Case:
We present 2 case reports: the first, a diaphyseal fracture of the humerus treated with a Marchetti nail resulting in a nonunion in 2017. The second, a fracture of the femur treated with a Kuntscher nail in 1989. A gunshot injury to that femur in 2014 evolved in nonunion and displacement. In both cases, the old nails were removed by using pieces of the Ilizarov apparatus.
Conclusions:
In case of complications, the versatility of the Ilizarov apparatus allows us to connect the intramedullary element to the universal extraction system; it proves itself to be an excellent cost-effective extraction system.
It is estimated that approximately 5% to 10% of fractures will evolve into nonunions. Nonunions have a significant impact on patient quality of life and on socioeconomic costs. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive therapy widely used within the orthopedic community to accelerate the healing of fresh fractures, to minimize delayed healing, and to promote healing of nonunions. In this case series, 46 nonunions and 19 fresh fractures were treated with LIPUS for at least three months or until fracture healing. Bone healing was assessed both at a radiological and a functional level. Of the nonunions healed, 89% had a mean healing time of 89 ± 53 days. In the group of fresh fractures, the healing percentage was 95% with a mean healing time of 46 ± 28 days. LIPUS treatment is proven to be safe and well tolerated; there were no adverse events related to the use of the device, even in the presence of internal fixations and infections. LIPUS therapy should be considered a low-risk option both as an adjunct to surgery or as a standalone therapy in the management of nonunion and fresh fractures.
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