Objective: To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. Design: Nonrandomized prospective, case series, single-center study. Setting: Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt. Participants: Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. Intervention: Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique. Outcome Measurements: The external fixation index (EFI); functional and bone results; and complication rates. Results: All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups. Conclusions: Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Purpose. To evaluate the condition of the tendons and neurovascular bundles after percutaneous release for trigger finger of the middle, ring, and little fingers. Methods. 30 women and 13 men aged 20 to 55 (mean, 40) years underwent percutaneous release of the A1 pulley using a 18-gauge needle for 43 trigger fingers of the middle, ring, or little finger unresponsive to conservative treatment. 19 trigger fingers were grade II and 24 were grade III. Open exploration was performed to evaluate the condition of the tendons and neurovascular bundles after percutaneous release. Results. Incomplete release of the A1 pulley was noted in 3 fingers, which occurred during the early study period. Superficial flexor tendon laceration was noted in 6 fingers but this did not interfere with tendon function. No injury to the A2 pulley, nerve, or artery of any finger was noted. Conclusion. Percutaneous release of trigger fingers is quick, safe, and effective.
AIM:To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment transfer. METHODS:Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. RESULTS:The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care (surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc .) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM nail. CONCLUSION:Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities. Core tip: Fifty patients with infected nonunion tibia (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. ORIGINAL ARTICLE Observational StudyEarly removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance and health authorities.Emara KM, Diab RA, Ghafar KAE. Cost of external fixation vs external fixation then nailing in bone infection.
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