1/104. The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique.We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/104. Use of a custom retrograde intramedullary rod for the management of distal femoral nonunion: a report of two cases.Nonunion of the distal femur is a rare injury that is difficult to manage. A variety of surgical implants and techniques are available. We present an alternative mode of treatment for supracondylar femoral nonunion using a custom retrograde titanium femoral nail (Biomet; Warsaw, IN) to successfully achieve union in two cases. We believe the added length, custom modifications, and enhanced stability allowed better fixation in an osteopenic distal femur.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/104. Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up.Displaced lateral condyle fractures in the pediatric population are usually treated with open reduction and internal fixation. Significant complications associated with the nonoperative management include nonunion, malunion, deformity, and tardy ulnar nerve palsy. However, few cases of nonunion of the lateral condyle and tardy ulnar nerve palsy with long-term follow-up have been reported. We present a radiographically documented case of a pediatric lateral condyle fracture and subsequent nonunion with significant cubitus valgus deformity without ulnar nerve palsy sixty years following injury.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/104. Nonunion following subcapital (neck) fractures of the proximal phalanx of the thumb in children.Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
5/104. Is there a place for external fixation in humeral shaft fractures?There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.- - - - - - - - - - ranking = 0.011471900060451keywords = trauma (Clic here for more details about this article) |
6/104. The application of arthroscopic principles to bone grafting of delayed union of long bone fractures.The purpose of this study was to explore the potential of applying arthroscopic techniques to autogenous bone grafting of long bone fracture delayed union. There were 9 patients in this initial series, including 4 patients (average age, 37 years) with humeral lesions and 5 patients (average age, 25 years) with tibial fractures. There were 6 men and 3 women. Techniques customarily employed in arthroscopy were used to visualize, expose, and deliver the onlay cancellous bone grafts. Bony union occurred in all but 1 patient in an average of 4 months. This patient had a fibrous union and sustained a reinjury that led to successful repeat open bone graft surgery. The arthroscopic approach for bone grafting of certain long bone delayed union appears to be a safe and effective procedure. The procedure is best suited for patients with mechanically stabilized fragments, and it lends itself to those with overlying skin or soft tissue compromise. There are some relative contraindications: grossly unstable fragments, severe malunion, and/or infection.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
7/104. Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure.We describe a case of infected nonunion of the radius with extensive bone loss in an 11-year-old boy treated by centralization of the ulna. The technique used differs from the original Hey Groves procedure in that it preserves the distal end of the ulna with its important triangular fibrocartilage complex, thereby retaining stability and contour of the wrist joint. Our patient obtained a functionally and cosmetically satisfactory, stable forearm and wrist. We present the technique as a useful armament in the management of extensive bony defect of the radius arising from trauma or infection.- - - - - - - - - - ranking = 0.011471900060451keywords = trauma (Clic here for more details about this article) |
8/104. Nonunion in a fracture of the proximal phalanx of the thumb.We describe the management of atrophic nonunion in a fracture of the proximal phalanx of the thumb in a patient who presented one and a half years after the injury. By using threaded external fixators applied across the fracture nonunion, stability for active mobilization of the metacarpophalangeal joint was achieved. The gradual distraction resulted in correction of the deformity and the shortening, as well as creation of an adequate space between the bone ends. Bone grafting and compression of the fracture with the same fixators followed. Consolidation of the fracture occurred within five months. Follow-up examination two and a half years postoperatively revealed complete remodeling of the fracture and excellent function of the hand.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
9/104. Fracture of an interphalangeal coalition: a report of two cases.Congenital coalition of the middle and distal phalanges in the fifth toe are common. They have been reported to occur in up to 50% of American and European populations and in up to 73% of people of Japanese descent. Congenital interphalangeal coalition of the other toes is less common. We report two cases of fracture through an interphalangeal coalition following blunt trauma. diagnosis was delayed in these fractures. One fracture healed only after prolonged immobilization and the other developed a delayed union. patients with this fracture should be advised of the prolonged convalescence since this may delay their return to preinjury activities.- - - - - - - - - - ranking = 1.0114719000605keywords = injury, trauma (Clic here for more details about this article) |
10/104. Treatment of infection and non-union after bilateral complicated proximal tibial fracture.BACKGROUND AND AIMS: Complicated tibial fractures form a great challenge for orthopaedic surgeons. Non-unions and infections are more common in complicated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilateral open proximal tibial fractures. MATERIAL AND methods: A female patient born in 1946 was multi-traumatised, when a car hit her as a pedestrian. She went through multiple operations of both tibias due to bilateral complicated proximal fractures. Fractures were stabilised at first with internal fixation, which had to be changed to external fixation due to infection of both sides. During the last operative step a commercial bone graft based on hydroxyapatite and bovine type I fibrillar collagen/tricalcium phosphate ceramic (Collagraft) mixed with autogenous bone marrow was applied. RESULTS: Fractures united after 28 (right tibia) and 22 (left tibia) months of follow-up. At the final follow-up visit 55 months after the initial accident patient walked without any aid and showed no signs of an infection. CONCLUSIONS: The use of commercial mixed xeno-/autogenous-bone graft may provide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.- - - - - - - - - - ranking = 0.011471900060451keywords = trauma (Clic here for more details about this article) |
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