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1.
Rev. bras. ortop ; 56(6): 796-803, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357140

ABSTRACT

Abstract Objective To evaluate the role of serum alkaline phosphatase (ALP) and ultrasonography (USG) in monitoring the progress of treatment in diaphyseal non-unions. Methods This prospective observational cohort study included adult patients with diaphyseal fractures of major long bones previously treated with internal fixation and eventually resulting in non-union. Following the definitive treatment for non-union, the patients were followed-up periodically for six months, and serial monitoring of the levels of ALP and USG were performed along with radiographs (X-rays) to ascertain the status of the union. Results After an initial rise at seven weeks, ALP levels declined to normal values in fractures which united, whereas they remained high in cases of persistent non-union. Similarly, after an elevation of the vascular resistive index (RI) at around 12 weeks in all the patients, it decreased in cases progressing to union, while it remained persistently high even at 24 weeks in fractures failing to unite. Cases of persistent non-union continued to show hypoechogenic callus at 24 weeks instead of converting into hyperechogenic callus, as observed in cases which progressed to union. Conclusion Significant changes suggestive of union appeared simultaneously on the X-rays, USG and ALP levels during the follow-up. However, a serial examination of the ALP levels and USG during the follow-up gave a hint of the direction of progress in the healing process of fracture non-union. Their role in monitoring the outcome of nonunion is more complimentary than supplementary to the X-rays.


Resumo Objetivo Avaliar o papel da concentração sérica de fosfatase alcalina (FA) e da ultrassonografia no monitoramento do progresso do tratamento da ausência de consolidação em fraturas diafisárias. Métodos Este estudo de coorte observacional prospectivo incluiu pacientes adultos com fraturas diafisárias dos principais ossos longos previamente submetidas a fixação interna sem consolidação. Após o tratamento definitivo, os pacientes foram avaliados periodicamente por seis meses, com realização seriada de ultrassonografia, determinação da concentração de FA e radiografias para verificar a presença de consolidação. Resultados Após um aumento inicial em sete semanas, os níveis de FA voltaram ao valor normal em pacientes com fraturas consolidadas, mas continuaram elevados nos casos de ausência de consolidação. Da mesma forma, após uma elevação do índice de resistência (IR) vascular em cerca de 12 semanas em todos os pacientes, o IR diminuiu nos casos que progrediram para consolidação, mas continuou alto até as 24 semanas em fraturas não consolidadas. Os casos com ausência de consolidação ainda apresentavam calo hipoecogênico às 24 semanas, que não se converteu no calo hiperecogênico observado nos casos que progrediram para consolidação. Conclusão Alterações significativas sugestivas de consolidação foram simultaneamente observadas nas radiografias, na ultrassonografia e na concentração de FA durante o período de acompanhamento. No entanto, a realização seriada de exames da concentração de FA e de ultrassonografia durante o acompanhamento indicou o progresso da consolidação da fratura. Seu papel no monitoramento da ausência de consolidação é mais complementar do que suplementar à radiografia.


Subject(s)
Humans , Male , Female , Bony Callus , Ultrasonography , Outcome Assessment, Health Care , Alkaline Phosphatase , Fractures, Bone/therapy , Fractures, Ununited
2.
Article in Chinese | WPRIM | ID: wpr-879431

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#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.@*RESULTS@#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).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Subject(s)
Adult , Bone Nails , Bone Plates , Bone Transplantation , Female , Femoral Fractures/surgery , Femur , Fracture Fixation, Intramedullary , Fracture Healing , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
3.
Rev. bras. anestesiol ; 70(3): 295-298, May-June 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137170

ABSTRACT

Abstract Morbid obesity is associated with various pathophysiological changes which affect the outcome of anaesthesia and surgery. So it's challenging to give anaesthesia to such patients. We present a 59-year-old adult morbidly obese, hypertensive, diabetic female with hypothyroidism operated for proximal humerus fracture and now presented with non-union of fracture, requiring percutaneous injection of bone marrow aspirate from the iliac crest to the site of non-union. The patient was extremely anxious and refused to undergo the procedure under local anaesthesia or sedation and demanded anaesthesia. Given her comorbidities general anaesthesia (GA) was avoided and the procedure was accomplished using Ultrasound (USG) guided Transversus abdominis plane (TAP) block and Lateral Femoral Cutaneous Nerve (LFCN) block for the bone marrow aspirate from the iliac crest and Intercostobrachial nerve block (T2) was given to prevent pain while injecting the aspirate into the non-union site. Dexmedetomidine and ketamine were given for deep level sedation and analgesia. TAP block and LFCN block is generally used for post-op analgesia but can be also used for surgical anaesthesia instead of General anaesthesia in specific scenarios. Its perioperative application and its potential use instead of GA have been discussed.


Resumo A obesidade mórbida se associa a várias alterações fisiopatológicas que afetam o desfecho da anestesia e cirurgia. É, portanto, um desafio anestesiar tais pacientes. Apresentamos uma mulher adulta de 59 anos, obesa mórbida, hipertensa, diabética, com hipotiroidismo, submetida a cirurgia devido a fratura proximal do úmero e que compareceu ao serviço com fratura não consolidada, e com indicação de injeção percutânea de aspirado de medula óssea da crista ilíaca na fratura não consolidada. A paciente estava extremamente ansiosa e recusou o procedimento sob anestesia local ou sedação e exigiu anestesia. Em função de suas comorbidades, Anestesia Geral (AG) foi evitada e o procedimento foi realizado usando bloqueio do Plano Transverso Abdominal (PTA) guiado por Ultrassonografia (USG) e bloqueio do Nervo Cutâneo Femoral Lateral (NCFL) para aspiração de medula óssea da crista ilíaca. O bloqueio do nervo Intercostobraqueal (T2) foi realizado para evitar dor durante a injeção do aspirado. Dexmedetomidina e ketamina foram dadas para sedação profunda e analgesia. O Bloqueio PTA e bloqueio NCFL geralmente são usados para analgesia pós-operatória, mas também podem ser usados para anestesia cirúrgica substituindo a anestesia geral em condições clínicas específicas. O emprego desses bloqueios no perioperatório e seu uso potencial no lugar de AG têm sido discutidos.


Subject(s)
Humans , Female , Shoulder Fractures/surgery , Bone Marrow Transplantation , Ultrasonography, Interventional , Fractures, Ununited/surgery , Nerve Block/methods , Peripheral Nerves , Shoulder Fractures/complications , Obesity, Morbid/complications , Fractures, Ununited/complications , Anesthesia , Middle Aged
4.
Article in Chinese | WPRIM | ID: wpr-773903

ABSTRACT

OBJECTIVE@#To investigate the methods and clinical effects of autologous iliac bone transplantation, platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) in the treatment of nonunion.@*METHODS@#From January 2015 to December 2016, 60 patients with nonunion were treated, including 41 males and 19 females, aged 18 to 42 years old with an average age of 29 years old. Patients with nonunion were divided into autologous bone transplantation treatment group(control group), autologous bone transplantation and platelet-rich plasma(PRP) combined with extracorporeal shock wave(ESW) treatment group(experimental group). The callus formation, local complications, final growth of fracture and Johner-Wruhs functional classification of operative limbs of the two groups were compared 3 months after operation.@*RESULTS@#Fifty-five patients were followed up, 27 in the control group and 28 in the experimental group, 5 patients were lost. The follow-up period ranged from 8 to 24 months. The callus score in the control group was significantly lower than that in the experimental group at 3 months after operation(<0.05). There was no swelling and infection in the skin of the iliac bone acquisition site and non-union operation site in both groups. The clinical and bone healing time of the control group was significantly longer than that of the experimental group(<0.05). In the experimental group, 28 patients achieved bone union; in the control group, 24 patients achieved bone union, and 3 patients had bone nonunion again. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the control group was significantly lower than that in the experimental group(<0.05).@*CONCLUSIONS@#Autologous iliac bone transplantation combined with platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) has a certain effect in the treatment of bone nonunion after fracture surgery. It can significantly improve the formation of new bone. It is a comprehensive and useful way to treat bone nonunion after fracture surgery in clinical work.


Subject(s)
Adolescent , Adult , Bone Transplantation , Female , Fracture Healing , Fractures, Ununited , Humans , Ilium , Male , Platelet-Rich Plasma , Transplantation, Autologous , Young Adult
5.
Article in Chinese | WPRIM | ID: wpr-781671

ABSTRACT

OBJECTIVE@#To investigate the clinical results of locking compression plate combined with autologous iliac bone graft in the treatment of aseptic ulnar nonunion.@*METHODS@#From March 2009 to July 2017, 22 patients with aseptic ulnar diaphyseal nonunion with complete follow-up data were treated with surgery, including 12 males and 10 females, aged from 16 to 58 (39.7±9.9) years old and ranging in course of disease from 10 to 192 (39.4±55.7) months. There were 15 atrophic nonunions, 5 hypertrophic nonunions and 2 synovial pseudo-articular nonunions. After debridement of the nonunion, locking compression plate was used to fix the nonunion and autogenous iliac bone graft was given. Bone healing rate, surgical complications and clinical results were evaluated.@*RESULTS@#All the patients were followed up, and the duration ranged from 13 to 42 months, with a mean of (22.5±8.2) months, and 1 patient did not heal. Visual analogue pain scores ranged from 0 to 3 (0.9±0.9). Pronation of forearm was 47 to 86 (69.0±14.7) degrees, supination was 35 to 85 (63.0±9.4) degrees, wrist flexion was 20 to 80 (51.0±10.2) degrees, wrist flexion was 32 to 88 (71.0±11.7) degrees, elbow flexion contracture was 0 to 25 (9.0±5.6) degrees, further flexion was 105 to 150 (134.0±13.9) degrees, and grip strength was 87% on the opposite side. According to the Anderson scoring system, 8 cases were excellent, 11 were satisfied, 2 were not satisfied, and 1 was failed.@*CONCLUSIONS@#LCP combined with autologous iliac bone graft can effectively treat aseptic ulna diaphyseal nonunion.


Subject(s)
Adolescent , Adult , Bone Plates , Bone Transplantation , Diaphyses , Female , Fracture Fixation, Internal , Fractures, Ununited , General Surgery , Humans , Ilium , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Ulna , Young Adult
6.
Rev. bras. ortop ; 53(6): 668-673, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-977911

ABSTRACT

ABSTRACT Objectives: The aim of this study was to assess the results of percutaneous injection of autologous bone marrow in the treatment of fractures presenting with delayed union or non-union after internal fixation. Methods: This prospective study was carried out at the Orthopeedics Department from June 2005 to June 2010. A total of 93 patients with delayed union and non-union (56 delayed unions and 37 non-unions) of the long bone were recruited from the Emergency and Outpatient Departments and treated with percutaneous autologous bone marrow injections. The clinical results of this study were rated on the basis of the criteria of union. All patients were followed for 24 months. Results: All the fractures (delayed union and non-union) were united within 12 weeks. Most of the patients had discomfort at the donor site for few days; none had problems of persistent pain. The results were excellent in 68.81% (64/93) of cases, good in 19.35% (18/93) of cases, and poor in 11.82% (11/93) of cases. Conclusion: Percutaneous autologous bone marrow injection is an effective and safe method for the treatment of diaphyseal non-union and delayed union. Thus, it is concluded that with an adequate amount of autologous bone marrow injection, successful union in delayed union and non-union of fractures of long bones can be achieved.


RESUMO Objetivo: Avaliar os resultados da injeção percutânea de medula óssea autóloga no tratamento de fraturas com retardo de consolidação ou pseudoartrose após fixação interna. Métodos: Estudo prospectivo feito no Departamento de Ortopedia de junho de 2005 a junho de 2010. Foram recrutados 93 pacientes com retardo de consolidação e pseudoartrose (56 retardos de consolidação e 37 pseudoartroses) de osso longo dos Departamentos de Emergência e Ambulatórios e tratados com injeções de medula óssea autóloga percutânea. Os resultados clínicos deste estudo foram avaliados com base em critérios de consolidação. Todos os pacientes foram seguidos durante 24 meses. Resultados: Todas as fraturas (retardo de consolidação e pseudoartrose) apresentaram consolidação dentro de 12 semanas. A maioria dos pacientes apresentava desconforto na região doadora por alguns dias; nenhum caso de dor persistente foi observado. Os resultados foram excelentes em 68,81% (64/93), bons em 19,35% (18/93) e ruins em 11,82% (11/93) dos casos. Conclusão: A injeção de medula óssea autóloga percutânea é um método efetivo e seguro para o tratamento da pseudoartrose e do retardo de consolidação diafisários. Assim, conclui-se que uma quantidade adequada de injeção autóloga de medula óssea pode levar a uma consolidação bem sucedida em casos de retardo de consolidação e pseudoartrose de fraturas de ossos longos.


Subject(s)
Adult , Middle Aged , Aged , Aged, 80 and over , Bone Nails , Femoral Fractures , Fracture Fixation, Internal , Fractures, Ununited
7.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 5(2): 130-140, dic. 2018. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088686

ABSTRACT

Introducción: La transportación ósea se refiere al traslado de un fragmento de hueso a través de un defecto óseo, por distracción osteogénica. Objetivo: Describir la técnica quirúrgica con fijador externo AO, y evaluar los resultados de este tratamiento en defectos óseos diafisarios de tibia mayores de 4 cm, secundarios a fracturas expuestas graves o pseudoartrosis infectadas. Material y método: Se realizó un estudio descriptivo de tipo serie de casos, retrospectivo, de los 14 pacientes tratados entre abril del 2011 y abril del 2015, con las lesiones o secuelas mencionadas en diferentes centro de Montevideo. Resultados: Todos los pacientes tenían secuelas a fracturas expuestas graves con defecto segmentario de tibia mayor a 4 cm. El seguimiento promedio fue de 13 meses (entre 6 y 27). La media de edad fue de 32 años (entre 15 y 53), la perdida ósea promedio 6,7 cm (entre 4 y 11), la velocidad de distracción de 0,58 mm/día, el período de distracción promedio fue de 92 días (entre 35 y 172), y el tiempo medio de fijadores externos desde el inicio fue de 194 días. Todos los pacientes requirieron algún procedimiento quirúrgico en el sitio de acoplamiento. Se logró la consolidación en 9 pacientes, hubo 2 pseudoartrosis, 2 pacientes abandonaron el tratamiento y uno decidió la amputación. No hubo ninguna recidiva de infección. Conclusión: La técnica de transportación ósea mediante el uso de fijadores externos AO, es una alternativa válida para el tratamiento de las perdidas óseas diafisarias de tibia con o sin infección.


Introduction: Bone transport is the slow transportation of the bone fragment along a bone defect, providing distraction osteogenesis. Objective: To describe the surgical technique of bone transport using the AO external fixator and to present the result of this procedure in tibial diafisis defects of more than 4 cm long, which were the result of severe open fractures or infected no unions. Material and Methods: This is a retrospective, descriptive study of 14 patients treated in several centers in Montevideo from April 2011 to April 2015. Results: The average age of the patients was 32 years (15-32), the average bone loss 6,7 cm (4-11), the distraction speed 0,58 mm/day, the mean distraction period 92 days (35-172) and the mean time external fixation was 194 days. The mean follow up was 13 months (6-27). All patients needed an additional surgical procedure in the docking site. Bone healing was accomplished in 9 patients and there were 2 no unions. There were 2 further patients who abandoned the treatment and another patient who requested amputation. At the latest follow up there was no recurrence of infection. Conclusion: Bone transport using AO external fixator, is a valid alternative for the treatment of segmental bone loss of the diafisis of the tibia with or without infection.


Introdução: O transporte ósseo é o transporte lento do fragmento ósseo ao longo de um defeito ósseo, que proporciona distração osteogênica. Objetivo: Descrever a técnica cirúrgica de transporte de osso, utilizando o fixador externo AO e apresentar o resultado deste procedimento nos defeitos da diáfise da tíbia de mais de 4 cm de comprimento, que foram um resultado de fracturas expostas graves ou ausência de juntas infectados. Material e métodos: Trata-se de um estudo descritivo e retrospectivo de 14 pacientes atendidos em diversos centros de Montevidéu no período de abril de 2011 a abril de 2015. Resultados: A idade média dos pacientes era de 32 anos (15-32), a 6,7 cm perda óssea média (4-11), a taxa de distracção 0,58 milímetros/dia, período médio de 92 dias distracção (35-172) e o tempo médio de fixação externa foi de 194 dias. O seguimento médio foi de 13 meses (6-27). Todos os pacientes precisaram de um procedimento cirúrgico adicional no local de encaixe. A cicatrização óssea foi realizada em 9 pacientes e não houve 2 articulações. Houve mais 2 pacientes que abandonaram o tratamento e outro paciente que solicitou a amputação. No último seguimento, não houve recidiva da infecção. Conclusão: O transporte ósseo utilizando o fixador externo AO é uma alternativa válida para o tratamento da perda óssea segmentar da diáfise da tíbia com ou sem infecção.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Tibial Fractures/surgery , Bone Lengthening/methods , External Fixators , Osteogenesis, Distraction/methods , Fracture Fixation/methods , Fractures, Ununited/surgery , Bone Diseases, Infectious , Epidemiology, Descriptive , Retrospective Studies , Treatment Outcome
8.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(1): 31-37, mar. 2018. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896287

ABSTRACT

Introducción: El objetivo de este trabajo es presentar los resultados clínicos y radiológicos de una serie de pacientes tratados con injerto óseo vascularizado pediculado del radio distal para seudoartrosis recalcitrantes de cúbito diafisario o proximal. Materiales y Métodos: Se realizó un estudio retrospectivo que incluyó a pacientes con seudoartrosis del cúbito diafisario o proximal con defectos <6 cm y, al menos, tres cirugías previas y un seguimiento mínimo de dos años tratados con injerto óseo vascularizado pediculado del radio distal. Se registró la cantidad de cirugías previas. Se evaluaron el rango de movilidad del codo y la muñeca, la fuerza de puño comparativa, el dolor mediante la escala analógica visual, el cuestionario QuickDASH y el puntaje de la Clínica Mayo para codo. Resultados: Se incluyó a siete pacientes. La edad media fue de 42 años (rango 26-64). El número promedio de cirugías previas fue 4 (rango 3-7). El seguimiento medio fue de 31 meses (rango 24-43). Todas las seudoartrosis consolidaron. El puntaje de la Clínica Mayo fue bueno en 4 pacientes, excelente en 2 pacientes y moderado en uno. El puntaje QuickDASH posoperatorio promedio fue de 13 (rango 0-29). El arco de flexo-extensión de la muñeca fue del 81% del contralateral. El rango de movilidad del codo fue >100° en 5 pacientes y de 50°-100° en 2 pacientes. Conclusión: El injerto óseo vascularizado pediculado del radio distal es una alternativa eficaz para el tratamiento de la seudoartrosis del cúbito. Nivel de Evidencia: IV


Introduction: The purpose of this study was to analyze the clinical and radiological outcomes of a series of patients treated with pedicled distal radius vascularized bone graft for recalcitrant ulnar nonunions. Methods: A retrospective study was performed. The inclusion criteria were patients with diaphyseal or proximal ulnar nonunions with bone defects <6 cm, at least three previous surgeries and a minimum follow-up of 2 years, treated with pedicled vascularized bone graft of distal radius. The number of previous surgeries was recorded. Elbow and wrist range of motion, comparative grip strength, and pain using the Visual Analogue Scale, QuickDASH questionnaire and Mayo Clinic score for elbow were evaluated. Results: Seven patients were included. The mean age was 42 years (range 26-64). The average number of previous surgeries was 4 (range 3-7). The mean follow-up was 31 months (range 24-43). All pseudoarthrosis consolidated. The Mayo Clinic score was good in 4 patients, excellent in 2 patients and moderate in one patient. The mean postoperative Quick- DASH score was 13 (range 0-29). Flexion-extension arch of the wrist was 81% of the contralateral. The elbow range of motion was >100° in 5 patients and 50°- 100° in 2 patients. Conclusion: The pedicled vascularized bone graft of the distal radius is an effective alternative for the treatment of recalcitrant ulnar nonunions. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Pseudarthrosis/surgery , Ulna Fractures/surgery , Bone Transplantation/methods , Fractures, Ununited/surgery , Retrospective Studies , Follow-Up Studies , Treatment Outcome
9.
Repert. med. cir ; 26(3): 172-177, 2017. Ilus, tab
Article in English, Spanish | LILACS, COLNAL | ID: biblio-907073

ABSTRACT

Objetivo: describir las características clínicas y quirúrgicas que pueden catalogarse como factores de riesgo biológico en el desarrollo de seudoartrosis en los pacientes con fracturas de tibia y fémur tratados con o sin cirugía. Materiales y métodos: estudio de corte transversal; se revisaron los factores de riesgo biológico en seudoartrosis por fracturas de tibia y fémur en las historias clínicas de los hospitales de San José e Infantil Universitario de San José de Bogotá, Colombia. Se utilizó estadística descriptiva para el análisis. Resultados: Se incluyó a 91 pacientes tratados inicialmente con osteosíntesis. De los factores de riesgo evaluados, el 41,8% fue fumador, el 8,9% consumió medicamentos asociados con el riesgo de desarrollar seudoartrosis y el 8,8% presentaba alguna comorbilidad. El tutor externo fue el tipo de osteosíntesis más usado (37,4%). La mediana de tiempo para la cura de seudoartrosis fue de 9 meses (IQR 6-11). Discusión: los factores que afectan al proceso de consolidación se clasifican en mecánicos y biológicos. Como fortaleza se destaca que es el primer reporte local sobre los factores de riesgo biológico, excluyendo los de tipo mecánico, que pueden contribuir por otras vías a la generación de seudoartrosis. Conclusión: Al identificar y conocer los factores de riesgo biológicos para el desarrollo de esta patología, se puede lograr una intervención temprana que defina la terapia apropiada y favorezca un buen pronóstico.


Objective: To describe the clinical and surgical features which may be classified as biological risk factors for the formation of pseudarthrosis in patients with tibia and femur fractures receiving surgical or non-surgical treatment. Materials and methods: Cross-sectional study. The biological risk factors for bone non-union secondary to tibia and femur fractures in patients seen at the San José and Infantil Universitario de San José hospitals in Bogotá Colombia were identified by reviewing their clinical records. Descriptive statistics were used to analyze the data. Results: 91 patients initially receiving a surgical fixation were included. The risk factors identified were, 41.8% of patients smoked, 8.9% received medication associated with the risk of delaying fracture healing and 8.8% had comorbidities. The external tutor was the most used type of fixation (37.4%). The median time to non-union healing was 9 months (IQR 6 -11). Discussion: The factors affecting bone healing processes are classified as mechanical and biological. A positive feature of our study is that it is the first local report on biological risk factors, excluding mechanical risk factors which in other ways favor fracture non-union. Conclusion: Early identification and knowledge of biological risk factors for pseudarthrosis promotes a timely intervention and defining an adequate treatment providing a good prognosis.


Subject(s)
Humans , Male , Female , Adult , Pseudarthrosis , Fractures, Ununited , Therapeutics
10.
Article in Korean | WPRIM | ID: wpr-12365

ABSTRACT

PURPOSE: The purpose of this study was to analyze the results of patients with scaphoid waist nonunion treated with percutaneous screw fixation without bone grafting under local anesthesia. METHODS: We enrolled scaphoid waist nonunion of 15 patients which had no deformity, displacement, evidence of avascular necrosis and bone cyst under 5 mm on its radiological study. All patients were male with an average age of 28.9±6.2 years (range, 17–38 years). The mean time to surgery from initial injury was 10.8±2.2 months (range, 6–14 months). All patients were treated with percutaneous screw fixation without bone grafting via volar approaching under local anesthesia and postoperative radiographs were reviewed and documented the flexion and extension arcs of the injured wrist and uninjured wrist, disability of the arm, shoulder and hand (DASH) score at final follow-up. RESULTS: All 15 patients showed radiological union at an average 5.5±1.0 months. At 12 months follow-up, the flexion and extension arcs of the injured wrist were 95% and 98.5% of the uninjured wrist. The average DASH score at final follow-up was 7±3.9 (range, 0–15). None of these patients showed any complications associated with surgery. CONCLUSION: Percutaneous screw fixation without bone grafting under local anesthesia was reliable primary treatment method for scaphoid waist non-union without displacement or deformation in the fracture site.


Subject(s)
Anesthesia, Local , Arm , Bone Cysts , Bone Transplantation , Congenital Abnormalities , Follow-Up Studies , Fracture Fixation , Fractures, Ununited , Hand , Humans , Male , Methods , Necrosis , Scaphoid Bone , Shoulder , Wrist
11.
Article in English | WPRIM | ID: wpr-11451

ABSTRACT

A 12-year-old castrated Toy Poodle was referred to the Kangwon National University Animal Hospital with an oligotrophic nonunion fracture in the distal 1/3 of the left radius and an intact ulna. After fixation by a locking plate and screws, adipose-derived mesenchymal stem-cell sheets expressing bone morphogenetic protein 7 (BMP-7) were transplanted to the fracture site to enhance the healing activity. The fracture was healed at 9 weeks after surgery. In the present case, the mesenchymal stem-cell sheets expressing BMP-7 promoted bone regeneration and healing in a nonunion fracture.


Subject(s)
Animals , Bone Morphogenetic Protein 7 , Bone Regeneration , Child , Dogs , Fractures, Ununited , Hospitals, Animal , Humans , Play and Playthings , Radius , Ulna
12.
Rev. Asoc. Argent. Ortop. Traumatol ; 81(3): 163-169, set. 2016. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-842488

ABSTRACT

Introducción: La falta de consolidacion de una fractura es, en general, un fenomeno multifactorial. El objetivo de este estudio fue estimar los valores de referencia de vitamina D (25OHD3) en fracturas que no consolidaron, estudiar su asociacion con la edad y su localizacion. Materiales y Métodos: Estudio prospectivo, de observacion y descriptivo en 29 pacientes con fracturas no consolidadas. Se determinaron las concentraciones sericas de vitamina D (25OHD3) junto con los estudios prequirurgicos. Se calcularon modelos generalizados para estimar los efectos de la edad y la localizacion, y detectar grupos de pacientes con niveles inferiores al valor recomendado. Resultados: El 68,9% de los pacientes tenia concentraciones sericas promedio de vitamina D inferiores al valor normal (30,0 ng/ml), que se asociaron inversamente con la edad, 40 anos fue el punto de corte a partir del cual otras caracteristicas, como la localizacion de la fractura (en huesos que afectan a los miembros inferiores), condicionan conjuntamente la falta de consolidacion. Conclusiones: La mayoria de los pacientes cuya fractura no consolido tenia deficiencia de vitamina D y este fenomeno es marcado a partir de los 40 anos de edad. Es importante identificar a los pacientes con mayor riesgo de presentar este deficit en las primeras etapas del tratamiento de las fracturas, ya que el aporte de este micronutriente es un factor reconocido para disminuir el riesgo de falta de consolidacion. Nivel de Evidencia: IV


Introduction: Absence of bone union after a fracture is generally multifactorial phenomenon. The objective of this study was to determine reference vitamin D values (25OHD3) in non-unions, and to study their association with age and localization. Methods: A prospective, observational and descriptive study was performed to evaluate 29 patients with non-union fractures. Serum vitamin D levels (25OHD3) were determined together with standard preoperative studies. Generalized models were used to estimate the effects of age and location, as well as to detect the group of patients with vitamin D levels lower than recommended. Results: The 68.9% had serum levels of vitamin-D lower than the normal value (30 ng/mL), which was inversely associated with age, being the age of 40 the cutoff point from which other characteristics, such as location, conditioned simultaneously the non-union. Conclusions: Most patients with a non-union fracture had vitamin D deficiency, and this phenomenon was more evident in patients >40 years. Prompt identification of patients with increased risk of presenting this deficiency is important, as treatment could reduce the incidence of fractures that evolve into a non-union. Level of Evidence: IV


Subject(s)
Adult , Vitamin D/metabolism , Fracture Healing , Fractures, Bone , Fractures, Ununited/metabolism , Prospective Studies
13.
Article in Chinese | WPRIM | ID: wpr-300834

ABSTRACT

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.


Subject(s)
Aged , Comparative Effectiveness Research , Fracture Healing , Fractures, Multiple , Therapeutics , Fractures, Ununited , Epidemiology , Humans , Humerus , Wounds and Injuries , General Surgery , Orthopedic Procedures , Methods , Osteoarthritis , Epidemiology , Osteonecrosis , Epidemiology , Randomized Controlled Trials as Topic , Reoperation , Shoulder Fractures , Therapeutics , Treatment Outcome
14.
Article in Chinese | WPRIM | ID: wpr-304350

ABSTRACT

<p><b>OBJECTIVE</b>To analyze rationality of internal fixation with original fixation in the second operation for femoral nonunion.</p><p><b>METHODS</b>A retrospective study was conducted to analyze the clinical data of 19 femoral nonunion patients treated by internal fixation with original fixation in the second operation since January 2009 to July 2014, including 14 males and 5 females with an average age of (43.63 ± 3.95) years old ranging from 18 and 75 years old. The original fixations involved plate fixation in 11 cases and interlocking intramedullary nail in 8 cases (including 3 cases of retrograde interlocking intramedullary nails). There were 13 cases of atrophic nonunion and 6 cases of hypertrophic nonunion in pathological classification. After second operation, the fracture healing time, Harris hip score and range of motion of the knee joint was recorded and compared with preoperative.</p><p><b>RESULTS</b>After the second operatioin, all patients were followed up for 6 to 30 months with an average of (18.67 ± 7.59) months. All patients got fracture healing, and the fracture radiological healing time was from 7 to 29 months with an average of (15.78 ± 4.97) months. Harris hip scores were improved from preoperative 62.37 ± 19.48 to postoperative 87.42 ± 8.86. The range of motion of the knee joint was improved from preoperative (52.16 ± 20.10)° to postoperative (96.32 ± 22.10)°.</p><p><b>CONCLUSION</b>It has a better clinical healing rate for using original fixation to treat femoral nonunions, and theoretically speaking it was rationality.</p>


Subject(s)
Adolescent , Adult , Aged , Female , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Methods , Fracture Healing , Fractures, Ununited , General Surgery , Humans , Male , Middle Aged , Retrospective Studies
15.
Article in Chinese | WPRIM | ID: wpr-304345

ABSTRACT

<p><b>OBJECTIVE</b>To observe the incidence, causes and deviation angle of axial offset in patients with fracture ununited treated by Ilizarov bone transport technology.</p><p><b>METHODS</b>From January 2007 to December 2012, 10 patients with fracture ununited were treated by Ilizarov bone transport including 8 males and 2 females with an average age of (30.3 ± 10.6) years old ranging from 18 to 49 years old. The segment of bone defect involved upper tibial in 2 cases, medial tibia in 2 cases, lower tibial in 5 cases, upper femoral in 1 case. For Paley type of bone defect, 6 cases were type B1, 4 cases were B3. The incidence and deviation angle of axial offset after Ilizarov bone transport technology were observed and evaluated on bone result by Paley assessment.</p><p><b>RESULTS</b>All patients were followed up from 19 to 32 months with an average of (22.0 ± 5.6) months. Three cases were natural healed at fracture ends, the other 7 cases were healed after bone graft. The time of external fixator was 16 to 28 months. At the last follow-up, there were 3 cases occurred coronal angulation of angle 5° to 11° with an average of (8.7 ± 3.2). Sagittal angulation was in 4 cases, angle 6° to 9° with an average of (8.5 ± 2.1)°. There were 4 cases occurred axial offset. In the last follow-up, according to Paley evaluation criteria, osseous results were excellent in 7 cases, good in 3 cases; functional results were excellent in 6 cases, good in 4 cases.</p><p><b>CONCLUSION</b>Axial deviation after the Ilizarov bone transport treatment is relatively common, which will result in delayed healing of bone and poor limb alignment. In order to improve the bone healing, corresponding measurements should be taken to avoid or reduce the incidence of axial deviation during and after the operation.</p>


Subject(s)
Adolescent , Adult , Female , Fracture Healing , Fractures, Ununited , General Surgery , Humans , Ilizarov Technique , Male , Middle Aged
16.
Chinese Journal of Traumatology ; (6): 109-112, 2016.
Article in English | WPRIM | ID: wpr-235772

ABSTRACT

<p><b>PURPOSE</b>To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing.</p><p><b>METHODS</b>We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 (ranging from 21 to 56) years old. The inclusion criteria included: (1) traumatically closed fracture of femoral shaft, with pre- operative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; (2) closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; (3) complete follow-up data available. The relationship between the following factors (fracture site, reduction degree, direction of nail insertion and nail size) and nonunion was studied.</p><p><b>RESULTS</b>The incidence of femoral nonunion was 2.8% in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail (p < 0.05). There was no significant difference between antegrade nail and retrograde nail (p > 0.05).</p><p><b>CONCLUSIONS</b>Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.</p>


Subject(s)
Adult , Age Distribution , China , Cohort Studies , Female , Femoral Fractures , Diagnostic Imaging , General Surgery , Follow-Up Studies , Fracture Fixation, Intramedullary , Methods , Fracture Healing , Physiology , Fractures, Ununited , Epidemiology , General Surgery , Humans , Incidence , Injury Severity Score , Male , Middle Aged , Reoperation , Methods , Retrospective Studies , Risk Factors , Sex Distribution , Time Factors , Trauma Centers , Treatment Outcome , Urban Population , Young Adult
17.
Chinese Journal of Traumatology ; (6): 217-220, 2016.
Article in English | WPRIM | ID: wpr-235744

ABSTRACT

<p><b>PURPOSE</b>Fractures of the humeral shaft are common and account for 3%-5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors.</p><p><b>METHODS</b>The study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures.</p><p><b>RESULTS</b>Of 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p=0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p=0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p =0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months.</p><p><b>CONCLUSION</b>Contrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.</p>


Subject(s)
Adult , Female , Fractures, Ununited , General Surgery , Humans , Humeral Fractures , General Surgery , Incidence , Male , Postoperative Complications , Epidemiology , Radial Neuropathy , Epidemiology , Retrospective Studies
18.
Chinese Journal of Traumatology ; (6): 298-301, 2016.
Article in English | WPRIM | ID: wpr-235724

ABSTRACT

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.


Subject(s)
Aged , Bone Plates , Female , Fibula , Transplantation , Fracture Fixation, Intramedullary , Methods , Fractures, Ununited , General Surgery , Humans , Humeral Fractures , General Surgery , Male , Middle Aged , Osteoporosis
19.
Rev. Asoc. Argent. Ortop. Traumatol ; 80(2): 85-93, jun. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-757161

ABSTRACT

Introducción: El objetivo de este trabajo es evaluar las indicaciones y la incorporación del aloinjerto criopreservado en fracturas y consolidaciones fallidas de huesos largos. Materiales y Métodos: Estudio retrospectivo, 20 pacientes tratados entre 2005 y 2011, 7 fracturas y 14 consolidaciones fallidas de huesos largos en los que se utilizó aloinjerto óseo criopreservado (un paciente con compromiso bilateral de fémur), 11 asociados a autoinjerto. Edad promedio: 45.2 años (rango 19-74). Diez mujeres y 10 hombres. Defectos óseos clasificados en circunferenciales y no circunferenciales. Resultados: La consolidación luego del uso de aloinjerto molido de Banco se logró en 14 casos tras un promedio de 8 meses (rango 4-18); de los 7 restantes, se logró la consolidación luego de cirugías de revisión en 5 casos, uno permaneció sin consolidación y, en otro, se amputó el miembro. Conclusiones: El autoinjerto sigue siendo el patrón de referencia en la reconstrucción de defectos óseos. Los nuevos sistemas de extracción de autoinjertos, como el fresado con irrigación/aspiración (RIA, Synthes) han llevado a que el uso de aloinjerto en fracturas sea poco frecuente. Pero, en los pacientes de nuestra serie, con múltiples cirugías, defectos óseos o trastornos psiquiátricos graves, el aloinjerto óseo crioconservado aislado o asociado a autoinjerto permitió obtener buenos resultados (18 casos consolidaron), aunque 5 casos requirieron cirugías de revisión.


Background: The aim of this study was to evaluate the indications and incorporation of cryopreserved allograft in long bone fractures and nonunions. Methods: Retrospective study of 20 patients treated between 2005 and 2011, with 7 fractures and 14 long bones nonunions in which cryopreserved allograft bone was used (one patient had bilateral femoral involvement), associated with autograft in 11 cases. Average age 45.2 years (range 19 to 74). Ten women and ten men. Bone defects were classified according to whether they were circumferential or not. Results: Bony union after using morcellized allograft was achieved in 14 cases, after an average of 8 months (range 4 to 18), among the remaining 7 cases union was achieved after revision surgery in 5 cases, another case did not achieve consolidation, and an amputation was performed in another patient. Conclusions: Bone autograft remains the gold standard in bone defect reconstructions. Using new extraction systems for autografts, such as reamed irrigation/aspiration (RIA, Synthes) has made the use of allograft in fractures infrequent. In our patients with multiple surgeries, bone defects or severe psychiatric disorders, the use of isolated cryopreserved allograft or associated with bone autograft obtained good results (18 cases with consolidation), although 5 patients required revision surgeries.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Allografts , Fractures, Open/surgery , Fractures, Bone/surgery , Fractures, Ununited/surgery , Bone Transplantation/methods , Retrospective Studies , Treatment Outcome
20.
Article in English | IMSEAR | ID: sea-159277

ABSTRACT

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.


Subject(s)
Adult , Bone Plates/methods , Bone Transplantation/adverse effects , Bone Transplantation/methods , Fractures, Ununited/complications , Fractures, Ununited/surgery , Humans , Male , Osteotomy/instrumentation , Osteotomy/methods , Tibial Fractures/complications , Tibial Fractures/surgery
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