7months for the matched cohort. There were no significant differences in reported outcomes measured by the SMFA or VAS. Patients treated with the induced membrane technique required more revision surgeries than those not treated with an induced membrane. Outcomes following treatment of acute bone loss from the diaphysis of long bones with the induced membrane technique produces clinical and radiographic outcomes similar to those of long bone fracture nonunions without bone loss that go on to heal. III.

Muscle pedicle bone graft in ununited fracture neck of femur in children

Delayed presentation of fracture neck of femur is not uncommon in our scenario and is difficult to treat because of precarious vascularity and bony defect at fracture site. The purpose of the present study is the analysis of functional outcome of the muscle pedicle bone graft porcedure in ununited fracture neck of femur in children and adolescents.: Sixteen patients with ununited fracture neck of femur (presenting late) in children and adolescents were treated with quadratus femoris based muscle pedicle bone graft along with open reduction and internal fixation. Mean age of the patient was 14.25 year (range 12-16 years). Boys dominated our series (n= 10 i.e.62.50%). Road traffic accident was the leading cause. Average injury –surgery interval was 5.88 week (range 3-9 week). A minimum follow up was two years. There were 2 Transepiphyseal, 11 Transcervical and 3 Cervicotrochanteric fractures. Most of the cases showed union in 16 to 24 weeks. In one case there was implant failure. : The result was analysed using Harris Hip Score. We had 11 (68.75%) excellent, 2 (12.50%) Good, 2(12.50%) Fair and one (06.25%) Poor results in our series.Quadratus femoris based Muscle pedicle bone with internal fixation is a very effective method to address the difficult problem of non-union fracture neck of femur. There was statistically significant association (p value <.005) between accuracy of reduction and functional outcome.

Complex one-stage treatment of nonunion fractures, false joints and defects of long bones of the extremities complicated by osteomyelitis

The experience in complex one-step treatment of306patients with ununited fractures, pseudoarthrosis and defects of long bones as sequelae of traumatic (260 patients) and gunshot (46 patients) injuries complicated by osteomyelitis was presented. Complex treatment included radical fistulosequestrnecrectomy up to vast resection with simultaneous mono-, bi- or polyfocal osteosynthesis by pin-, rod or pin-rod external fixation devices; various types of dermatoplasty (when required); stimulation osteogenesis; general and local target antibacterial therapy; adequate postoperative drainage; correction of immune status and metabolic therapy; rehabilitation. That method enabled to decrease more than twice the rate ofpostoperative recurrent of osteomyelitic process; considerably decrease the duration and improve outcomes of treatment.

Results of single-stage acetabulum reconstruction and total hip arthroplasty in the management of pelvic discontinuity caused by ununited acetabulum fracture

Introduction: Non-union of acetabulum fracture is a common occurrence in developing countries. Pelvic discontinuity due to ununited fracture acetabulum poses a serious challenge in the management of the patient. Results of ORIF of these fractures are not promising due to various reasons. We aim to present results on single-stage acetabulum reconstruction and total hip arthroplasty, the literature on which is lacking. Materials and Methods: We prospectively studied the outcome of single-stage acetabulum reconstruction and total hip arthroplasty in patients with pelvic discontinuity caused by ununited fracture acetabulum of more than 3 months duration. From March 2015 to December 2018, 11patients (7 males, 4 females, average age 42 years) were treated in our hospital. All cases underwent open reduction internal fixation with posterior column plate, impaction bone grafting, uncemented porous coated hemispherical acetabulum cup hip arthroplasty. Results: Union of the columns was achieved in all the cases with 7 patients (63.6%) showed union at 12 months and rest 4 patients (36.4%) took 18 months to unite. At final follow up, mean Harris hip score improved from 54.2 points (range 24-63) to 91.4 points (range 79-95). One superficial surgical site infection and one heterotopic ossification was noted in our study which had no sequel on clinical outcome at their last follow up. Conclusion: Single stage acetabulum reconstruction by posterior column plating with impaction bone grafting and uncemented porous coated hemispherical acetabulum cup hip arthroplasty is a genuine option in management of pelvic discontinuity caused by ununited fracture of acetabulum. Keywords: Neglected fracture acetabulum, Ununited fracture acetabulum, Pelvic discontinuity, Acetabulum reconstruction, Single stage acetabulum reconstruction.

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of thefracture site and restores limb length. Very few reports have dealt with the results of this procedureinternally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospectivestudy was performed at the institution level for the evaluation of results of valgus osteotomy andfixation of the femur neck fracture in young patients. Material and Methods: A total of 32 patientswere included in the study. There were 24 males and 8 females in the study. Before osteotomy, theaverage neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3cm (1.0–3.2cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction beforesurgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractureswere treated with a dynamic hip screw and double angle barrel plate. The patients had a minimumfollow-up of 14months and a maximum of 42months. Results: In a total of 28 patients the excellentresults were obtained, however in 4 patients the poor result was due to cut – out of implants. Noneof the patients were lost on follow up, the fracture went on to achieve the satisfactory union afterthe minimum of 14 weeks follows up. The average preoperative neck-shaft angle of 101° (range 80–120°) increased to 134° (range 120–145°) after surgery. The average limb length discrepancypostoperatively was 2.3cm. Conclusion: From the study, it was concluded that valgus osteotomyand fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate inyoung patients with neglected and ununited intracapsular fracture neck of the femur as far as theunion of fracture is concerned.

Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

<p class="abstract"><strong>Background:</strong> Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.</p><p class="abstract"><strong>Conclusions:</strong> Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.</p>

Results of quadratus femoris muscle pedicle bone grafting (Meyers' procedure) in the management of ununited femoral neck fractures.

Femoral neck fractures in young patients are associated with increase complication risk. The objective of this study was to evaluate the results of quadratus femoris muscle pedicle grafting in the treatment of ununited femoral neck fractures. This study includes 16 patients with ununited femoral neck fractures treated with quadratus femoris muscle pedicle graft. 7 patients had neglected femoral neck fractures while 9 had ununited femoral neck fractures after fixation. Quadratus femoris muscle with 2 × 1 × 1 cm (length-width-height) bone in its insertion was elevated and placed in the posterior cortex of the femoral neck with additional cancellous graft from the posterior iliac bone. The graft was fixed with 3.5-mm cortical screws. The average follow-up period was 96 weeks and the radiological union occurred at an average of 7 months. The femoral inclination of all patients was 128.5° ± 3.9° with an average 7 (range 0-35) mm thigh atrophy in the last follow-up visit. Only 1 patient (6%) had avascular necrosis of the femoral head and was treated with hip arthroplasty. Quadratus femoris muscle pedicle grafting provides better stability and blood supply in ununited femoral neck fractures. Achieving fracture union provides better clinical and functional results in the treatment of femoral neck fractures.

3D Printing Aided Elbow Deformity Correction

Introduction: Fracture of lateral condyle of humerus is known for nonunion, if not treated properly in children, often leads to a cubitus valgus deformity. For the late presenting cases with deformity and restricted range of motion, surgical management is often challenging, and an appropriate preoperative planning is required. Case Report: We report a case of an un-united fracture of the lateral condyle of the humerus in an adult with a cubitus valgus deformity with early tardy ulnar nerve palsy. He was treated by corrective osteotomy with bone grafting of the nonunion and internal fixation with contoured plates. A virtual preoperative surgical planning was done using 3D printing to define the exact location and direction of the osteotomy, plate contouring and likely place of screw placement to achieve full correction of the elbow deformity. Results: There was good correction of deformity, with union of the nonunion and osteotomy, at three months follows- up. At one year, there was complete recovery of ulnar nerve palsy with excellent function of the elbow and hand. Conclusion: 3D printing is effective in treating complex orthopedic cases and deformity correction. Virtual preoperative surgical planning on the computer and on a 3D model help to study the exact site of osteotomy, plate contouring and screw placement to achieve accurate correction of the deformity. Virtual preoperative planning and 3D printing help in reducing the surgical time and help to achieve desired correction of the deformity.

A study of surgical outcome with cemented bipolar prosthesis in fracture neck of femur in elderly patients: original article

Introduction: A hip fracture is a break that occurs in the upper part of the femur and the symptoms may include pain around the hip particularly with movement and shortening of the leg. Usually the person cannot walk. They most often occur as a result of a fall. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Intracapsular fractures of the proximal femur account for a major share in the community and have a tremendous effect on both the health care system and society in general. Despite the marked improvements in surgical interventions, treatment of fracture neck of femur since then remains a debate, especially in the elderly. Materials and methods: Twenty cases of fracture neck of femur in elderly patients of age 60 years and above treated by hemi-arthroplasty using cemented bipolar prosthesis. Inclusion criteria employed was 1) Intra-capsular fracture neck of femur in patients of age 60 years and above, 2) Un-united fracture neck of femur, 3) Fracture neck of femur with avascular necrosis. Results: At the end of 6 months after surgery, the functional results are analysed in 20 cases. All patients were in the age group of 60 to 82 years with mean average age of 75 years. 35% of the patients had a Garden type III fracture radiologically, while 60% had a Garden type IV and 1 patient was diagnosed with a non union fracture neck of femur. In 75% percent cases the mode of injury was trivial trauma. Associated medical conditions like hypertension, diabetes mellitus and heart disease or a combination of these were seen in 11 patients. Some of the complications observed were superficial infection of the wound or a limb length discrepancy, following the procedure. There were 50% excellent results and 30% good results. Conclusion: The success of hemiarthroplasty no doubt depends on preoperative planning and proper attention to surgical details to achieve the optimum biomechanical stability. This study showed that the final functional outcomes were dependent on the presence of associated co-morbidities and the optimum post operative rehabilitation of the patient following surgery.

The association between patient education level and economic status on outcomes following surgical management of (fracture) non-union

BackgroundSocioeconomic disparities are an inherent and currently unavoidable aspect of medicine. Knowledge of these disparities is an essential component towards medical decision making, particularly among an increasingly diverse population. While healthcare disparities have been elucidated in a wide variety of orthopaedic conditions and management options, they have not been established among patients who present for treatment of an ununited fracture. The purpose of this study is to answer the following questions: 1) Following surgical management of (fracture) non-unions, are there differences in outcomes between differing ethnic groups? 2) Following surgical management of (fracture) non-unions, are there differences in outcomes between patients with differing education levels? 3) Following surgical management of (fracture) non-unions, are there differences in outcome between patients with differing incomes? MethodsBetween September 2004 and December 2017, operatively treated patients who presented with a long bone fracture non-union were prospectively followed. These patients presented with a variety of fracture non-unions that underwent surgical intervention. Sociodemographic factors were recorded at presentation. Long-term outcomes were evaluated using the Short Musculoskeletal Function Assessment (SMFA), pain scores, post-operative complications and physical exam at latest follow up. The SMFA is a 46-item questionnaire, assessing patient functional and emotional response to musculoskeletal ailments. ResultsThree-hundred-twenty-nine patients met inclusion criteria. Patients with a lower education had worse long-term functional outcomes (P < 0.001) and increased pain scores (P = 0.002) at latest follow-up. Patients who made less than $50,000 annually had worse long-term functional outcomes (P = 0.002) and reported higher pain scores (P = 0.003) following surgical management of (fracture) non-unions. Multiple linear regression demonstrated education level to be an independent predictor of long-term functional outcomes following surgical management of (fracture) non-unions (B= -0.154, 95% Confidence Interval [CI]=-10.96 to -1.26, P = 0.014). No differences existed in outcomes or pain scores between those of different ethnic groups. No differences existed regarding post-operative complications and time to union between patients of different ethnic groups, educational levels and income status. ConclusionPatients with lower education levels and individuals who make less than $50,000 annually have worse functional outcomes following surgical management of (fracture) non-unions. Orthopaedic trauma surgeons should therefore be aware of these disparities, and consider early interventions aimed at optimizing patient recovery in these subsets.

Un-United Fracture Neck Femur Results of Treatment with Close Reduction, Cancellous Screw Fixation & Fibular Strut Graft

Background: Ununited, femur neck fractures are a common problem in the developing countries like India where medical facilities are already deficient and ignorance, illiteracy and poverty further delay the patients in seeking proper treatment. The struggle to find the best treatment continues as relentlessly as it did half a century ago. The study was undertaken to evaluate the results of close reduction, cancellous screw fixation and fibular graft in ununited fractures of femoral neck in young adults with regards to achievement of fracture union, effect of this procedure on pre-existing AVN and establishment of relatively easy new surgical technique. Materials & Methods: This study was conducted in Government hospital, Pali, Rajasthan. It includes 25 cases treated by close reduction, cancellous screw fixation and fibular strut graft who have non-united fracture. The patients are systemically interrogated for personal details, mode of injury, time elapsed after injury, complaints, any other associated injury, any previous treatment taken and other systemic illness. Grading of fracture (Garden’s classification) resorption of neck and avascular necrosis changes are based on roentgen graphic findings. Results: Our study showed that the mean age of patients was 35.19 years and maximum patients were seen in 21-40 years of age (72%), male to female ratio was 2.57:1. Average union time in our series was 19 weeks. In present series good to excellent results found in 96% of cases; in only one case (4%) result was poor that was because of failure of procedure. Conclusion: We concluded that the cancellous screws fixed in closed reduced fracture and supplemented with fibular strut graft is one of the good methods as far as union and functional results are concerned in ununited fractures of femoral neck.

Induced Membrane (Masquelet) Technique for Treatment of Long Bone Defects

AbstractBackground: Reconstruction of large segmental bone defects following trauma, tumor resection or debridement of an infected segment, is a complicated problem with significant long-term morbidity, both for anatomical and functional results. Treatment of large bone defects represents a great challenge, as bone regeneration is required in large quantity and may be beyond the potential for self-healing. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge. In the first stage, a polymethyl methacrylate spacer is placed in the defect to produce a bioactive membrane. In the second, cancellous autograft is placed within this membrane and, via elution of several growth factors, the membrane appears to prevent graft resorption and promote revascularization and consolidation of new bone. Excellent clinical results have been reported, with successful reconstruction of segmental bone defects >20cm.Objective: The aim of the present study is to evaluate the Masquelet technique in the treatment of post-traumatic seg-mental bone defects.Study Design and Setting: A prospective study.Patients and Methods: This study included twenty patients having segmental bone defects ranging from 4 to 19cm (av-erage 6.35cm) either post-traumatic or following resection of the infected segment in cases of infected un-united fractures. All cases were treated using induced membrane (Masquelet) technique. The mean follow-up period was 11 months.Results: Union was achieved in 17 patients (85%). Satis-factory end results were achieved in fifteen patients (75%) according to the system modified by El-Rosasy from Paley et al., Reconstruction failure with non-union occurred in three patients. Infective complications occurred in two patients (10%). Both of them suffered from non-union.Conclusion: The technique of delayed bone grafting after initial placement of a cement spacer provides a reasonable alternative for the challenging problem of significant bone loss in extremity reconstruction.

Preoperative Planning in the Surgical Correction of Tibial Nonunions and Malunions.

Three typical cases demonstrate the achievement of precision in the reconstruction of ununited fractures of the tibia by preliminary planning with the aid of tracings on roentgenograms, templates, and goniometer measurements.

A Rare Cause of Foot Pain in an Adolescent Male Multisport Athlete

HISTORY: A 13 year old male football, basketball, and baseball athlete presented to sports medicine clinic with a 3 month history of non-traumatic exertional right lateral foot pain. He reported 8/10 pain with strenuous activities, such as running and jumping. He had no pain with walking. He reported aching discomfort in the morning upon waking. He denied numbness, tingling, or abnormal sensation. PHYSICAL EXAMINATION: There was no significant deformity. He was able to walk with a non-antalgic gait. There was tenderness to palpation over the lateral base of the 5th metatarsal. Range of motion of the foot and ankle was normal. There was normal strength upon manual muscle testing, but resisted ankle eversion reproduced pain. He was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Metaphyseal-Diaphyseal (Jones) Fracture 2. Fifth Metatarsal Stress Fracture 3. Traction Apophysitis (Iselin’s Disease) 4. Insertional Peroneal Tendinopathy 5. Avulsion Fracture TESTS AND RESULTS: - Right foot radiograph: Well-corticated bone fragment proximal and perpendicularly-oriented to the base of the 5th metatarsal, representing an accessory ossicle (os vesalianum) versus ununited fracture. No evidence of acute fracture and normal-appearing apophysis. - Right foot MRI: Osseous body at base of the 5th metatarsal with irregular margins, hyperintense T2 fibrous union, and internal edema of the ossicle and adjacent proximal metatarsal, favored to represent a symptomatic os vesalianum. No increased apophyseal distraction. FINAL WORKING DIAGNOSIS: Symptomatic Accessory Os Vesalianum TREATMENT AND OUTCOMES: 1. Immobilize in a walker boot for 6-8 weeks. 2. Physical therapy after immobilization, with emphasis on peroneal muscle strengthening and range of motion. 3. If complete resolution of symptoms, may gradually return to sport as tolerated. If symptoms persist, consider surgical excision.

Effect of ununited fracture of the ulnar styloid process on wrist function following internal fixation of distal radius fracture

Objective To investigate the effect of nonunion of ulnar styloid process fracture on the wrist function following internal fixation of distal radius fracture. Methods From January 2012 to December 2012, 128 patients with distal radius fracture were treated by open reduction and internal fixation (ORIF). They were 41 males and 87 females, aged from 18 to 80 years (average, 53.2 years). The ulnar styloid process fracture united in 41 cases but did not in the other 87 ones. The postoperative radiological parameters, the Gartland-Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores, ulnar rotation wrist pain, grip strength and ranges of active wrist motion at the final follow-ups were compared between the 2 groups of patients. The 2 groups were compatible in terms of preoperative demographic data (P >0.05). Results All the 128 patients were followed up for 39 months on average (range, from 30 to 46 months). For the fracture union group and the fracture nonunion group, respectively, the fracture healing time was 12.1±1.8 weeks versus 11.8±1.6 weeks; the palmar tilt of the distal radius was 11.0°±2.0° versus 10.3°±1.8°; the ulnar inclination angle was 21.4°±1.8° versus 21.5°±2.1°; the radial height was 10.9±2.4 mm versus 11.2±2.4 mm; the grip strength was 24.1±8.6 kg versus 25.8±8.3 kg; the ranges of active wrist motion between the healthy and affected sides were 4.8°±4.2° versus 4.6°±4.1° at dorsal extension, 4.9°±4.8° versus 5.0°±4.6° at palmar flexion, 2.9°±2.7° versus 2.7°±2.1° at radial deviation and 2.8°±2.6° versus 2.1°±1.9° at ulnar deviation; the Gartland-Werley score was 3.3±3.4 versus 2.5±2.7; the DASH score was 12.3±6.4 versus 13.3±5.5; the ulnar rotation wrist pain was found in 24 and 57 ones. No significant differences were found in all the above indexes between the 2 groups (P >0.05). Conclusion The ununited fracture of the ulnar styloid process may have little effect on the wrist functional recovery following ORIF of the distal radius fracture. Key words: Carpal joints; Fractures, ununited; Fracture fixation, internal

The use of traction for treating femoral shaft fractures in low- and middle-income countries: a systematic review.

The use of traction for treatment of femoral shaft fractures remains common in low- and middle-income countries (LMICs). The objective of this study is to systematically review the literature on outcomes of traction as definitive treatment for adult femoral shaft fractures in LMICs. Using the recommended PRISMA methods for systematic reviews, MEDLINE, EMBASE, LILACS, and AJOL were searched for relevant publications. Results were limited to studies occurring in LMICs as defined by the World Bank. Data on time spent in traction (TT), length of stay (LOS), time to partial weight bearing (PWB), complication incidences, and a total complication incidence were recorded. Of the 693 initial results, nine were eligible for analysis giving a total of 455 unique patients with a mean age of 32.9years (range: 0 to 96). The average time spent in traction was 52.8days (range: 19.8 to 122.5), the average length of stay was 55.4days (range: 45 to 140), and the average time to partial weight bearing was 52.2days (range: 42 to 60days). There were a total of 91 malunions, 25 un-united fractures, 60 infections, 45 other complications, giving a total of 221 complications in 455 patients. The use of traction in treating femoral shaft fractures is associated with a high incidence of complications and prolonged course of treatment. Although operative stabilization may be a better alternative, comparative studies are needed to assess whether this can be achieved in a safe and cost-effective manner for widespread application in LMICs.

Treatment of nonunion of neck fracture of the femur in young patients with valgus osteotomy

Background Nonunion of the femoral neck fractures usually can be diagnosed within 1 year of fracture, although a fairly accurate prediction of healing can be made only after 6 months or less. Valgus osteotomy increases the healing power of femoral neck fractures by translation of the shearing force to compression force. Patients and methods This study included 20 patients with ununited femoral neck fractures, with their ages ranging from 22 to 50 years. All patients had fractures with high-angle fractures (Pauwel’s III). They were 16 males and four females. They were treated through valgus osteotomy and internal fixation with dynamic hip screw with angle of 150°. Results Overall, 18 fractures were healed and all osteotomies were healed. Two patients with ununited fractures could not walk. Conclusion Valgus osteotomy with internal fixation with dynamic hip screw is a very useful solution for treatment of ununited femoral neck fractures in young adults with excellent results.

The use of autofibrinum for the stimulation of osteoreparation in the treatment of long bones fractures

The use of autofibrinum enriched with erythrocytes for the stimu­lation of reparative osteogenesis is one of the perspective trend of bioimplantology. The goal: to investigate the forming of bone regenerate under conditions of placing of autofibrinous clot around or between the bone fragments during the surgical treatment of patients with diaphyseal long bones fractures of extremities. Methods: the main group included 24 patients — 14 with acute fractures (tibia/fibula 5, humerus 1, femur 1, ulna 3, radius 4) and 10 with ununited fractures 4–6 month after initial trauma (humerus 5, tibia/fibula 2, forearm 2). 21 patients with acute diaphyseal fractures were included in the comparison group (tibia/fibula 8, forearm 9, humerus 4). The patients underwent osteosynthesis with LCP-plates, external fixators, intramedullary pin. Autofibrinum was produced according to J. Choukroun method. It was placed subperiostaly with covering of fracture zone or in bone defect. Regeneration in the place of clot was assessed with radiografy. The results: it was defined that 89.47 % patients of the main group had formation of bone regnerate of corresponding size with fragments healing. The expert assessment of X-ray films was performed by two independent specialist. Coefficient of agreement was equal to 0.8–1 according to Cohen’s Kappa (complete matching). The formation of periostel regenerate was noticed in 23.8 % patinets of comparison group. However, its relative height (14 ± 2.4) % was sagnificantly less comparing with the same index in main group (45 ± 10) %. Conclusion: usage of autofibrinum, produced ac­cording to J. Choukroun method, as a osteoplastic material in the surgical treatment of the long bones of extremities leads to forming of bone regenerate in the place of its location.

Role of locking plates in treatment of difficult ununited fractures: a clinical study

ObjectiveTo present our experience in treatment of difficult ununited long bone fractures with locking plate MethodsRetrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture (3 patients) supracondylar fracture of femur (gap nonunion) fracture of clavicle fracture of both forearm bones (radius and ulna) fracture of ulna fracture of shaft of humerus fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each). Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic two were oligotrophic and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients ResultsMinimum follow-up was 6months (range, 6months to 2.5years). Average time for union was 3.4months (range 2.5 to 6months). None of the patients had plate-related complications or postoperative wound infections. ConclusionAlong with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Analysis of mid-term efficacy of biological type long-stem artificial caput femoris replacement operation in the treatment of unstable senile intertrochanteric fracture

Objective To explore the mid- term efficacy of biological type, long- stem artificial caput femoris replacement operation in the treatment of unstable senile intertrochanteric fracture. Methods 73 patients accepted the treatment of biological type long- stem artificial caput femoris replacement operation, and 64 cases were followed. After 3 months of operation,these 64 patients were divided into four groups which marked as A,B,C and D according to the Berg balance scale(BBS). Accordingly,54 patients that in grade A,B and C would be brought into in long- term follow- up study.54 cases include 25 male patients and 29 female patients with an average age of 81.6 years old who aged from 73 to 94 years old.According to Evans- Jensen classification,28 cases were Evans- Jensen Ⅱ and the left 26 cases were Evans- Jensen Ⅲ. Results The follow-up period was in the range of 24 to78 months(mean 42months). During this period, except the 9 death cases, there was no case of femoral trochanteric ununited fracture, femoral prostheses loosening or dislocation of hip joint. In total,3 cases occurred with loss of fixing wire,4 cases occurred with acetabular wear, one case was experienced prosthesis adjacent fracture and three cases of heterotopic ossification. According to the Engh standard, all femoral prostheses got osseous fixation. The rate of excellent and good result were 88.9% with in which excellent in 23 cases and good in 17 cases. Conclusion The application of biological type long-stem artificial caput femoris replacement in the treatment of unstable senile intertrochanteric fracture can achieve satisfactory midterm efficiency. Key words: Femoral Fracture; Arthroplasty, Replacement, Hip; Aged