Background: The most feared complication of fracture management is non-union. Non-union can be of the following types, hypertrophic, oligotrophic, atrophic, and septic. In view of a non-union, exchange nailing is preferred and so routinely performed for non-unions and fractures of the tibia. Case Presentation: Here, we present a case of an implant failure from an atraumatic event in a case of atrophic non-union of the tibia, which was treated by exchange nailing and bone grafting. A 22-year-old male, with a history of the left closed tibia fibula diaphysis fracture 1 year ago, underwent exchange nailing with bone grating after having an atrophic non-union with implant breakage. Conclusion: Implant failure and non-union are caused due to a wide variety of factors. Appropriate implant selection for fracture type, reaming, fracture site compression, good reduction, and adequate and early mobilization are important factors for a satisfactory union and prevention of secondary surgeries.
The optimal treatment of the calcaneal fracture is a controversial topic. Many patients get a very good result with open reduction and internal fixation using extensile lateral approach. But there are many patients who do not qualify this category. This is the reason why many of them are either denied any surgical intervention or are put at a significant risk of developing major complications because of the open surgical intervention. The height, width, length and shape of the hind foot can be restored using minimally invasive reduction and fixation (MIRF) and also the orientation of the posterior facet of calcaneus (Bohler's angle) can be restored. In this paper we present a series of 23 patients treated with minimally invasive reduction and fixation using Steinmann as a treatment method for the patients not suitable for open reduction and internal fixation. The use of Steinmann pin in the MIRF technique proved out to be very effective. As per our experience the time of the surgery is short and it can be easily performed even in the presence of extensive soft tissue swelling in the period immediate after the injury. The risk of infection is low also the morphology of the calcaneus was improved and properly maintained in the term of Bohler's angle. This technique is very suitable for the patients with medical co-morbidities such as smokers, diabetics and is also very effective for the patients who are not suitable foe extensile approach and internal fixation.
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