Complex Nonunion Of Fractures Of The Femoral Shaft Treated By Wave-plate Osteosynthesis

Abstract

We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation. Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.

Interlocking Contoured Intramedullary Nail Fixation for Selected Diaphyseal Fractures of the Forearm in Adults

“…The one ulnar nonunion was treated with plate osteosynthesis and an autologous bone graft. Standard surgical treatment of diaphyseal fractures with plate osteosynthesis requires an extensive softtissue dissection, which can compromise the blood supply of the healing fracture 2 . Moreover, atrophy of cortical bone underlying the plate and placement of drill-holes for screws can weaken the forearm bones.…”

“…However, although this technique usually results in adequate reduction and satisfactory healing, it has been criticized because periosteal stripping may increase the probability of delayed fracture union 2,3 . A 2.3% to 4% rate of nonunion 4,5 , a 1.9% to 30.4% rate of refracture [6][7][8][9][10] , and a 0.8% to 2.3% rate of infection 11,12 have been reported as complications of plate fixation of forearm fractures.…”

Bone Grafting in Malunited Fractures

“…Where necessary, this may be associated with a synthesis material review ( Figure 5) (Ring et al 1997;Schemitsch & Richards, 1992;Segmüller et al 1969;Tydings et al 1986). b1) Using the abovementioned technique, with the bone graft filling the gap.…”

“…The process of evolution of the bone healing can be clinically and radiographically evidenced and followed up (Boyd, 1943;Ring et al 1997). …”

Uso de plasma rico en plaquetas autólogo en el tratamiento quirúrgico de pseudoartrosis atrófica de fémur y tibia

“…El tratamiento clásico incluía la estabilización de los fragmentos y el aporte de injerto óseo autólogo. Se ha descrito que en pacientes con no unión atrófica de fémur la tasa de consolidación no supera el 60%, siendo necesario el uso de métodos de estabilización adicional o aporte de injerto en más de una ocasión (2,6,7). En la tibia, por su configuración anatómica, las tasas de consolidación pueden ser mucho menores.…”