Infected Non-union of Tibia Treated with Ilizarov External Fixator: Our Experience

@#Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results:The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.

Effects of Weekly Teriparatide Administration for Vertebral Stability and Bony Union in Patients with Acute Osteoporotic Vertebral Fractures

STUDY DESIGN: An open-label, non-randomized prospective study. PURPOSE: Teriparatide (TPTD) is known to be an antiosteoporotic agent that may accelerate the healing of fractures. This study was designed to investigate the effect of once-weekly TPTD administration on vertebral stability and bony union after acute osteoporotic vertebral fracture (OVF). OVERVIEW OF LITERATURE: Once-weekly TPTD administration can lead to early vertebral stability and promote bony union of fractured vertebrae in patients with severe osteoporosis. METHODS: Forty-eight subjects with acute OVF were assigned to receive activated vitamin D3 and calcium supplementation or onceweekly subcutaneous injection of TPTD (56.5 μg) in combination with activated vitamin D3 and calcium supplementation for 12 weeks. Vertebral stability was assessed using lateral plain radiography. Vertebral height at the anterior location (VHa) and the difference in VHa {ΔVHa=VHa (supine position)−VHa (weight-bearing position)} were measured at baseline and 12 weeks after starting treatment. Bony union was defined as the absence of a vertebral cleft or abnormal motion (ΔVHa >2 mm). RESULTS: Although not significant, ΔVHa, indicating vertebral stability, tended to be lower in the TPTD group at 12 weeks (p=0.17). As for subjects with severe osteoporosis, ΔVHa at 12 weeks was significantly lower in the TPTD group than in the control group (mean ΔVHa: control group, 3.1 mm (n=15); TPTD group, 1.4 mm (n=16); p=0.02). The rate of bony union was significantly higher in the TPTD group than in the control group (control group, 40%; TPTD group, 81%; p=0.03). CONCLUSIONS: Once-weekly TPTD administration may facilitate early bony union after acute OVF accompanied by severe osteoporosis.

Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.

The Treatment Results in Site of Tibia Fracture Treated with Interlocking Intramedullary Nail / 계명의대학술지

Intramedullary nailing is the treatment of choice for most diaphyseal fractures of the tibia. The purpose of this study is to evaluate the result of tibia fractures treated with interlocking intramedullary nail, according to different sites of fractures. From september 2004 to august 2012, 106 cases of tibia fracture with a minimum follow up until bony union were selected and analyzed retrospectively. The mean follow-up period of the patients was 24.5 months. The location of fractures were divided into three groups, proximal (n = 18), mid (n = 42), distal (n = 46). Delayed union, mal-alignment and additional operation were investigated. The number of angle change over 5 degrees in the coronal plane and 10 degrees in the sagittal plane were 7 cases in proximal, 7 cases in mid, and 12 cases in distal with statistic significance. And an additional operation was required in 6 patients in proximal fracture, 2 patients in mid fracture, and 7 patients in distal fracture during bony union. Conclusively, intramedullary nailing in proximal and distal tibia fracture showed higher delayed union rate and could result in excessive angle change due to mal-alignment. Therefore, proximal level or distal level tibia fractures need more accurate reduction of fracture than midshaft level would need more accurate reduction of fracture and observe bony union through regularly radiography examination.