RESUMO
INTRODUCTION: Infected nonunion of long bones is a chronic and debilitating disorder. It is more difficult to deal with when the implant used for internal fixation itself becomes a potential media for infection because of bacterial adhesion and biofilm formation. Traditionally, it is managed by two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement coated nailing as single stage treatment modality for treating infection and achieving stability at the same time. MATERIALS AND METHODS: Twenty patients (above 18 years of age) with infected nonunion of tibia with bone gap less than 2 cm were managed using antibiotic cement coated K-nail. Antibiotic cement nail was prepared using endotracheal tube method. Antibiotics used were a combination of vancomycin and teicoplanin. RESULTS: Infection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Remaining 8 patients required additional procedures like bone grafting or exchange nailing and these were done in six patients, with union of fracture. Two patients refused to undergo further procedures. Complications encountered were difficult nail removal in three cases, broken nail in two cases, and bent nail in one case. Recurrence of infection was observed in two patients. Average period of follow-up was 13 months. CONCLUSION: Antibiotic cement impregnated nailing is a simple, economical and effective single stage procedure for the management of infected nonunion of tibia. It is advantageous over external fixators, as it eliminates the complications of external fixators and has good patient compliance. The method utilizes existing easily available instrumentation and materials and is technically less demanding, and therefore can be performed at any general orthopaedic center.
RESUMO
PURPOSE: To review the outcome of wide resection and wrist fusion through centralisation of the ulna for recurrent giant cell tumour (GCT) of the distal radius in 10 patients. METHODS: Records of 7 women and 3 men aged 25 to 40 years who underwent wide resection and wrist fusion through centralisation of the ulna for grade I (n=6) and grade II (n=4) recurrent GCT of the distal radius were reviewed. Functional outcome was evaluated using the modified Musculoskeletal Tumor Society scoring system. Grip strength and range of motion of the metacarpophalangeal joint were also assessed. RESULTS: The mean follow-up period was 45 (range, 30-60) months. All tumours were benign and there was no evidence of metastasis. The mean grip strength was 45% (range, 30-70%) of the contralateral side. All patients achieved normal range of motion of the metacarpophalangeal and interphalangeal joints, but 4 patients had an extensor lag of the thumb. The mean time to wrist fusion was 6 (range, 4-8) months: 3 to 4 months for the 6 patients with bone grafting and 5 to 6 months for the 4 patients without bone grafting who developed painful subluxation necessitating total wrist arthrodesis using a plate and morcellised bone grafts. CONCLUSION: Wrist fusion through centralisation of the ulna for recurrent GCT of the distal radius is a viable option, despite a loss of wrist motion.
