Antibiotic Impregnated Cement Coated Ilizarov Rod For The Management Of Infected Non Union Of Long Bone.

The infected non union of the long bones in the presence of the intramedullary nail is a dreaded complication of fracture management. Around 7% patients may develop an infected non union of the long bones in intramedullary nailing. Amongst the various grades of infection, grade three infection is the most difficult to cure and manage as it involves an osteomyelitic bone. Amongst an array of therapeutic modalities, the two stage methods are commonly used with the first stage aimed at controlling the infection and the second stage at inducing union. This increases the number of surgical procedures. We used an Ilizarov threaded rod coated with antibiotic impregnated cement to replace the intramedullary nail with the idea of delivering higher concentration of antibiotic locally as well as provide stability. We achieved a union rate of 91% in a relatively small number of patients with this single procedure. The antibiotic impregnated cement coated Ilizarov rod that we used in our study achieves both infection control and union simultaneously and does not allow cement debonding at removal.

Operative management of displaced acetabular fractures: an institutional experience with a midterm follow-up.

BACKGROUND: Operative management is considered to be the treatment of choice in acetabular fractures as this is the unique way of achieving precise anatomical reduction, stable internal fixation, and early mobilization of joint. With this background in mind we undertook a prospective study with an aim to assess the outcome of surgery in displaced acetabular fractures at our general orthopedic centre as a first experience. MATERIAL AND METHODS: This study was conducted on 59 patients (45 Males, 14 Females ) with mean age of 38.35 years (range 18-60 years) with displaced acetabular fractures who were admitted consecutively at our centre from May 2008 through November 2011. Nine patients (7 Male, 2 Female) were lost during follow up. The average follow up was 3.5 years (range 2-5 years). Prophylaxis for deep venous thrombosis and heterotopic ossification was used routinely in all patients. RESULTS: Clinical evaluation was based on modified Merle-d'Aubigne and Postel scoring system. Radiological evaluation was done according to criteria developed by Matta. It was graded as excellent in 16% hips, good in 54% hips, fair in 20% hips and poor in 10% hips. Good to excellent results were achieved in 42 cases (70%). The complications included were implant backout, postoperative dislocation, iatrogenic nerve palsy, superficial wound infection, intraoperative bleeding and osteoarthritis. There is a positive relationship between quality of reduction and functional outcome. In our series, radiographic congruity (75%) correlated well with the function (70%). CONCLUSIONS: 1. We conclude that operative treatment is a safe and effective method of managing displaced acetabular fractures even in general orthopedic centres. 2. Time spent on a thorough study of the radiographs/CT scan for a proper preoperative plan is worthwhile and helps to outline an appropriate surgical approach and avoid complications.

External fixation of pediatric femoral shaft fractures: a consecutive study based on 45 fractures.

Forty-five displaced femur fractures in children were treated with unilateral external fixation as a standard treatment from March 2007 to March 2009 and the last follow-up was completed in May 2012. The average age of the children at presentation was 9.93 years. Patients were followed up till union, at 1 year, and at an average of 3.5 years after fixation. The fixator was removed at an average of 12.23 weeks. Twenty-one (47%) patients had a minor complication of pin-site infection. One patient had a major complication of refracture. Treatment of uncomplicated femur fractures using an external fixator in children yields satisfactory results. Our series had a longer duration of follow-up and fewer refractures compared with other series.