Reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate for treatment of chronic tibial osteomyelitis after intramedullary nail fixation / 中华创伤骨科杂志

Objective:To compare the early clinical efficacy between reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate and trench grooving combined with polymethyl methacrylate (PMMA) for the treatment of chronic tibial osteomyelitis after intramedullary nail fixation.Methods:A retrospective analysis was conducted in the 20 patients who had been surgically treated for chronic tibial osteomyelitis after intramedullary nail fixation at Department of Trauma Orthopaedics, Honghui Hospital from January 2019 to January 2021. According to the surgical methods, they were divided into a reaming group and a grooving group. In the reaming group, there were 6 males and 3 females with an age of (47.6±11.4) years; in the grooving group, there were 9 males and 2 females with an age of (49.2±13.9) years. The 2 groups were compared in terms of duration of infection, operation time, intraoperative blood loss, bacterial culture results, total hospital stay, time for inflammatory indexes to return to normal, time for weight-bearing, complication rate, infection control rate, and good to excellent rate by Johner-Wruhs joint function scoring.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P > 0.05). All patients were followed up for 12 to 25 months after operation. There were no significant differences in the duration of infection, operation time, intraoperative blood loss, bacterial culture results, time for inflammatory indexes to return to normal, complication rate, infection control rate, or Johner-Wruhs scoring between the 2 groups ( P > 0.05). The total hospital stay [(11.7 ± 4.7) d] and weight-bearing time [(5.8 ± 1.6) weeks] for the reaming group were significantly shorter than those for the grooving group [(16.8 ± 4.6) d and (8.1 ± 2.9) weeks] ( P < 0.05). Conclusion:In the treatment of chronic tibial osteomyelitis after intramedullary nail fixation, compared with conventional trench grooving combined with PMMA, reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate can not only obtain satisfactory outcomes by infection control but also shorten the treatment cycle by allowing the patients to start early weight bearing.

Iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade in-tramedullary nails / 中华创伤骨科杂志

Objective To analyze the iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade intramedullary nails. Methods We reviewed the patients who had been treated with antegrade intramedullary nails for type 12-A humeral shaft fracture from October 2006 to March 2017. They were 13 males and 13 females with an age range from 22 to 76 years and an average age of 44. 5 years. Six of them were complicated with other fractures or radial nerve injury. We divided the patients into an iatrogenic fracture ( IF ) group and a non-iatrogenic fracture ( NIF ) group and compared gender, age, fracture type, reaming and nonunion between the 2 groups. Results The follow-up time for the 26 patients ranged from 13 to 182 weeks ( 63. 8 weeks on average ) . Of them, 7 suffered iatrogenic fracture and 4 nonunion. The union time for the other 22 patients ranged from 9 to 29 weeks ( 14. 6 weeks on average ) . All the 7 patients in the iatrogenic fracture group were treated with reaming while only 9 of the 19 patients in the non-iatrogenic fracture group were treated with reaming. Nonunion occurred in 3 patients in the iatrogenic fracture group but in only one patient in the non-iatrogenic fracture group. All the above comparisons were statistically significant between the 2 groups ( P < 0. 05 ) but there were no significant differences in comparisons between the 2 groups regarding gender, age, nail diameter, fracture type, way of locking proximal and distal screws or rate of secondary surgery ( P > 0. 05 ) . Conclusions Antegrade intramedullary nailing may cause an iatro-genic fracture in the treatment of type12-A humeral shaft fractures. The iatrogenic fracture may affect fracture union. Intraoperative reaming may be the risk factor for the iatrogenic fracture.

Thermal Injury Complicating Improperly Reamed Intramedullary Nailing of the Tibia: A Case Report

Endosteum and bone marrow thermal necrosis caused by reaming during tibial intramedullary nail insertion, and unskilled operation of soft tissue penestration by reamer resulted in chronic osteomyelitis and soft tissue defect. So, several times of free flaps were done but the result was unsuccessful. At last, the authors performed radical necrotic bone resection and internal bone transport using Ilizarov external fixator. The authors report case with literature review.

The Relationship between Fat Embolism and Intramedullary Reaming / 대한정형외과학회잡지

To evaluate leading mechanisms of fat embolism, we investigated patients who received femoral procedures prospectively. Forty patients were classified into three groups according to reaming procedures. Group A (10 cases) was the control group who operated with open reduction and internal fixation for peritrochanteric fractures. Group B (18 cases) was composed of hip arthroplasty patients and group C (12 cases) patients received intramedullary nailing procedures due to femoral shaft fracture. Pulmonary function test and chest X-ray were taken to evaluate pulmonary condition. Perfusion and inhalation radionuclide scan proved pulmonary embolism and fat embolism. Arterial blood gas analysis, lipid metabolites (cholesterol, triglyceride and NEFA (Non-esterified Fatty Acid)) and coagulation battery (PT, aPTT, TAT-III (Thrombin anti-thrombin III complex) and D-dimer) were measured in preoperative, intraoperative (reaming and post-reaming) and postoperative period, individually. Although two cases of fat embolism were verified only in group C preoperatively, there was no difference with the incidence of pulmonary embolism between reaming and non-reaming group (P<0.05). Blood gas analysis revealed no difference between control group and reaming one in each stage. NEFA in lipid metabolism was abruptly increased in group C only during reaming procedure. The titer of D-dimer and TAT-III were elevated specifically in fat embolism patients by reaming procedure. We suggest that D-dimer and TAT-III may be preliminary screening tools for the early diagnosis of fat embolism. And the coagulation system seems to be more related to fat embolism rather than lipid metabolism.