Management of Infected Non-Union by Implant Retainment and Papineau Open Bone Grafting – Report of Two Cases.

Introduction : Infection following implant surgery in orthopaedics is a disaster both for surgeon and patient. Management of infected non-union is a most challenging task an orthopaedic surgeon can ever face. Infection following implant surgery not only leads to repeated surgeries, long term antibiotic use, stiffness of neighbouring joints and long term hospital stay but also effects patients economic, social, psychological status. Cases : Here we present report of 2 cases infected non-union ulna which was managed by stabilisation of non-union site by altering position of existing plate followed by period of open dressing till healthy granulation tissue appears. Later open bone grafting procedure done. Both patients were followed up for 15 months. Results : At the end of 4 months both patients achieved bony union without recurrence of infection. So, we conclude management of infected nonunions by altering plate position and by following papineau method of open bone grafting leads to satisfactory results. Conclusion : This technique is simple, effective and done with minimal expenditure and could be best procedure of choice in patients where cost benefit analysis appears critical.

Evaluation of the results of open reduction and internal fixation of intra-articular calcaneal fractures by one third tubular plate

Treatment of intra-articular calcaneal fracture is still controversial. The aim is to evaluate the results of open reduction and fixation of calcaneal fracture using one third tubular plate and small set screws. Twenty patients with intra-articular calcaneal fractures were treated by open reduction and fixation using one third tubular plates. The average age was 32.5 +/- 4.5 years. The majority were manual workers. Falling from height was the causative trauma in all patients. Eleven patients [55%] had associated fractures. Fractures were classified according to Sanders classification into: six type II, twelve type III and two type IV fractures. Our results showed three excellent, eleven good, three fair and three poor outcomes. The results were affected by the height of falling, type of fracture, time elapsed before surgery, presence of infection and the degree of Gissane angle restoration. We concluded that reduction is the main factor to have satisfactory results and that one third tubular plates is an acceptable method of fixation of type II and III intra-articular calcaneal fractures but should not be used in type IV