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Devendra A, Patra SK, Velmurugesan P, Zackariya M, Ramesh P, Arun Kamal C, Dheenadhayalan J, Rajasekaran S. Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients. Injury 2024; 55:111412. [PMID: 38341997 DOI: 10.1016/j.injury.2024.111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups. MATERIALS AND METHODS We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT. RESULTS Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01). CONCLUSION Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India.
| | - Sudipta Kumar Patra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Velmurugesan
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Mohd Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Ramesh
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Chandramohan Arun Kamal
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
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Patil AR, Patil DS, Jagzape MV. Physiotherapy Rehabilitation in an Infected Non-union Shaft of Femur Repair Patient: A Case Report. Cureus 2023; 15:e50786. [PMID: 38239531 PMCID: PMC10795792 DOI: 10.7759/cureus.50786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
While definitions may vary, infected non-union is generally described as a condition where a fracture fails to heal due to infection, typically persisting for a duration of six to eight months. Infected non-unions occurring in the shaft of the femur are infrequent and typically result from severe open fractures with deep fragmentation and segmental bone loss or following internal fixation of a severely fragmented closed fracture. Some associated factors contributing to non-union include positive bacterial cultures from deep wounds, histological evidence of bone necrosis, exposed bone without a vascularized periosteum for more than six weeks, and the presence of purulent discharge. Osteomyelitis, stiffness in adjacent joints, smoking, loss of soft tissue resulting in multiple sinus tracts, osteopenia, and deformities leading to limb length discrepancies are all complicating factors that impact treatment and prognosis. Infected non-union of bones, although rare, presents a significant challenge for physiotherapists striving to provide appropriate treatment. The level of stabilization at the fracture site is the most critical factor influencing whether a fracture progresses to non-union or successfully heals. Infection, such as osteomyelitis, also contributes to the development of non-union. Additionally, issues like tissue atrophy, joint stiffness, and muscle contractures can further complicate the non-union of a bone, posing a considerable challenge for physical therapists in helping patients achieve their recovery goals. Top of form this case report reviews the case of a 35-year-old male who was reported to Acharya Vinoba Bhave Rural Hospital (AVBRH) with an infective non-union of the shaft of the femur fracture after two months of repair. This case report highlights the recovery of patients from post-operative complications like non-union, stiffness, and reduced range of motion through tailored physiotherapy rehabilitation and improved quality of life.
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Affiliation(s)
- Anushri R Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Medhavi V Jagzape
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series. Int J Surg Case Rep 2023; 103:107908. [PMID: 36753821 PMCID: PMC9937947 DOI: 10.1016/j.ijscr.2023.107908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The management of implant failure in femoral shaft fractures remains a challenging problem for orthopaedic surgeons. This series aim to evaluate the effectiveness of intramedullary (IM) nailing for treating femoral shaft nonunions after implant failure. CASE PRESENTATION Three patients presented with pain after walking on crutch and limping with history of fixation using plate for femoral shaft fracture. Implant removal was then performed with subsequent refixation using intramedullary nailing with A2FN. The Lower Extremity Functional Score and Visual Analogue Score evaluation showed excellent result in these patients. CLINICAL DISCUSSION IM nailing is the mainstay of treatment for patients with femoral shaft fractures. This intervention provides support to fractures and aid in union of fractures. Several advantages have been reported in IM nailing, including shorter length of stay, rapid union, and early functional capacity of the limb. Insertion of IM nailing may preserve anatomical structure in the patients, which leads to better improvement of functional capacity. Nailing also limits soft tissue damage. Thus, in patients presented with previous plate failure similar to our patients, IM nailing with reaming is recommended. CONCLUSION Nonunion after femoral shaft plating are common. Nailing conversion is one of available treatment options to achieve maximum recover in this type of case.
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Treatment of Femoral Shaft Pseudarthrosis, Case Series and Medico-Legal Implications. J Clin Med 2022; 11:jcm11247407. [PMID: 36556022 PMCID: PMC9787375 DOI: 10.3390/jcm11247407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Pseudarthrosis (PSA) is a possible complication of femoral shaft fracture treatment. It is often associated with reduced bone quality and can, therefore, adversely affect quality of life. Its treatment poses a major challenge for orthopaedic surgeons. Several authors have set forth different surgical approaches for the treatment of pseudarthrosis, such as internal fixation with plate and screws, replacement of an intramedullary nail or prosthetic replacement. In cases associated with bone loss, osteopenia, or comminution of fracture fragments, autologous or homologous bone grafts may also be used. The chronic outcomes of the surgical treatment of femoral shaft pseudarthrosis, even when consolidation is achieved, are linked to disabling sequelae of clinical-functional relevance, deserving an adequate medico-legal evaluation. The purpose of this retrospective study is to analyse a clinical case series of patients treated for atrophic femoral shaft pseudarthrosis at the IRCCS Orthopaedic Institute Galeazzi, Milan, Italy, from 2014 to 2020 and their orthopaedic-traumatological and medico-legal implications.
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Landrino M, Alberio RL, Clemente A, Grassi FA. The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review. Orthop Rev (Pavia) 2022; 14:37889. [PMID: 36213618 PMCID: PMC9534743 DOI: 10.52965/001c.37889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures. Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union. The Reamer-Irrigator-Aspirator (RIA) System® was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature. In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed. Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.
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Affiliation(s)
- Marco Landrino
- Department of Health Sciences, University of East Piedmont, Novara (Italy)
| | | | - Alice Clemente
- Department of Health Sciences, University of East Piedmont, Novara (Italy)
| | - Federico Alberto Grassi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia (Italy); IRCCS Hospital San Matteo, Pavia (Italy)
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Houston J, Armitage L, Sedgwick PM, McGovern M, Smith RM, Trompeter AJ. Defining the Mean Angle of Diaphyseal Long Bone Nonunions-Does Shear Prevail? J Orthop Trauma 2021; 35:e322-e327. [PMID: 33395179 DOI: 10.1097/bot.0000000000002050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To define the mean angle of a series of diaphyseal nonunions based on radiographic analysis. DESIGN A retrospective cohort study. SETTING Two level-1 trauma centers. PATIENTS One hundred twenty patients presenting with nonunion. INTERVENTION A mean nonunion angle was calculated from a series of AP and lateral X-rays using a standardized technique. The nonunion angle was then estimated in a single plane by considering the greater of the 2 measured angles. Additional data collected included patient age, sex, nonunion site, initial fracture angle, and original fracture pattern. MAIN OUTCOME MEASUREMENT Single plane nonunion angle. RESULTS The mean angles of all nonunion in coronal plane was 42 degrees (SD 17 degrees) and 42 degrees in sagittal plane (SD 18 degrees) and 48 degrees (SD 15 degrees) in single plane. The single plane nonunion angle in fractures which were originally multiplanar was steeper to those occurring in originally single plane fractures (P 0.002) although both were close to 45 degrees. There was no significant difference in the nonunion angles on subgroup analysis of cohort location, sex, or anatomic location. CONCLUSIONS This study demonstrates the mean angle of diaphyseal nonunions from long bones of the lower limb approaches 45 degrees. This is noted in all types of fractures and is irrespective of anatomic location or sex. This confirms the hypothesis that shear is likely to play a role in the development of a nonunion. This study provides further evidence that nonunions occur primarily because of mechanical instability. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- James Houston
- Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Leanne Armitage
- Institute for Medical and Biomedical Education, St. George's, University of London, London, United Kingdom
| | - Philip M Sedgwick
- Institute for Medical and Biomedical Education, St. George's, University of London, London, United Kingdom
| | - Madeline McGovern
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; and
| | - Raymond M Smith
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Alex J Trompeter
- Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, London, United Kingdom
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Incidence and risk factors of hardware-related complications after proximal femoral osteotomy in children and adolescents. J Pediatr Orthop B 2018; 27:264-270. [PMID: 28277416 DOI: 10.1097/bpb.0000000000000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femoral osteotomy with BP or LCP between May 2003 and December 2014, and who were followed up until 6 months after hardware removal. Following consensus building, hardware-related complications were identified from the patients' medical records and hip radiographs. Patient age, sex, type of plate, and Gross Motor Function Classification System (GMFCS) level in cerebral palsy patients were evaluated as possible risk factors, and a generalized estimating equation was used to assess the risk factors for hardware-related complications. A total of 417 hips from 251 patients were finally included in this study. Seven losses of fixation around the plate (five patients, 3.0%) occurred in the BP, three implant-related fractures (three patients, 3.6%) occurred in the LCP, and there was no significant difference (P=0.74). All hardware-related complications occurred in cerebral palsy patients, and the implant-related fractures occurred in patients with GMFCS IV/V. The risk of complications increased with age (P=0.002). The risk of loss of fixation around the BP is a well-known complication. However, LCP is not without hardware-related complications. The LCP provides strong stability of fixation. However, it is speculated that the LCP is related to implant-related fractures because of the stress shielding effect. Therefore, care should be exercised when using a locking plate in patients with osteoporosis, such as cerebral palsy with GMFCS IV/V. LEVEL OF EVIDENCE Therapeutic Level III.
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Vaishya R, Agarwal AK, Gupta N, Vijay V. Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union. J Orthop 2016; 13:242-5. [PMID: 27408496 DOI: 10.1016/j.jor.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Non-union after intramedullary nail fixation of femur shaft fractures is although infrequent but a challenging condition to treat. The treatment options available to deal with such a situation include exchange nailing, removal of nail and re-osteosynthesis with plating, or Ilizarov fixation. We believe that rotational instability, in the presence of a nail, is one of the main reasons for most of the non-union. We present our experience of plate augmentation leaving the nail in situ for non-union of femoral shaft fracture. METHODS In this retrospective study, we had operated 16 cases of the femoral shaft non-union, which were treated by plate augmentation and bone grafting (if needed) with retention of the intramedullary interlocking nail in situ. The cases of infected non-union and any fracture less than one-year duration were excluded from the study. RESULTS Bone grafting was done only in 4 cases with atrophic non-union. We could achieve union in all the cases at an average time of 6.25 months. The average time of surgery between the primary surgery of interlocking nail fixation and the plate augmentation was 13 months. Mean surgical time for plate augmentation and bone grafting was 71 min. No major complication or implant failure was encountered. An average residual shortening of the limb was 0.9 cm and average range of motion of the knee was 115°. CONCLUSION Plate augmentation seems an effective, reliable, safe and an easy procedure for the treatment of femoral shaft non-union after an intramedullary nailing.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Amit Kumar Agarwal
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Nishint Gupta
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Vipul Vijay
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
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Successful treatment of infected femoral shaft nonunion with teriparatide after eradication of infection. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pan K, Chan W. Symptoms indicating imminent breakage of a femoral interlocking nail: a case report. Malays Orthop J 2013; 7:21-3. [PMID: 25674303 PMCID: PMC4322138 DOI: 10.5704/moj.1311.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Fractures of the femoral shaft treated with interlocking nails
will ultimately result in breakage of the nail if the bone does
not unite. Further management requires removal of the
broken nail which may be a difficult process for the distal
segment. If we can identify the symptoms just before the nail
breaks, an exchange nailing becomes much easier. We
present a patient with fibromatosis who underwent repeated
surgery as well as radiotherapy at the age of 16. Six years
later, she had a pathological fracture of the upper third of the
femur for which an interlocking nail was inserted. The femur
did not unite and the nail subsequently broke. Over a period
of 12 years, three nails broke and had to be replaced. Two to
3 months before each breakage, the patient experienced the
same set of symptoms for each episode. Knowing that her
fracture was not going to heal will now alert us to do an
exchange nailing before the nail broke again. It is well known
that where there is evidence of non-union, pre-emptive
treatment is necessary before implant failure.
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Affiliation(s)
- Kl Pan
- Department of Orthopaedics, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - Wh Chan
- Department of Orthopaedics, Universiti Malaysia Sarawak, Kuching, Malaysia
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Ilizarov external fixation without removal of plate or screws: effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure. J Orthop Trauma 2012; 26:e123-8. [PMID: 22337486 DOI: 10.1097/bot.0b013e318238bea7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with hypertrophic and oligotrophic nonunion of the femoral diaphysis associated with plate failure can be treated by Ilizarov external fixation without plate removal. Advantages of this technique include a lack of damage to the blood supply and simultaneous deformity correction.
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Comparison of the Resistance to Bending Forces of the 4.5 LCP Plate-rod Construct and of 4.5 LCP Alone Applied to Segmental Femoral Defects in Miniature Pigs. ACTA VET BRNO 2011. [DOI: 10.2754/avb201079040613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study deals with the determination of mechanical properties, namely resistance to bending forces, of flexible buttress osteosynthesis using two different bone-implant constructs stabilizing experimental segmental femoral bone defects (segmental ostectomy) in a miniature pigex vivomodel using 4.5 mm titanium LCP and a 3 mm intramedullary pin (“plate and rod” construct) (PR-LCP), versus the 4.5 mm titanium LCP alone (A-LCP). The “plate and rod” fixation (PR-LCP) of the segmental femoral defect is significantly more resistant (p< 0.05) to bending forces (200 N, 300 N, and 500 N) than LCP alone (A-LCP). Stabilisation of experimental segmental lesions of the femoral diaphysis in miniature pigs by flexible bridging osteosynthesis 4.5 mm LCP in combination with the “plate and rod” construct appears to be a suitable fixation of non-reducible fractures where considerable strain of the implants by bending forces can be assumed. These findings will be used in upcomingin vivoexperiments in the miniature pig to investigate bone defect healing after transplantation of mesenchymal stem cells in combination with biocompatible scaffolds.
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Radiographic Assessment of Implant Failures of Titanium 3.5 LCP vs. 4.5 LCP Used for Flexible Bridging Osteosynthesis of Large Segmental Femoral Diaphyseal Defects in a Miniature Pig Model. ACTA VET BRNO 2011. [DOI: 10.2754/avb201079040599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study describes types, absolute and relative numbers of implant failures in flexible bridging osteosynthesis using a six-hole 3.5 mm titanium Locking Compression Plate (n = 9) or a five-hole LCP 4.5 mm titanium (n = 40) selected for the fixation of segmental ostectomy of femoral diaphysis in the miniature pig used as an in vivo model in a study on the healing of a critically sized bone defect using transplantation of mesenchymal stem cells combined with biocompatible scaffolds within a broader research project. Occasional implant failure was evaluated based on radiographic examination of femurs of animals 2, 4, 8, 12 and 16 weeks after surgery. When bone defect was stabilized using 3.5 mm LCP, in 6 cases (66.7%) the screw was broken/lost in the proximal fragment of the femur 2 weeks after implantation (n = 4) and 4 weeks after implantation (n = 2). In 4 cases of these, the implant failure was accompanied also by loosening of the screw in position 3 in the proximal fragment of the femur. During ostectomy stabilization with 4.5 mm LCP, in 3 cases (7.5%) LCP was broken at the place of the empty central plate hole (without inserted screw) at the level of the segmental bone defect. Compared to the six-hole 3.5 mm LCP, the five-hole titanium 4.5 mm LCP is more suitable implant for flexible bridging osteosynthesis of a critically sized segmental defect of femoral diaphysis in the miniature pig. The results of this study will allow reducing implant failures in time- and cost-demanding transplantation experiments focused on bone healing.
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Kim JR, Chung WC, Shin SJ, Seo KB. The management of aseptic nonunion of femoral shaft fractures after interlocking intramedullary nailing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2010. [DOI: 10.1007/s00590-010-0679-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H. Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics 2009; 32:409. [PMID: 19634823 DOI: 10.3928/01477447-20090511-12] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nonunion after intramedullary nailing of femoral and tibial fractures, although infrequent, remains a challenge for orthopedic surgeons. Augmentation plate fixation can be a reasonable choice in this situation. From 2003 to 2005, 38 patients (25 femoral nonunions and 13 tibial nonunions) were treated after intramedullary nailing with augmentation plate fixation, leaving the nail in situ, with or without autogenous cancellous bone graft. Patients were followed for at least 1 year postoperatively. All 25 femoral nonunions healed with solid union (100% union rate), but 2 of 13 tibial nonunions remained symptomatic and did not achieve union (84.6% union rate) at a mean 4.78 months postoperatively (range, 1-6 months). No serious complications were encountered at 1-year follow-up. We suggest augmentation plate fixation for femoral and tibial nonunion after intramedullary nailing.
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Schulz AP, Faschingbauer M, Seide K, Schuemann U, Mayer M, Jürgens C, Wenzl M. Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate. Eur J Trauma Emerg Surg 2008; 35:127-31. [PMID: 26814765 DOI: 10.1007/s00068-008-8009-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 07/02/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse the results of the treatment of aseptic femoral non-unions using a singular locked implant. DESIGN Consecutive case series. SETTING A level-1 trauma center with a high number of specialist referrals. PATIENTS The study is based on a consecutive series of patients with prospective data evaluation. From 1993 to 2003, 75 patients were treated with a wave plate. All patients had persistent non-union of the femoral shaft without clinical or laboratory signs of infection and previous unsuccessful attempts to treat the non-union. INTERVENTION The method of treatment was standardized and included a lateral approach, cancellous bone hip grafting, osteosynthesis with a wave-shaped plate (PPF) and polyaxial locking screws as well as the application of a gentamicin-PMMA chain. MAIN OUTCOME MEASUREMENTS Time to achieve union, rate of implant failure and number of remaining nonunions after treatment. A total of 75 patients had full follow-up and were included in the study. RESULTS The union of the fracture was found in 64 patients after the initial procedure. In eight cases a second procedure was performed to achieve union in the form of a second bone graft because of a delay in callus formation. The mean time to union was 7.3 months with a range from 3 to 19 months. The implant failed in three cases accounting for 4% of the total. CONCLUSION The locked wave plate offers a further reliable treatment for complex aseptic femoral non-unions.
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Affiliation(s)
- Arndt P Schulz
- BG Trauma Hospital Hamburg, Trauma and Reconstructive Surgery, Hamburg, Germany. .,Department of Musculoskeletal Surgery, University Hospital Lübeck, Lübeck, Germany. .,BG Trauma Hospital, Hamburg Trauma and Reconstructive Surgery, Bergedorfer Strasse 10, 21027, Hamburg, Germany.
| | | | - Klaus Seide
- Department of Musculoskeletal Surgery, University Hospital Lübeck, Lübeck, Germany
| | - Uwe Schuemann
- Department of Musculoskeletal Surgery, University Hospital Lübeck, Lübeck, Germany
| | - Martin Mayer
- Medical Faculty, University Hospital Lübeck, Lübeck, Germany
| | - Christian Jürgens
- BG Trauma Hospital Hamburg, Trauma and Reconstructive Surgery, Hamburg, Germany.,Department of Musculoskeletal Surgery, University Hospital Lübeck, Lübeck, Germany
| | - Michael Wenzl
- Department of Musculoskeletal Surgery, University Hospital Lübeck, Lübeck, Germany
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