RESUMO
@#Introduction: Distraction osteogenesis has been used effectively in the management of tibia non-unions with skeletal defect. A retrospective case series study of the infected non-union tibia managed with acute docking in a rail fixation system was conducted at a tertiary care hospital in South India. It was designed to evaluate the use of autologous bone graft at the docking site in achieving an early union with a seven years follow-up period. Materials and Methods: From 2010 to 2017, a total of 19 patients with infected tibia non-union and a bone defect less than 3cm, were treated with debridement and a monolateral frame fixation with acute shortening and lengthening. The patients were divided into two groups: one in which no bone graft was used at the docking site during early years of the study; and a later group in which autologous bone graft was used at the acute docking site primarily in addition to compression. Consolidation at the docking site was assessed both radiographically and clinically, and the results were statistically analysed. Results: There were 12 patients in Group I without bone graft, where consolidation at the docking site was noted after a mean duration of 22.08 ± 3.87 weeks. There were seven patients in Group II with bone graft, where the mean time for docking site consolidation was significantly lower at 16.57 ± 3.82 weeks. No docking site complications were noted in either group. Conclusion: Primary autologous bone graft enhances docking site consolidation in acute shortening. The routine use of bone graft at the docking site in acute shortening will expedite the docking site union with reduction of treatment time.
RESUMO
@#Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology. Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extracortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies. Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intracortical width. Femoral offset, head height and diameter were significantly less in females. Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.