Treatment of postoperative tibial chronic osteomyelitis using bone transport techniques; an observational study.

PURPOSE: Postoperative Tibial chronic osteomyelitis is one of the most challenging orthopaedic conditions especially when extensive, the anatomy of subcutaneous anteromedial part of the tibia with less soft tissue coverage complicates the situation. The extent of infected tibial part varies in size and duration from one patient to another. We report our experience using Bifocal and Monofocal bone transport techniques with regard to clinical outcome, recurrence of infection and re-fracture rate. METHODS: This is a retrospective observational review of 49 patients with postoperative Tibial chronic osteomyelitis which were treated using either Bifocal distraction compression BFDCO technique group I (31 patients) or Monofocal compression osteosynthesis MFCO technique Group II (18 patients). The average age of the patients was (41.6 ± 13.1 years), (range: 17-67 years). Leg length discrepancy was measured in 33 (58.9%) patients with an average of (1.4 ± 1.7 cm). Contracture of the ankle joint and equinus deformity were detected in 36 (64.3%) patients. Pre and Post-operative radiography together with Modified Irzhansky A.A et al. leg functional assessment system were used to assess the functional outcome. RESULTS: The time spent in the Ilizarov fixator (External Fixation Index) in the first group was (142 ± 72 days) and in the second group was (75 ± 54 days). The infection recurred in 2 patients (6%) in group I and in 5 patients (28%) in group II. Lack of consolidation or re-fracture within 6 months after the dismantling of the apparatus was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in group II. Lack of consolidation or re-fracture within 6 months after dismantling of the apparatus in group I was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in Group II. The average functional state score (AFSS) in the first group was (12.45 ± 2.41) on admission and increased to (16.16 ± 2.99) on the final follow-up which corresponded to a "good" result. In the second group II the AFSS was (12.11 ± 2.22) on admission and increased to (15.06 ± 2.88) at the final follow-up which corresponded to a "satisfactory" result. CONCLUSION: Treatment of Tibial chronic osteomyelitis using either Bifocal or Monofocal bone transport is an effective method. However our results have demonstrated better functional outcome and less infection recurrence and re-fracture rates when using the Bifocal distraction compression technique (BFDCO).

Less Invasive Anterior Iliac Approach and Compression Osteosynthesis for the Treatment of High Anterior Column Fractures of the Acetabulum.

BACKGROUND: Displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum. METHODS: In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up. RESULTS: This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis. CONCLUSIONS: Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.

Compression Osteosynthesis - An Effective Solution for Hypertrophic Nonunion of Tibia in Children.

INTRODUCTION: Hypertrophic non-union of the tibia is rare in children. Gradual deformity correction by distraction osteogenesis is the conventional management strategy for this problem. In cases with significant multiplanar deformities, this needs careful pre-operative planning and execution that involves long periods of "dynamic" phase of Ilizarov method. CASE REPORT: We devised a simpler strategy of complete intraoperative deformity correction in one or two stages followed by compression osteosynthesis. We report the good outcome in four patients (3 males, and 1 female, age 4--years) with regard to union, alignment, limb length, and function, with significantly short duration of the "dynamic" phase of Ilizarov osteosynthesis. CONCLUSION: Acute deformity correction and compression osteosynthesis is are an effective strategy in hypertrophic non-union of tibia in children. This is applicable for cases with significant deformity without shortening. This considerably shortens the "dynamic" phase of Ilizaov osteosynthesis, facilitating early return to home of patients who need to travel long distances for treatment.

Less Invasive Anterior Iliac Approach and Compression Osteosynthesis for the Treatment of High Anterior Column Fractures of the Acetabulum

BACKGROUND: Displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum. METHODS: In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up. RESULTS: This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis. CONCLUSIONS: Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.

A Comparative Evaluation of Fixation Techniques in Anterior Mandibular Fractures Using 2.0 mm Monocortical Titanium Miniplates Versus 2.4 mm Cortical Titanium Lag Screws.

OBJECTIVE: To compare the efficacy and surgical outcome of treatment of anterior mandibular fracture using either 2.0 mm titanium miniplate or 2.4 mm titanium lag screw technique. MATERIALS AND METHODS: A total of 30 patients were managed by open reduction and internal fixation utilizing the miniplate and lag screw technique for fractures of anterior mandible. The patients were randomly divided into two groups. Group I: (15 patients) were treated with Leibinger, 2.0 mm titanium mini plates system with self-tapping screws and Group II: (15 patients) were treated with 2.4 mm cortical lag screw (Synthes). Intraoperatively duration of surgery was measured from the time incision was placed till the closure of wound. Subsequent follow up was done at 3, 6, 12, 24 weeks, postoperatively. During every follow up, patients were assessed clinically for malocclusion, neurosensory deficit, biting efficiency, implant failure, mal-union/non-union. Pre and postoperative radiographs were taken to assess the gap between fracture segments. Results were evaluated using Chi square and the unpaired t test. RESULTS: In our study, the mean duration of surgery (hours) was 1.97 ± 0.52 for group I and 1.26 ± 0.55 for group II. The difference was found to be statistically significant (p value 0.001). i.e. more time was taken in case of surgery with mini-plates when compared to the lag screw. Short surgical procedure reduces the incidence of infectious complications, which significantly lowers the financial burden. The mean post-operative radiographic distance between all measuring points were considerably more in case of mini-plate group as compared to lag screw group. Lag screw group showed faster improvement in terms of biting efficiency as compared to mini-plate group which showed a tendency to masticate only medium hard food items by 24 weeks. In both groups, no postoperative malocclusion was noted. In initial weeks, neurosensory deficit was seen more in mini-plate group as compared to lag screw group but after six weeks all patients showed improvement in neurosensory function without any permanent nerve damage. CONCLUSION: According to this prospective study, rigid internal fixation provided by lag screw technique for anterior mandibular fracture offers several advantages over conventional bone plating. It is an excellent means of achieving rapid and safe fixation which is followed by primary bone healing in anterior mandibular fractures, without any major complications.

Evaluation of compression and non-compression internal fixation for mandibular fractures / 实用口腔医学杂志

Objective: To observe effects of treatment of mandibular fractures with compression or non compression internal fixation. Methods: In the in vivo study mandibular fractures were fixed by compression internal fixation on one side and non compression on other side in 15 dogs and observed radiologically and histologically. In clinical practice 42 patients with 58 mandibular fractures were treated with compression internal fixation, and 56 patients with 78 madibular fractures were treated with non compression internal fixation. Their clinical effects were evaluated by masticatory efficiency test, radiological and clinical observation after operation. Results: Primary bone healing was found histologically in group of compression fixation and bone healing through callus in group of non compression in the dogs. In the patients treated with compression internal fixation bone fracture line disappeared 1 week earlier and masticatory efficiency was heigher than in those with non comprission fixation. Conclusion: Both methods are all effective in the treatment of mandibular fractures. The miniplate is convenient in use and the indication is wide ranging. The compression plate can speed healing of mandibular fractures, but the operation is more strict technically.

The Methods of Treatment in Estabilished Non-union of Femur Shaft / 대한정형외과학회잡지

The incidence of non-union in the shaft of femur is increasing gradually in spite of considerably improved methods of femoral fracture care. It is necessary that orthopaedic surgeon must draw attention to improve the method of treatment and to prevent the occurance of non-union. This paper presents the follow-up result of 27 cases among 30 established femoral shaft non-union cases, that were treated at the orthopaedic dept. of the National Medical Center from March 1971 to March 1980 by various methods. The study of this series shows the following. l. Amount 27 cases, male was predominant (82%), peak age group was 3rd & 4th decades (52%). 2. The causes of injury were auto-accident (56%), falling down accident (22%), direct blow (11%) & slipping down accident (11%). 3. The most common location was around the mid-shaft of femur (44.4%). 4. The probable causes of non-union were loosening of the implants & metal failure due to improper internal fixation (10 cases), incomplete reduction (7 cases), infection (5 cases) & inadenaute external immobilization (5 cases). 5. Excellent results were obtained by combined method of compression plate, screws & intramedullary nailing with additional autogenous bone graft.

The Result of Compression-Plate Fixation in Forearm Fractures / 대한정형외과학회잡지

We meet much difficult problem to solve in the treatment of the forearm fractures which are not encountered in the treatment of fractures of the other long bone and there are many reports on the results of treatment of forearm fractures and many methods have been introduced. In the late 1950's ASIF compression plate was invented and developed by Muller, Allgower, and Willenegger and it has shown excellent union rate and functional results in the treatment of forearm fractures. From Jan. 1971 to Dec. 1979, we have experienced 71 cases of fresh or old forearm fractures treated by different methods and devices and among them, 53 patients, those were treated with compression plate and other various internal fixation devices, were possible to trace for more than 3 months. The Author divided the traceable patients into two groups, the one was the group treated with compression plate and the othtr one was the group treated with other various internal fixations, and compared the results in the aspect of healing time and functional results. The results were as follows; 1. Among 71 patients, 45 patients (36.6%) were fresh and 26 were old cases. Of 61 adult patients 21 cases (34.4%) exhibited severe soft tissue injury due to crushing machinary injury. 2. There was 24 (33.8%) cases of open fractures and the most common fracture site was middle one-third of both radius and ulna. 3. The period between operation and exercise was 7.3 weeks in fresh cases which were treated with compression-plate fixation and 10.3 weeks in old cases with other fixation devices. 4. The time of radlological union was comparatively rapid in compression-plate fixation group, acute cases and radial fractures when compared it with those treated with other fixation devices, old cases and ulnar fractures, respectively. Radiological union time in average was as follows; Radius, compression-plate fixation: 12.1 weeks ulna, compression-plate fixation: 12.4 weeks redius, other fixation devices 14.9 weeks ulna, other fixation devices 15.5 weeks 5. By Anderson's functional criteria, the ratio of excellent or good results was as follows, Acute compression-plate fixation: 87% Acute, other fixation devices 67% Old, Compression-plate flxation: 67% Old, Other fixation devices 23% 6. Achieved bony union in all cases in compression-plate fixation group and experienced 3 cases of non-union in the group treated with other fixation devices. Among 3, two cases of non-union were due to post-operative infection and technical failure and the other one was a solitary ulnar fracture which was treated with rush pin.