Classification of non-union: Need for a new scoring system?

Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of nonunions according to the principles of 'diamond concept' and aspects that have to be attended. Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept. Results: If an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required. Conclusions: By using the 'diamond concept' as a complex concept, non-unions can be treated in different stages in a targeted manner.

show abstract

“…smoking) into a score (27). From this NUSS-score, there are therapy considerations that can be adapted to the patient (28)(29)(30).…”

Section: Classificationmentioning

confidence: 99%

Non-Union Current Treatment Concept

2016

View full text Add to dashboard Cite

show abstract

“…Lately, a classification system NUSS (Non Union Scoring System) was introduced allowing the evaluation of the risk factors and comorbidities of the patient, bone and other tissues, which can be used to obtain a prognosis and to provide guidance on surgical treatment [4,5]. Patients with a score higher than 75 points present very compromised general and local conditions and further reconstructive treatment is not recommended.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

View full text Add to dashboard Cite

Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

show abstract

“…[2][3][4][5] As such, treatment failure rates of up to 20% have been reported in the literature. 6 Non-unions can be classified as atrophic or hypertrophic, mobile or stiff, with or without deformity, with or without bone defects and as infected or not. [6][7][8][9][10][11] This diversity in non-union pathophysiology and presentation complicates their management, as each subgroup often requires radically different treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

“…6 Non-unions can be classified as atrophic or hypertrophic, mobile or stiff, with or without deformity, with or without bone defects and as infected or not. [6][7][8][9][10][11] This diversity in non-union pathophysiology and presentation complicates their management, as each subgroup often requires radically different treatment strategies. 6,[11][12][13] The management is further complicated by delays in referral that contribute to loss of limb function secondary to muscle atrophy, joint contractures and disuse osteopaenia.…”

Section: Introductionmentioning

confidence: 99%