[Treatment of distal femur nonunion with bone defect by less invasive stabilization system and fibular strut graft].

OBJECTIVE: To evaluate the therapeutic effects of less invasive stabilization system distal femur (LISS-DF) combined with fibular struts graft for distal femur nonunions and bone defects. METHODS: A total of 12 patients with distal femur nonunion and bone defect were underwent revision operation with locked plating, plus a nonvascularized autologous fibular strut bone graft from June 2007 to September 2014, including 10 males and 2 females with an average age of (56.2±14.1) years old ranging from 30 to 77 years old. The mean time from the initial trauma to the last revision operation was (16.4±5.5) months (ranged from 9 to 26 months). All cases were atrophic nonunions according to Weber-Cech classification and type B1 (bone loss) according to Paley classification. All patients were followed up and evaluated with clinical and imaging results. The KSS (American Knee Society Score) scores including knee clinical score and knee functional score were compared before and after the treatment. RESULTS: All patients were followed up from 12 to 17 months with an average of (13.7±1.9) months. All nonunions healed with an average time of (6.2±1.3) months (ranged from 4 to 8 months). The average range of movement (ROM) of the knee was improved from (67.1±29.6)° preoperatively to (102.5±13.6)° at the last follow up. KSS scores including knee pain, range of motion, clinical and functional score were significantly different before and after operation. No such complications as infection, hardware loosening or breakage occurred postoperatively. CONCLUSIONS: LIFF-DF fixation and autologous fibular strut bone graft facilitated the successful treatment of distal femur nonunions with bone defects.

Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft.

OBJECTIVES: Exchange nailing (EN) for aseptic femoral shaft nonunion is currently a standard orthopaedic treatment modality. However, according to recent studies there is occasionally a high failure rate when EN is used. In the present study, augmentative locked plating and bone graft was used as an alternative method for treating such cases. The purpose of this study was to report the treatment outcomes of selected femoral diaphyseal nonunions that had initially been treated by nailing. METHODS: Thirteen patients with femoral diaphyseal nonunions underwent revision surgery with locked plate and bone graft. The inclusion criteria were: (a) nonisthmic nonunion; (b) atrophic/oligotrophic nonunion. All patients were managed by augmentative locked plating and bone graft. RESULTS: All patients were followed up for a mean of 1.2 years (range, 1-2 years). After revision surgery all nonunions achieved bony union, the average union time being 7.5 months (range, 6-12 months). No major complications were observed in this case series. CONCLUSION: Augmentative locked plating is an effective and simple technique for treatment of femoral diaphyseal nonunion after nailing in selected cases.

Treatment of aseptic diaphyseal nonunion of the lower extremities with exchange intramedullary nailing and blocking screws without open bone graft.

OBJECTIVE: To report the preliminary results of the treatment of aseptic diaphyseal nonunion of the lower extremities with exchange nailing plus blocking screws. METHODS: Between June 2005 and September 2008, twelve patients with diaphyseal nonunion in the lower extremities (femur in five patients and tibia in seven; hypertrophic nonunion in eight patients and atrophic nonunion in four) were treated by reaming, exchanging the original intramedullary nail with a larger one, and using blocking screws, and the therapeutic effect assessed. RESULTS: All patients were followed up for 1-2 years (average, 1.5 years) to assess union. Bony union was achieved in all patients within 4.7-13.5 months (average, 7.8 months). All patients were pain free without any complications by the last follow-up. CONCLUSION: The therapeutic method of exchanging the nail combined with blocking screws is effective for aseptic nonunion of the lower extremity after intramedullary nailing.

The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach.

The posterolateral shearing tibial plateau fracture is relatively uncommon and few studies have concentrated on it so far. The purpose of this study was to review the results of surgical treatment of this kind of fracture using a modified posterolateral approach. The clinical results of a case series of 11 patients, collected prospectively, were presented here. At final follow-up 10 out of 11 (91%) patients had satisfactory reduction of the articular surface and all had acceptable alignment. There was neither any loss in reduction or alignment at one year postoperation, with a mean HSS score of 93 (s.d. 3.67, range 84 to 97), nor superficial or deep infections, except that one case had a sanguinous effusion for more than one week postoperatively. It was concluded that the modified posterolateral approach could help to expand the surgical options for an optimal treatment of this kind of fracture, and plating of posterolateral shearing fractures would result in restoration and maintenance of alignment.