Infected non-union of the humerus after failure of surgical treatment: management using the Orthofix external fixator

<p><b>INTRODUCTION</b>The failure of a humeral fracture to unite after surgical treatment may be due to many factors. When there are additional complications of infection, treatment by conventional methods of internal fixation becomes very difficult.</p><p><b>MATERIALS AND METHODS</b>We treated 8 infected non-union of diaphyseal fracture of the humerus by the Orthofix external fixator. All had previous surgical treatment. Non-union followed plating in 6 cases and in 2 cases after the external fixator. All patients had pain, at least one sinus discharging pus and severe functional impairment of the affected arm. There were 6 men and 2 women with a mean age 40.6 years.</p><p><b>RESULTS</b>Bone union was achieved in all cases. The mean time to union was 4.5 months (range, 2 to 8). Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvement in pain and function, mainly because of long standing infection and intractable non-union. There were no major pin tract problems requiring the removal of the Schanz screws. Radial nerve palsy developed in 1 patient who recovered spontaneously. No patient required an additional bone grafting procedure.</p><p><b>CONCLUSION</b>The use of the Orthofix external fixator without bone grafting was successful in the treatment of infected non-union of the humeral shaft. It shortened the duration of hospitalisation and immobilisation with moderate functional recovery.</p>

Intrarenal reflux: a retrospective and comparative study

Intrarenal reflux [IRR] has been considered a classic indication for surgical intervention in cases with vesicoureteric reflux [VUR]. During 1990s, the natural history of VUR and its spontaneous disappearance especially during the first years of life became clearer, leading to the concept of conservative treatment even for the moderate and high grades. This retrospective study aimed at finding if there is an increased incidence of pyelonephritis in spite of proper antibiotic prophylactic treatment of IRR and whether the presence of IRR carries a higher risk in patients with VUR, which dictates earlier surgical intervention. One hundred and eighty five patients less than 5 years old with VUR were operated upon between 1989 and 2000 at the Children's Hospital of Trousseau in Paris. Thirteen [7%] patients [9 females and 4 males] with IRR were diagnosed [Group A]. These children were compared with 13 other children with the same age, sex, and grade of reflux but without IRR [control group B] to find out the impact of IRR on the pattern of presentation and prognosis. The indication of surgical intervention was pyelonephritis under medical treatment [1: 3 episodes] in all patients in Group A except 4 [70%]; while for Group B patients, this indication of surgical intervention was present in 6 infants [1: 2 episodes] [46%] .The frequency of pre-operative renal scarring [1-3 scars] was higher in group A than in group B [4 cases, 31%, versus 3 cases, 23%]. The results were in favour of higher incidence of pyelonephritis at presentation and in patients under medical treatment. Renal scarring in the pre-operative period was more frequent in patients with IRR. A prospective multicentric study with greater number of patients suffering of IRR is needed, and prolonged surveillance with systematic radio99mTc-DMSA renoscintigraphy scan is highly recommended