1/28. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/28. Nonunion of a Hoffa fracture in a child.The authors report a case of a Hoffa fracture of the lateral femoral condyle that subsequently went on to nonunion in an eight-year-old child. The child presented with symptoms of knee pain and snapping five years after a motor vehicle accident. The nonunion fragment involved most of the lateral femoral condylar articular surface but spared the physis. After treatment by open reduction and limited internal fixation, the nonunion has healed, and the child has virtually full range of motion of the knee and no evidence of growth disturbance.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/28. Salvage of a malpositioned anterior odontoid screw.STUDY DESIGN: Description of surgical technique with case correlation. OBJECTIVE: This article presents an alternative approach to anterior odontoid screw salvage in a patient with established nonunion. SUMMARY OF BACKGROUND DATA: Type II odontoid fractures are often treated surgically because of their risk of nonunion. Anterior odontoid screw fixation offers stable fixation without loss of atlantoaxial motion. treatment failure may occur despite adequate screw placement but is more likely when fixation is inadequate. The traditional solution is a posterior fusion. In selected cases the surgeon may want to revise the anterior instrumentation with the hope of retaining as much C1-C2 motion as possible. methods: A 43-year-old man presented 16 months after Type II odontoid fracture treated by anterior odontoid screw fixation. He had neck pain, instability, and a pseudarthrosis confirmed on radiographs. The screw was excessively long, piercing the C3 vertebral body and providing inadequate fixation. To avoid posterior fusion, a modified anterior approach was used. An entry point was selected 10 mm lateral to the midline, along the anterior rim of the C2 vertebral body. A large-diameter lag screw was then passed to the tip of the fragment. An angled curette was introduced into the fracture gap through the interval between the odontoid and the C1 ring. Autogenous bone was packed into the gap and along the old screw tract. RESULTS: At the 2-year follow-up the patient had a solid union with no neck pain, no headaches, no radicular symptoms, and excellent range of motion. The approach is described. CONCLUSION: In properly selected patients an anterior revision approach can provide a better outcome than posterior cervical fusion. This modified approach allows placement of an adequate fixation screw in a vertebra damaged by previous screw failure.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
4/28. Supracondylar distal femoral nonunions treated with a megaprosthesis in elderly patients: a report of two cases.The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/28. Long-standing nonunion of fractures of the lateral humeral condyle.BACKGROUND: patients with nonunion of a fracture of the lateral humeral condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral humeral condyle to correlate the clinical long-term outcome of this condition with the original fracture type. methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. RESULTS: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60 degrees to 145 degrees; average, 99 degrees) was more restricted than that in Group 2 (range, 100 degrees to 150 degrees; average, 129 degrees) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). CONCLUSION: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/28. Nonunion of a scapula body fracture in a high school football player.We report the case of a 16-year-old boy who sustained a minimally displaced fracture of the inferior angle of the scapula during a high school football game. This fracture progressed to symptomatic nonunion and persistent pain. Treatment included curettage of loose, fibrous tissue interposed at the fracture site; fragment excision; range-of-motion exercises started early in the postoperative period, and progressive scapula strengthening. Four and a half months after initial injury, the patient returned to all activities and was asymptomatic.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/28. Nonunion as a complication of an open reduction of a distal radial fracture in a healthy child: a case report.Nonunion of a distal radial fracture is rare in children. We report one referred case of a nonunion of the distal radius after an open reduction. The patient is a 10-year-old healthy male with a displaced bicortical fracture of the distal radius and an undisplaced ulnar fracture. This fracture was initially treated by the referring orthopedist with open reduction and single Kirschner wire fixation, as closed reduction was thought to be difficult to achieve. The patient was seen with a distal radius nonunion at 14 months following the initial procedure. A complete workup revealed a healthy child with no general or local pathologies. He was treated with open reduction of the nonunion site, correction of angular deformity, and plate fixation. This resulted in bony union with no limitation of motion. Potential reasons for the development of nonunion and suggestions to avoid this complication are discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/28. Surgical repair of a talar body nonunion.Fractures of the talus are significant injuries and are usually intra-articular. The authors discuss the evaluation and management of a patient with a delayed union of a talar body fracture. Assessment of talar vascularity and joint integrity should be performed preoperatively. The role of internal fixation and continuous passive motion is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/28. Treatment of infected tibial nonunions with debridement, antibiotic beads, and the Ilizarov method.This study of 10 patients presents the early results of a protocol of debridement, antibiotic bead placement, and use of the Ilizarov method with a circular external fixator for treatment of infected nonunions of the tibia in a military population. The nonunions resulted from high-energy fractures in nine cases and an osteotomy in one. The Ilizarov techniques used were transport (five cases), shortening and secondary lengthening (two cases), minimal resection with compression (one case), and resection with bone grafting (two cases). Flap coverage was required for five patients. There were two recurrences of infection (20%) among patients with the most compromised soft tissue. Only 50% of patients were able to perform limited duties while wearing the external fixator. Only four patients returned to active duty; however, three patients from special operations units were able to return to jump status. Six patients underwent medical retirement because of insufficient function, resulting from decreased ankle or knee range of motion and arthrosis or muscle weakness.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/28. Neglected femoral diaphyseal fracture.Femoral diaphyseal fractures usually result after trauma of high magnitude and because of this, can be life-threatening injuries or may result in considerable physical disability if not treated with care and caution. Nonoperative treatment of these fractures continues to be popular among the patient population in the Indian subcontinent, which in majority of cases, leads to healing in malalignment, shortening of the limb, chondromalacia patellae, and loss of knee motion. Although the majority of these fractures are being treated by operative methods today, success of the treatment depends largely on the surgeon's familiarity with the procedure or the type of fracture pattern (comminuted or segmental) particularly in a polytraumatized patient. Delayed union and nonunion of femoral-diaphyseal fractures and implant failures usually result after these procedures or the type of injury. The purpose of this study is to discuss various types of neglected femoral diaphyseal fractures and to review the literature on their treatment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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