The pathogenesis of tibial non-union

Ferreira, Nando; Marais, LC; Aldous, Colleen

doi:10.17159/2309-8309/2016/v15n1a5

Cited by 13 publications

(11 citation statements)

References 95 publications

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“…The case series comprised an inhomogeneous group of patients which makes the results difficult to interpret. The sample size of 12 cases would appear to fall short when compared to studies of a similar nature conducted on tibias; 14 however, it must be remembered that the underlying event rate of complex humeral fractures and non-unions is significantly lower than for the same pathology seen in tibias. 14 Witness to this fact is the sum total of 12 cases collected in a time span of six years.…”

Section: Discussionmentioning

confidence: 92%

Circular frames of the humerus: salvage surgery case series

et al. 2019

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Introduction: High energy fractures like gunshot-related injuries or high velocity road traffic accidents are often complex to treat and have been associated with a higher non-union rate, especially when there is extensive bone loss. Fractures with severe comminution may not heal due to bone loss and an inability to achieve adequate fracture stability. Treatment of fractures that are not amenable to plating or nailing may lead to non-unions, septic or aseptic, that need repeat surgeries. Stabilisation with external fixation is a reliable option to maintain stability and provide a suitable environment for union. Materials and methods: This retrospective study used medical records of all patients with complex mid-shaft humerus fractures, as well as their complications, that were treated with hexapod circular external fixation between January 2009 and September 2015. All the patients in this case series presented with severe humerus fractures or complications thereof which were not amenable to conventional therapy. Results: Union was achieved in ten out of the 12 cases (83.3%). Union was achieved without bone graft or any other interventions at the fracture site except implant removal where indicated. The median time in external fixation was 196 days (interquartile range: 112-228). The most common complication encountered in this series was pin-site infection. Fixation points were noted to be infected in 33% of cases at some time during the treatment period. Conclusion: This study suggests that humeral non-unions and complex humerus fractures that are not amenable to conventional fixation methods, such as intramedullary nails and plates, can successfully achieve union when treated with a hexapod circular external fixator.

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Section: Discussionmentioning

confidence: 92%

Circular frames of the humerus: salvage surgery case series

et al. 2019

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“…Those are systemic compromise of the host, local condition of the affected area, specific injury characteristics and iatrogenic factors relating to the treatment of the initial injury. 22 Most commonly, inadequate stability, poor blood supply and deep seated hidden infection lead to develop non-union.…”

Section: Discussionmentioning

confidence: 99%

Accordion maneuver with Ilizarov placed plate in situ, in a case of femoral shaft non-union and refracture with quiescent infection, discussion on treatment strategies: a case report

Rob¹,

Hossain²,

Mustof³

2022

MOJOR

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Introduction: Aim of this study to evaluate the clinical efficacy and highlight their relevance in present orthopedics practice where multiple newer choices have been become famous. Accordion maneuver design with modified Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection place dynamic compression plate (DCP) in situ. Femoral shaft fractures (FSFs) are frequently occurring injury due to RTA. Infection (0.4%) and non-union (1.1 - 14%) are the morbid complications of femur fractures. The healing rate for femora shaft non-unions is too high (90%).1 Accordion Maneuver (AM) is the “Bloodless Stimulation” of bone healing described by Professor G. A. Ilizarov. It comprises of alternate compression and distraction which produce stress in living tissue and also convert biologically inactive scar tissue at non-union site into tissue capable of neo-osteogenesis.2 The suggested treatment for quiescent type of infected non-union is a single stage procedure with minimal or no debridement and if implant is provide sufficient stability it placed in situ.3 Case Report: In the case, a 26 years man treated by DCP with MIPO for his Gustilo type – Ⅰ open, comminuted fracture of mid femoral shaft (Left) following RTA. Post-operative infection occurred within 2 weeks of operation. Infection controlled by exploration and surgical toileting with antibiotic. After four (4) months later he was sustained re-fractured with bending plate due to fall again. Finally he was diagnosed as H. Rosen`s type 3 Quiescent infected non-union (Oligotrophic) and Romano stage -1 post-implant infection with re-fracture mid shaft of left femur. Then he was treated following accordion principles with modified Ilizarov frame. AM was applied according to protocol of Baruah and Patowary of non-union treatment. Result: After complete union and consolidation, substantiated by radiological evidence Ilizarov apparatus was dispelled six (6) months later of installation without removal of plate and four (4) months of that finally plate was removed. After one (1) year and four (4) months of mounted Ilizarov frame, the patient was in full free movement of knee and hip. He had no problem during walking even running. Conclusion: We pursue for the treatment, accordion maneuver with Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection kept plate in situ. Few authors reported, Accordion Maneuver (AM) techniques with Ilizarov apply over intramedullary nail (IMN) in situ for aseptic non-union of femur. In this study, we discussed the role of this tool (AM) for the treatment of femoral shaft non-union and re-fracture with quiescent infection place plate (DCP) in situ.

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“…We recorded non-unions as mobile or stiff, and whether they were atrophic, oligotrophic or hypertrophic. [26][27][28][29][30] Chronic osteomyelitis was defined as osteomyelitis with radiological evidence of sequestra, involucrum, radiolucency, and clinical evidence of infection in the form of a sinus or fistula. 31 Deep infection was defined as an infection involving any tissue (including bone) deep to the dermis at any point in time.…”

Section: Methodsmentioning

confidence: 99%

An audit of circular external fixation usage in a tertiary hospital in South Africa

Walt¹,

Ferreira²

2018

SA orthop. j.

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Background: Circular external fixation is a well-known treatment modality in reconstructive orthopaedic surgery and is frequently used for deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. The current use of this treatment modality in the South African context remains largely unknown. This retrospective review aims to describe the indications, outcomes and complications of the use of circular external fixation in a tertiary hospital in South Africa. Materials and methods: We retrospectively reviewed the records of 480 patients treated with circular external fixation in a specialist limb reconstruction unit. We report on patient demographics, comorbidities, indications and outcomes. Results: The final cohort consisted of 346 men and 134 women with a mean age of 35.5 years (SD 14.9, range: 5-73). Comorbidities were identified in 163 (34.0%) patients. These included diabetes in 14 (2.9%) patients and smoking in 102 (21%) patients. HIV infection was diagnosed in 120 patients (25%) with a mean CD4 count of 425 cells/mm 3 (SD: 223, range: 82-1056). The mean time in external fixator was 24.6% weeks (SD: 15.3, range 4-159). The treatment objective was achieved in 441 patients (92%). The overall complication rate excluding pin-site infection was 26%. Pin-site infection occurred in 88 patients (18.3%) but had no impact on the outcome of treatment. Conclusion: Circular external fixation treatment objectives can be achieved in a high percentage of patients in the context of a South African specialist reconstruction unit. This study shows favourable outcomes in deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. Comorbid factors, including HIV, diabetes and smoking had no effect on achieving the planned outcomes, but smoking did increase the overall time in external fixator.

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The pathogenesis of tibial non-union

Cited by 13 publications

References 95 publications

Circular frames of the humerus: salvage surgery case series

Circular frames of the humerus: salvage surgery case series

Accordion maneuver with Ilizarov placed plate in situ, in a case of femoral shaft non-union and refracture with quiescent infection, discussion on treatment strategies: a case report

An audit of circular external fixation usage in a tertiary hospital in South Africa

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