Locked intramedullary nailing using the sign nailing device.

OBJECTIVE: Locked intramedullary nailing is the treatment of choice not only in diaphyseal fractures of long bone but also in most metaphyseal and periarticular fractures. In this study, we set out to present our experience with the Surgical Implant Generation Network (SIGN)] technique of locked intramedullary nailing in long bones that do not require the use of image intensifier, fracture table, and power reamers. PATIENTS AND METHODS: This was a hospital-based prospective descriptive study involving 54 consecutive patients seen over a 2-year period. All closed fractures of the femur and tibia/fibula seen within the period under review were included in the study. The patients were followed up for a minimum of 12 months. Fracture union was recorded when there was absence of pain at fracture site and X-ray shows presence of bridging callus in two orthogonal views. RESULTS: Fifty seven fractures in 54 patients were managed in the period of the study. There were 46 [81%] femoral and 11 [19%] tibia/fibula fractures recorded in 47 [87%] males and 7 [13%] females with a male to female ratio of 6.7:1. Majority of the patients were within the 31--40 years age bracket (n = 25, 46%). All the fractures were as a result of motor vehicle accident. Thirty six (78%) of the femoral fractures were operated through the antegrade approach, whereas the rest (22%) were through the retrograde approach. Both proximal and distal locking were achieved in all cases. Fracture union was recorded in all but one case [98%]. Complications were observed in 8 cases, which included 5 cases of superficial infection, one case each of osteomyelitis, delayed union and nonunion. CONCLUSION: Locked intramedullary nailing using external jigs for screw placement as in the SIGN technique gives a good result and is recommended for use in the developing countries where image intensifiers are not readily available.

The use of sural island musculo fasciocutaneous flap, in the management of chronic osteomyelitis of the tibia.

BACKGROUND: : The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. AIM: : This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. MATERIALS AND METHODS: : Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed. The study was prospective in nature. RESULTS: : There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3rd and 4th decades of life. Twelve patients had involvement of the distal third of the tibia, eight involved the middle third, while five patients had involvement of the proximal third. Most of the patients (17) developed osteomyelitis following open fractures of the tibia; thirteen of these were from road crashes and four from gunshot injuries. Four patients developed osteomyelitis through the hematogenous route. Flap sizes ranged from 8 × 7 cm to 16 × 11 cm. There was tip necrosis in 2 flaps and full survival in 19 flaps. The flaps with partial necrosis were managed by simple dressing. Fifteen patients (71%) had cessation of drainage within 4 weeks of surgery. Two patients presented with recurrence of infection within the period of follow-up. Mean follow-up period was 23 months. All donor sites were skin grafted primarily, with 95%-100% graft take. CONCLUSION: The sural Island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and soft-tissue defects in chronic osteomyelitis of the tibia. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia.

Reconstruction of complex soft-tissue defects around the knee using the proximally based sural Island fasciocutaneous flap.

BACKGROUND: : Complex soft tissue defects around the knee are not common. They pose significant reconstructive challenges; hence, several methods have been tried. In this study, the use of proximally based sural island fasciocutaneous flap is evaluated. AIM: : The aim of this study is to report our experience with the use of proximally based sural island fasciocutaneous flap in the reconstruction of complex soft tissue defects around the knee. PATIENTS AND METHODS: This was a prospective study. All patients that presented to the unit with complex soft tissue defects around the knee between December 2012 and November 2014 were included in this study. Data on age, sex, etiology, anatomical location of the defect, and flap size were noted and analyzed using descriptive statistics. Follow-up was for a minimum of 6 months. RESULTS: : There were 15 cases: 11 males and 4 females. Their ages ranged from 6 years to 47 years with an average age of 29 years. Ten of the defects resulted from road traffic accidents, while five were missile injuries. The anterior and lateral surfaces of the knee were more often involved, while the posterior surface was least involved. The flap sizes ranged from 8 cm × 6 cm to 16 cm × 12 cm, and the pedicle length ranged from 6 cm to 12 cm. All 15 flaps had full survival. A total of 13 patients had their donor sites skin grafted primarily with 96%-100% graft take. The other two patients had their donor sites closed directly. CONCLUSION: The proximally based sural island fasciocutaneous flap is a simple and reliable method of reconstruction for soft tissue defects around the knee.

Osseous union in cases of non-union in long bones treated by osteosynthesis.

OBJECTIVE: To determine the incidence of osseous union in cases of nonunion of long bones managed by open reduction and compression plating. PATIENTS AND METHODS: Between November, 2003 and June, 2005, 53 patients with nonunion of long bones were treated by open reduction and internal fixation and followed up. The follow up period for each case was 6 months. Immediate post- operative x-ray was done in each case. Patients were seen in the post- operative period at 4 weeks, 6 weeks, 12 weeks, and 6 months. At each visit, clinical and radiological assessments were done. RESULT: The male to female ratio was 3:2, and the average age at presentation was 39.7 years (range: 19-64years). The average time from injury to presentation was 19.98 months (range: 6-132months). The commonest bone involved was the humerus (18), followed by the femur (17), the Tibia (11), the ulna (5), and the radius (2). Osseous union was achieved in 44 patients (83%). There was no significant difference in incidence of osseous union among the various bones. It was observed that previous infection at the fracture site adversely affected osseous union. CONCLUSION: The management of nonunion in long bones by compression plating was found to be satisfactory.

Osseous Union in Cases of Non-Union in Long Bones Treated by Osteosynthesis

Objective: To determine the incidence of osseous union in cases of nonunion of long bones managed by open reduction and compression plating. Patients and methods: Between November; 2003 and June; 2005; 53 patients with nonunion of long bones were treated by open reduction and internal fixation and followed up. The follow up period for each case was 6 months. Immediate post- operative x-ray was done in each case. Patients were seen in the post- operative period at 4 weeks; 6 weeks; 12 weeks; and 6 months. At each visit; clinical and radiological assessments were done. Result: The male to female ratio was 3:2; and the average age at presentation was 39.7 years (range: 19-64years). The average time from injury to presentation was 19.98 months (range: 6-132months). The commonest bone involved was the humerus (18); followed by the femur (17); the Tibia (11); the ulna (5); and the radius (2). Osseous union was achieved in 44 patients (83). There was no significant difference in incidence of osseous union among the various bones. It was observed that previous infection at the fracture site adversely affected osseous union. Conclusion : The management of nonunion in long bones by compression plating was found to be satisfactory