ABSTRACT
INTRODUCTION: We evaluated the efficacy of the expandable nailing system for treating femur and tibia shaft nonunions. PATIENTS AND METHODS: Records of 24 patients (25 fractures) were retrospectively reviewed: 16 with femur and 8 with tibia nonunions. The bones underwent reaming, and the largest possible nail sizes were inserted during re-operation. Bone debris obtained from the reaming was used for bone graft at the site of the nonunion. RESULTS: The mean age of the patients was 32 years for the tibia group and 49 years for the femur group. The respective intervals between trauma and re-operation were 11 and 13 months, the operation times 60 and 78 min, and the fluoroscopy times 21 and 32s. Twenty-four of the 25 nonunions healed satisfactorily without requiring additional procedures. In 1 case, demineralised bone matrix was injected percutaneously and the femoral nonunion resolved. Healing time was 23 weeks (6-52) and 17 weeks (6-40) in the tibia and femur groups, respectively. We were able to reduce the need of an autologous bone graft to only two cases by using reamed debris in 17 of the 19 patients who required grafting. CONCLUSIONS: Our results demonstrated satisfactory healing for the treatment of diaphyseal nonunions of the femur and tibia. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. We recommend expandable nail systems for femur and tibia shaft nonunions and the use of reamed debris in order to decrease the use of autogenous bone graft.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary/instrumentation , Fractures, Ununited/surgery , Tibial Fractures/surgery , Adult , Aged , Aged, 80 and over , Bone Nails , Female , Femoral Fractures/diagnostic imaging , Fracture Fixation, Intramedullary/methods , Fracture Healing/physiology , Fractures, Ununited/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Reoperation , Retrospective Studies , Tibial Fractures/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: Coccygectomy is an uncommon procedure that many surgeons are reluctant to perform due to its proximity to the anus and the risk of rectal perforation and infection. OBJECTIVES: To evaluate the diagnostic accuracy and outcome of coccygectomy. METHODS: We retrospectively reviewed the operative results in nine patients (seven females and two males) who underwent coccygectomy for coccygodynia in the last 5 years following failure of conservative treatment. RESULTS: The outcome of the procedure was excellent in five patients, good in one patient and poor in two patients. CONCLUSIONS: It is mandatory to perform bone scanning in every patient with coccygodynia and before coccygectomy in order to rule out the presence of malignancy. Coccygectomy is recommended for patients with isolated coccygodynia.
