ABSTRACT
This study aimed at assessing the effectiveness of open reduction and plate fixation combined with autogenous bone grafting in the treatment of non-united fractures of the humeral shaft. Forty six patients (27 men, 19 women; mean age, 35.6 years; range, 23-53 years) were operated on for non-union of a diaphyseal fracture of the humerus. Sixteen patients had surgical treatments and 30 patients had non-surgical treatments prior to operation. They were operated on average 7.8 months (6-17) following their initial treatment. None of the nonunions were infected. Radial nerve deficit was present in no patient. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The mean follow-up period was 26 months (range: 13-41). No patient was lost to follow-up. The operative time averaged 91 minutes (range: 68-123). Union was achieved in all patients in a mean of 6.1 months (range: 5-13). There were nine postoperative complications (superficial infection in 5 and radial nerve palsy in 4). The infections resolved after local treatment. The radial nerve palsies recovered spontaneously. On clinical evaluation, shoulder range of motion was excellent in 41 patients (89.1%), and moderate in five patients (10.9%). Elbow range of motion was excellent in 30 patients (65.2%), moderate in 14 patients (30.4%) and poor in 2 patients (4.4%). Functional results were excellent in 24 patients (522%), good in 14 patients (30.4%), fair in 6 patients and poor in 2 patients (04.4%). In this study, plate fixation combined with autogenous bone grafting appeared as a safe and effective option in non-infected non-union of the humeral shaft.
Subject(s)
Fracture Fixation, Internal , Fractures, Ununited/surgery , Humeral Fractures/surgery , Bone Plates , Bone Transplantation , Female , Fracture Fixation, Internal/adverse effects , Fractures, Ununited/diagnostic imaging , Humans , Humeral Fractures/diagnostic imaging , Male , Radial Neuropathy/etiology , Radiography , Range of Motion, Articular , Recovery of Function , Shoulder Joint/physiopathology , Treatment OutcomeABSTRACT
PURPOSE: To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. METHODS: Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. RESULTS: The median follow-up period was 27 (range, 19-41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of more than or equal to 2 (p=0.041), and contaminated wounds (p=0.003). CONCLUSION: Identification of risk factors may help minimise morbidity in HIV-positive patients.
