Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients

Kanakeshwar, Raja Bhaskara; Jayaramaraju, Dheenadhayalan; Devendra, Agraharam; Rajasekaran, Raja Bhaskara

doi:10.1016/s0020-1383(17)30488-6

Cited by 23 publications

(27 citation statements)

References 24 publications

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“…A technological consideration that can reduce the probability of fixation failure is the use of relatively long plates [ 6 ]. Combining a locking plate fixation with the bone grafting technique by using an allograft strut to sustain the defect of the metaphyseal medial bone and auto-grafts provides a strong union and a good functional results by improving biology and providing good structural support to distal femur in the management of resistant non-union of the distal femur [ 9 ]. Further enhanced reduction, correction of the medial bone defect and biological help with bone grafting are the key principles for resolving a distal femoral non-union.…”

Section: Discussionmentioning

confidence: 99%

Infected Non-Union of the Distal Femur

Vellingiri¹,

Nagakumar²

2021

Cureus

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Section: Discussionmentioning

confidence: 99%

Infected Non-Union of the Distal Femur

Vellingiri¹,

Nagakumar²

2021

Cureus

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“…28,29,32 Antibiotic powder mixed with supplemental bone grafts may be an alternative to control bacterial growth during bone healing. [37][38][39] However, early depletion of water-soluble antibiotics in an uncontained space limits its bactericidal capacity. Other studies have focused on the implantation of antibiotic-loaded PMMA spacers during the stage one induced membrane technique.…”

Section: Discussionmentioning

confidence: 99%

<p>A Three-Dimensional Printed Polycaprolactone Scaffold Combined with Co-Axially Electrospun Vancomycin/Ceftazidime/Bone Morphological Protein-2 Sheath-Core Nanofibers for the Repair of Segmental Bone Defects During the Masquelet Procedure</p>

Lee

Hsu

et al. 2020

IJN

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Introduction: Masquelet proposed a new solution for the healing of segmental bone defects, thus minimizing the disadvantages associated with traditional bone grafting. However, a major factor leading to the failure of this technique pertains to be the residual infection. Accordingly, we developed an antibiotic-and osteo-inductive agent-loaded composite scaffold to solve this problem. Methods: A mesh-like polycaprolactone scaffold was prepared using a lab-exploited solutiontype three-dimensional printer, and hybrid sheath-core structured poly(lactic-co-glycolic-acid) nanofibers were fabricated using co-axial electrospinning technology. Vancomycin, ceftazidime, and bone morphological protein (BMP)-2 were employed. The in vitro and in vivo (rabbit fracture model) release patterns of applied agents from the composite scaffold were investigated. Results: The results revealed that the drug-eluting composite scaffold enabled the sustainable release of the medications for at least 30 days in vitro. Animal tests demonstrated that a high concentration of medications was maintained. Abundant growth factors were induced within the bioactive membrane stimulated by the applied scaffold. Finally, satisfactory bone healing potential was observed on radiological examination and biomechanical evaluation. Discussion: The developed composite scaffold may facilitate bone healing by inducing bioactive membrane formation and yielding high concentrations of antibiotics and BMP-2 during the Masquelet procedure.

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“…The application of a contralateral strut graft provides both biomechanical and biological advantages in long bones fractures and non-unions. 19,49,50 A series of 40 patients with PFF treated using a cortical strut graft (alone or associated with a plate) reported a union rate of 98% with satisfactory femoral alignment and bone stock. 51 Moreover, Robison et al 19 also support this type of surgery for the treatment of APFF considering that the transverse/short oblique fracture has a low rotational stability that is poorly controlled by the use of a single lateral plate, as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

et al. 2020

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Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. Methods: Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. Results: 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. Conclusions: Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

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Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients

Cited by 23 publications

References 24 publications

Infected Non-Union of the Distal Femur

Infected Non-Union of the Distal Femur

<p>A Three-Dimensional Printed Polycaprolactone Scaffold Combined with Co-Axially Electrospun Vancomycin/Ceftazidime/Bone Morphological Protein-2 Sheath-Core Nanofibers for the Repair of Segmental Bone Defects During the Masquelet Procedure</p>

Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

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