Analysis of causes and treatment modality in non-union of long bones diaphyseal fractures

The purpose of this study was to analyze the causes of nonunion leading to modification in treatment modalities in long bones diaphyseal fractures. Descriptive Study. Combined Military Hospital Quetta, Combined Military Hospital Sialkot, Pakistan, from 5th Sep 2005 to 26th Dec 2008. Non-healing long bones diaphyseal fractures > 6 months were included with exclusion of pathological fractures, delayed union < 6 months. Patients general profile and fracture details with non-union causes were recorded. Old failed surgery with re-do surgical intervention was analyzed. Infected cases were treated with removal of implant, thorough debridment, appropriate antibiotics followed by delayed stabilization while non-infected cases with stable fixation and bone grafting. Out of fifty six patients, tibial fractures were maximum 17[30.4%], femur 16[28.6%], radius ulna 15[26.6%], and humerus 8[14.3%]. Most patients were young 37[66.07%] and male 48[85.7%]. Road traffic accident caused 43[76.8%] fractures. Causes of non-union were high energy trauma 37[66%], insufficient stabilization 31[55.4%], followed by smoking, soft tissue interposition, poor nutrition, NSAIDs, broken implants, infection, intact fellow bone, multiple segment fracture, repeated manipulation, chronic illness and neurovascular impairment in descending order. Plates failed more than K nails. Complications like superficial and deep infection, neuroprexia and delayed healing settled with bone healing in mean time 4.76 months. Nonunion of long bones diaphyseal fractures can be prevented by avoiding causative agents, early intervention, tissue protection and stable fixation. Interlock nailing is best for femur, good for tibia, may be useful in humerus but not suitable for radius and ulna. Bone graft accelerates healing process. Early re do surgery must be considered because of manageable rate of complications

Treatment of infected nonunion tibia by ilizarov external fixator

Nonunion of the tibia associated with infection have always been a challenge to orthopedic surgeons. The ideal treatment should be comprehensive with the ability to simultaneously tackle axial deviations shortening, bone loss, poor local vascularity and achieve bony union without further compromising the soft tissue envelope. All of the above should be achieved by using Ilizarov external fixator in treatment of infected nonunion tibia by compression distraction technique. From 2005 to 2007; 25 patients with infected nonunion tibia were treated by Ilizarov external fixator. Of 25 infected nonunion tibia, 18 were diaphyseal, 7 were metaphyseal, 22 after open fractures and 3 after closed fractures, 5 nonunion with quiescent infection with no drainage, and 20 active infection with drainage, with infection developed after internal fixation in 15 cases, after external fixator in 7 cases and after casting in 3 cases. The mean duration of treatment was 12 months. The duration of follow up ranged 12 to 38 months [mean 22 months]. The mean time of union were 9 months [range 4-11 months]. Bone deformity was corrected in all patients except in 2 with residual deformity less than 5 degrees. The bone result was excellent in 18 cases, good in 6 cases, and fair in 1 case. The functional results were excellent in 15 cases, good in 5 cases, and fair in 5 cases

Enriquecimiento de injerto autologo con concentrado de factores de crecimiento / Autologous graft combined with growth factors concentrate

Introducción: Debido a los cambios recientes en torno al tratamiento de las fracturas, en los últimos años se ha priorizado una combinación de métodos no sólo mecánicos sino también biológicos. En este estudio se evalúan los resultados de un tratamiento combinado mediante osteosíntesis y aplicación de injerto enriquecido con agregado plaquetario, con resultados alentadores. Materiales y métodos: Nuestra serie comprendió 29 pacientes tratados entre 1999 y 2006, laboralmente activos, con una edad promedio de 42 años (rango, 26 a 62 años). En todos los casos se efectuó osteosíntesis con el agregado plaquetario rico en factores de crecimiento plaquetario. Los resultados se analizaron en función de la formación de callo fracturario a los 6 meses. La obtención de injerto esponjoso fue dificultosa en los pacientes reintervenidos. Resultados: La obtención y preparación del agregado plaquetario no presentó inconvenientes. La consolidación clínica y radiológica se alcanzó en los 29 casos al término de 4 meses (2-6 meses); en 2 casos fue necesario repetir el procedimiento de aporte sin recambio del implante a los 2 meses de la primera intervención. Conclusiones: El injerto autólogo enriquecido con plasma rico en factores de crecimiento pudo haber contribuido de manera favorable a la consolidación de estos casos complejos, con gran ausencia biológica, en los que habían fracasado otros métodos

Efecto del injerto de médula ósea autóloga percutánea como tratamiento de fracturas con retardo de consolidación en pacientes atendidos en el Hospital Central de Maracay: enero de 2002 - junio de 2003 / Effect of autologous bone marrow graft and percutaneous treatment of fractures with delayed consolidation in patients treated at the Hospital Central de Maracay: january 2002 - june 2003

Se realizó un estudio prospectivo en 40 pacientes que presentaron retardo de consolidación en el Hospital Central de Maracay, en el lapso comprendido entre enero de 2002 a junio de 2003, para determinar la eficacia del tratamiento con injerto percutáneo de médua ósea autóloga. Se evaluaron pacientes desde el punto de vista clínico y radiológico reportándose excelentes y buenos resultados en el 85 por ciento de los casos. Se utilizó una técnica segura y fácil de realizar sin ninguna complicación posterior. El paciente no ameritó hospitalización para realizar dicho procedimiento.

use of ilizarov technique in management of tibial non unions with bone loss

Sixteen patients aged 22-55 years were treated for tibial non-union [14 atrophic, two hypertrophic] with bone loss [1-10 cm, mean 5.2 cm] by the llizarov technique and fixator. Nine had chronic osteomyelitis, 12 had a bony defect [2-8 cm], mean 2.9 and 10 had a deformity. Non-union, bone defects, limb shortening, and deformity all were addressed simultaneously with the Ilizarov apparatus Bone defects were closed from within without bone grafts by the llizarov bone transport technique of sliding a bone fragment internally, producing distraction osteogenesis behind it until the defect is bridged [internal lengthening]. Length was re-established by distraction of a percutaneous corticotomy. The resulting distraction osteogenesis obviated the need for a bone graft in every case. Deformity was corrected by means of hinges on the apparatus. Infection was treated by radical resection of the necrotic bone and internal lengthening to regenerate the excised bone. Union was achieved in all cases. The mean time to union was 16 months. The bone results were excellent in 10 cases [62.5%] good in 4[25%] and fair in 2[12.5%]. The functional results were excellent in 11[68.75%] cases good in 3[18.75%] fair in 2 [12.5%]

Treatment of gap non-union of fore-arm bones

This study was carried out on 19 patients with gap nonunion of the radius and/or ulna. The average time passed since the original trauma and the treatment of gap nonunion was 4.5 months. All patients were suffering from pain, instability, limitation of elbow and wrist movements, partial loss of pronation supination, hand stiffness and three of them had discharging sinuses. All cases with diaphyseal gap nonunion were treated by dynamic compression plates together with tricortical strut iliac bone grafts 1 to 5 cm in length. After an average of 16 months follow up, 17 cases showed bony healing, a remarkable improvement of elbow and wrist motion, an improvement of pronation supination and a noticeable improvement of hand function. Excellent results were obtained in three cases, good in seven, fair in four and poor in three

Uso de la magnetoterapia en afecciones articulares y periarticulares / Use of magnetotherapy in articular and periarticular disorders

Se analizan los resultados obtenidos en 200 pacientes tratados en el Policlínico Integral Docente Centro, de Camagüey, con diversas artropatías y enfermedades ortopédicas y reumatológicas. Se utilizó el campo magnético producido por el equipo TERAMAG-MT-200. Se obtuvo buen resultado en 189 casos (94,5 por ciento). Las afecciones más beneficiadas fueron las de la rodilla (osteoartritis, sinovitis, fibrosis y rigideces posquirúrgicas, condromalacia y enfermedad de Hoffa), la epicondilitis y otras lesiones del codo, la periatritis escapulohumeral, tendinitis, insercionitis, trocanteritis, síndrome de Barré-Liéou y los dedos en resorte. Se describen los métodos utilizados en cada afección

Repositioning osteotomy in treatment of nonunited fractures of the femoralneck

The aim of the work is to study the results of Pauwels' repositioning subtrochanteric femoral osteotomy in the surgical treatment of nonunion of fracture of the neck of the femur. The total material comprised 14 patients, 8 - 55 years old, mean age 30.2 years. 11 were males and 3 females. The material was subdivided into two age groups: Group I of 6 patients who were children and adolescents, aged 5 - 15 years, mean 11.5 years; Group II, adults, 8 patents, aged 27 - 55 years, mean 42.3 years. Treatment was delayed 2 - 13 months, average 4.5 months. The fractures were of Pauwels' Type 2 in 5 cases, and Type 3 in 9. The method used was that of Pauwels. Preoperative Xrays were done. Tracings of those Xrays were used for precision planning of the osteotomy wedge to be removed for valgisation. The method used for preoperative planning in this study was a personal modification of that described by Muller et al in 1979. The rationale was to abolish shear stresses at the fracture line and transform them to compression forces acting across and perpendicular to the fracture line. The osteotomy was internally fixed. Partial weight bearing with crutches was allowed after 3 weeks, and full weight after radiological union of the osteotomy and fracture. Minimum follow-up was for 2 years. The hospital stay was 14-21 days, average 18 days, except in one case who stayed 6 weeks to treat a minor superficial infection. According to Stewart and Wells' criteria of postoperative assessment of the results there were 8 [57.1%], excellent cases, 4 [28.6%] good cases and 2 [14.8%] fair cases. Union of the osteotomy site was within 2 months, The fracture united after 2 - 6 months, average 3.8 months, for the whole material; it was 2.3 months in Group I, and 3.9 months in Group II. Two patients developed avascular necrosis of the femoral head 22 and 24 months after the fracture, and both 11 months after surgery, and the results in both were graded as fair

Estimulaçäo eletromagnética de fraturas näo consolidadas no prazo normal: resultados obtidos nos primeiros 28 casos / Electromagnetic stimulation of ununited fractures within normal term: results obtained in the first 28 cases

O autor estuda 28 casos de fraturas näo consolidadas no tempo normal e que, por esse motivo, passaram a ser tratadas pela estimulaçäo eletromagnética pulsátil (EEMP). O estimulador utilizado foi desenvolvido na Universidade Estadual de Campinas (Unicampi). Todos os casos, exceto um, foram tratados no Ambulatório de Ortopedia do Hospital das Clínicas (HC) da Unicamp. Uma paciente abandonou o tratamento; dos 27 que permanecem no programa, 22 obtiveram a consolidaçäo da fratura. As cinco falhas säo discutidas pormenorizadamente. O autor relata a experiência adquirida com o emprego do método em nosso meio. A percentagem de cura obtida, 80%, é semelhante à da literatura médica. Conclui-se que a EEMP com emprego do equipamento desenvolvido na Unicamp e com observaçäo das normas preconizadas por Bassett é método eficaz no tratamento de casos selecionados de retarde de consolidaçäo e de pseudartrose

Estimulación eléctrica como tratamiento de elección en retardos de consolidación y fracturas no consolidadas / Electric stimulation as elective treatment in delayed union and nonunited fractures

Se emplea un estimulador eléctrico de corriente directa constante por medio de clavos percutáneos colocados durante doce semanas en el foco de fracturas en retardo de consolidación o no consolidadas. Se presentan solamente los casos con seguimiento mayor a seis meses; se obtuvo consolidación clínica y radiológica en el 88.2% para un total de 34 fracturas. Se confirma la bondad del método que se coloca de acuerdo a estos resultados entre los tratamientos para fracturas abiertas o cerradas, en retardo de consolidación o no consolidadas, en donde otros métodos han fracasado. En nuestro servicio, utilizamos este método para tratamiento de fracturas con las características anotadas, desde agosto de 1980

Seudoartrosis / Pseudoarthrosis

Se presentaron 40 casos de seudoartrosis correspondientes al Hogar Clínica San Juan de Dios y Hospital Hipólito Unánue, sobre los cuales se ha realizado un estudio con referencia a la etiología, tiempo de fractura, tratamiento previo a la seudoartrosis, localización, tratamientos empleados y sus resultados