BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Ber...BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.展开更多
AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients an...AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.展开更多
AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify ...AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.展开更多
Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mea...Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.展开更多
Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible...Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting;treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26;70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36;69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing word.展开更多
AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The ...AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.展开更多
Quiescent Type of H. Rosen & Stage 2 of C.L. Romano et al. for Infected Non Union of Femur after K-nailing (Küntscher nailing) require no debridement & removal of nail and therefore can be treated by a si...Quiescent Type of H. Rosen & Stage 2 of C.L. Romano et al. for Infected Non Union of Femur after K-nailing (Küntscher nailing) require no debridement & removal of nail and therefore can be treated by a single stage procedure. There are a few reports of treating aseptic non-union of femur by compression alone or compression distraction over nail by Ilizarov Technique. However, no case of Infected Non-Union femur being treated by Accordion Manoeuvre with Ilizarov over nail in situ (i.e. without exchange nailing) has been reported so far. Here, we are reporting a case of Infected Non-Union following K-nailing for a fracture shaft of femur in a 15-year-old female, who was treated by this technique as a single stage procedure. An Ilizarov frame was mounted on the femur with nail in situ followed by Accordion Manoeuvre. The fracture was healed in 5.6 months with two cycles of Accordion Manoeuvre followed by rhythmic compression. There was no recurrence of infection.展开更多
Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid im...Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.展开更多
Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods a...Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods and vascularised bone grafting. These techniques require a high level of expertise and are frequently involved with a variety of side effects or complications. We present a rare case of ulnar fracture complicated by MRSA infection that led to septic non-union. We treated the septic non union with the technique of induced membrane formation （Masquelet technique）. A 33 year old male presented to the outpatient clinic, 2 months after internal fixation of a Gustillo I fracture of the left forearm. There was pus discharge from the operative wound and specimen culture was positive for MRSA. Initially the patient received conservative treatment with antibiotics for a period of one month. However, the patient returned with the same clinical presentation. The patient was then treated with hardware removal of the ulna and debridement of the septic non-union. The formed 5 cm bone defect was filled with cement spacer and the ulnar bone was fixed with external fixation. Eight weeks later, the spacer was removed and the bone gap was filled with autologous cancellous bone graft from iliac crest. Five months after grafting, the patient was reviewed. No clinical or functional problems were noted and osseous consolidation of the ulnar bone was confirmed in plain x-rays. The Masquelet technique is a promising alternative treatment for the management of infected long bone non-unions of the upper extremity.展开更多
This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse ...This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.展开更多
Clavicle fractures are frequent orthopedic injuries,often resulting from direct trauma or a fall.Most clavicle fractures are treated conservatively without any complications or adverse effects.Concomitant injuries of ...Clavicle fractures are frequent orthopedic injuries,often resulting from direct trauma or a fall.Most clavicle fractures are treated conservatively without any complications or adverse effects.Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures.They are potentially life-threatening conditions leading to hemorrhage,hematoma,pseudoaneurysm or upper limb ischemia.However,the clinical presentation might be obscure and easily missed,particularly in closed and minimally displaced clavicular fractures,and timely diagnosis relies on early clinical suspicion.Currently,computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency,as it demonstrates high accuracy and temporal resolution,acute turnaround time,and capability of multiplanar reconstruction.Depending on the hemodynamic stability of the patient and the severity of the injury,subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively.Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia,followed by stabilization of the displaced clavicle fracture.This review aims to provide a comprehensive overview of the incidence,clinical presentation,diagnostic approaches,and current management strategies of clavicle fractures associated with subclavian vessel injuries.展开更多
Mesenchymal stromal cells (MSCs) are a top candidate for new clinical treatments in the repair of bone and cartilage. In several clinical trials, they have shown reliable, effective, and safe management of inflammatio...Mesenchymal stromal cells (MSCs) are a top candidate for new clinical treatments in the repair of bone and cartilage. In several clinical trials, they have shown reliable, effective, and safe management of inflammation, pain, and the regenerative capabilities of resident tissues. MSCs are likely derived from pericytes. They modulate the environment they are placed in by secreting immunomodulatory and signaling molecules to reduce inflammation and direct resident cells to create new tissues. They are easily isolated from several different adult tissues, and inexpensive to grow in a lab. However, a mistake made in the initial classification of MSCs as stem cells has created deeply engrained misconceptions that are still evident today. MSCs are not stem cells, despite a large fraction of research and therapies using the name “mesenchymal stem cells”. This mistake creates false narratives attributing the observed positive outcomes of MSC treatments to stem cell characteristics, which has led to distrust in MSC research. Despite inconsistencies in their classification, MSCs demonstrate consistent positive effects in numerous animal studies and human clinical trials for non-unions and osteoarthritis. With an aging population, regenerative techniques are very promising for novel therapies. To produce trusted and safe new treatments using MSCs, it is essential for the International Society for Cellular Therapies to re-establish common ground in the identity, mechanism of action, and isolation techniques of these cells.展开更多
文摘BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.
文摘AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.
文摘AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.
文摘Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.
文摘Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting;treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26;70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36;69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing word.
文摘AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.
文摘Quiescent Type of H. Rosen & Stage 2 of C.L. Romano et al. for Infected Non Union of Femur after K-nailing (Küntscher nailing) require no debridement & removal of nail and therefore can be treated by a single stage procedure. There are a few reports of treating aseptic non-union of femur by compression alone or compression distraction over nail by Ilizarov Technique. However, no case of Infected Non-Union femur being treated by Accordion Manoeuvre with Ilizarov over nail in situ (i.e. without exchange nailing) has been reported so far. Here, we are reporting a case of Infected Non-Union following K-nailing for a fracture shaft of femur in a 15-year-old female, who was treated by this technique as a single stage procedure. An Ilizarov frame was mounted on the femur with nail in situ followed by Accordion Manoeuvre. The fracture was healed in 5.6 months with two cycles of Accordion Manoeuvre followed by rhythmic compression. There was no recurrence of infection.
文摘Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
文摘Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods and vascularised bone grafting. These techniques require a high level of expertise and are frequently involved with a variety of side effects or complications. We present a rare case of ulnar fracture complicated by MRSA infection that led to septic non-union. We treated the septic non union with the technique of induced membrane formation （Masquelet technique）. A 33 year old male presented to the outpatient clinic, 2 months after internal fixation of a Gustillo I fracture of the left forearm. There was pus discharge from the operative wound and specimen culture was positive for MRSA. Initially the patient received conservative treatment with antibiotics for a period of one month. However, the patient returned with the same clinical presentation. The patient was then treated with hardware removal of the ulna and debridement of the septic non-union. The formed 5 cm bone defect was filled with cement spacer and the ulnar bone was fixed with external fixation. Eight weeks later, the spacer was removed and the bone gap was filled with autologous cancellous bone graft from iliac crest. Five months after grafting, the patient was reviewed. No clinical or functional problems were noted and osseous consolidation of the ulnar bone was confirmed in plain x-rays. The Masquelet technique is a promising alternative treatment for the management of infected long bone non-unions of the upper extremity.
文摘This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.
文摘Clavicle fractures are frequent orthopedic injuries,often resulting from direct trauma or a fall.Most clavicle fractures are treated conservatively without any complications or adverse effects.Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures.They are potentially life-threatening conditions leading to hemorrhage,hematoma,pseudoaneurysm or upper limb ischemia.However,the clinical presentation might be obscure and easily missed,particularly in closed and minimally displaced clavicular fractures,and timely diagnosis relies on early clinical suspicion.Currently,computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency,as it demonstrates high accuracy and temporal resolution,acute turnaround time,and capability of multiplanar reconstruction.Depending on the hemodynamic stability of the patient and the severity of the injury,subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively.Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia,followed by stabilization of the displaced clavicle fracture.This review aims to provide a comprehensive overview of the incidence,clinical presentation,diagnostic approaches,and current management strategies of clavicle fractures associated with subclavian vessel injuries.
文摘Mesenchymal stromal cells (MSCs) are a top candidate for new clinical treatments in the repair of bone and cartilage. In several clinical trials, they have shown reliable, effective, and safe management of inflammation, pain, and the regenerative capabilities of resident tissues. MSCs are likely derived from pericytes. They modulate the environment they are placed in by secreting immunomodulatory and signaling molecules to reduce inflammation and direct resident cells to create new tissues. They are easily isolated from several different adult tissues, and inexpensive to grow in a lab. However, a mistake made in the initial classification of MSCs as stem cells has created deeply engrained misconceptions that are still evident today. MSCs are not stem cells, despite a large fraction of research and therapies using the name “mesenchymal stem cells”. This mistake creates false narratives attributing the observed positive outcomes of MSC treatments to stem cell characteristics, which has led to distrust in MSC research. Despite inconsistencies in their classification, MSCs demonstrate consistent positive effects in numerous animal studies and human clinical trials for non-unions and osteoarthritis. With an aging population, regenerative techniques are very promising for novel therapies. To produce trusted and safe new treatments using MSCs, it is essential for the International Society for Cellular Therapies to re-establish common ground in the identity, mechanism of action, and isolation techniques of these cells.
