Surgical management of infected non-unions: An update

Kanakaris, Nikolaos K.; Tosounidis, Theodoros H.; Giannoudis, Peter V.

doi:10.1016/j.injury.2015.08.009

Cited by 44 publications

(31 citation statements)

References 68 publications

(84 reference statements)

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“…The Ilizarov fixator has revolutionized the treatment of infected tibial nonunions 3435. It is minimally invasive and is able to reliably achieve union, lengthen and correct complex deformities, and allow the patient to walk.…”

Section: Introductionmentioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.

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Section: Introductionmentioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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“…einer Infektpseudarthrose. Dies kann dazu führen, dass LowGrade-Infekte nicht als solche diagnostiziert werden oder die Diagnosestellung deutlich verspätet erfolgt [7,9].…”

Section: Low-grade-infekte/ Infektpseudarthrosenunclassified

“…Eine zuverlässige Diagnose von LowGrade-Infekten ist zum gegenwärtigen Zeitpunkt jedoch nicht möglich [7,9]. Die zur Verfügung stehenden diagnostischen Verfahren bzw.…”

Section: Diagnostik Von Infektpseudarthrosenunclassified

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Low-Grade-Infekt

Steinhausen

2017

Trauma Berufskrankh

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“…Screw selfloosening will lead to fixation failure that could pose a hazard to the fixation stability and cause severe complication [13]. The failure of fixation create a great risk for non-union, malunion and reduction loss [16].There are various causes for non-union to occur at the fractured bone [3], [6], [17], [18] and one of the reasons is the biomechanical instability [7], [12], [17]. Harwood et al [3] described non-union as when the fracture have passed a certain time frame but there are no sign of union at the fractured bone and the progress of the fracture remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Screw-Bone Implant Loosening: Complication, Cause and Assessment

Ghani¹,

Hassan²,

Daud³

2018

IJET

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Bone fracture has become more common in this era of vehicular modernization. Internal fixation has been used in the treatment of such cases. The use of screw and plate in internal fixation has been proven to provide more stability to fracture to promote better healing. The use of screw also carries certain risk such as self-loosening that can cause non-union and prolong healing. The complication of selfloosening is studied to comprehend the danger of self-loosening in screw-bone implant. The review on self-loosening in bolted joint is done in this paper to gain better understanding on the nature of self-loosening phenomena. The factor that affects the screw selfloosening in bone is further studied in the screw-bone implant environment. The identification of the screw loosening can be done with radiography, CT scan, MRI and ultrasound. This article have done a brief review on the complication of screw self-loosening, the cause of screw loosening in bolted joint and screw-bone implant and the assessment of screw loosening done by ultrasound and radiography.

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Surgical management of infected non-unions: An update

Cited by 44 publications

References 68 publications

Infected nonunion of tibia

Infected nonunion of tibia

Low-Grade-Infekt

Screw-Bone Implant Loosening: Complication, Cause and Assessment

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