1/395. A metallurgical examination of fractured stainless-steel ASIF tibial plates. Between 1970 and 1973 99 tibial fractures were treated by rigid internal fixation with ASIF plates. The fractures were all regarded as sufficiently stable for exercise without weight bearing, thus needing no additional external support during the healing period. Four of the plates broke late in the healing period, after the onset of weight bearing. These fractures had some degree of delayed union with slight resorption of the bone ends, resulting in cyclical bending of the plate. Examination of 2 of the fractured plates by scanning electron microscopy, electron microprobe analysis and optical metallography revealed that the primary cause of plate fracture was fatigue. There was no evidence that corrosion fatigue or inclusion content were factors leading to plate fracture. ( info) |
2/395. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia. Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years). ( info) |
3/395. 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. ( info) |
4/395. Remission of idiopathic thrombocytopenic purpura after femoral lengthening. Clinical case followed for 5 years. We report on a patient with chronic idiopathic thrombocytopenic purpura (ITP) who went into remission after femoral lengthening. Although it is possible that spontaneous remission (frequency 5%-10%) of chronic ITP coincided with the femoral lengthening, limb lengthening could also have caused the thrombocytosis. This case suggests a close relationship between osteogenesis and hematopoiesis during regenerate bone formation. Limb lengthening can therefore be defined as the formation not only of bone and soft tissue but also of hematopoietic tissue. ( info) |
5/395. Non-union of undisplaced radial neck fracture in a rheumatoid patient. Non-union of an undisplaced fracture of the radial neck in a rheumatoid patient is presented. Possible causes are discussed, and the literature reviewed. ( info) |
6/395. 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. ( info) |
7/395. Difficulty in removal of the distal locking device of the Brooker-wills tibial nail. Complications in removal of the Brooker-wills tibial nail were encountered in eight patients, and breakage of the distal fins occurred in four of these patients. Although none of the patients experienced residual effects related to removal of the tibial nail, the procedure is associated with potential risks such as infection or nonunion. Three methods of nail removal are described. ( info) |
8/395. Management of nonunion below proximal humeral prosthesis. Fractures below proximal humeral prostheses are rare and their successful management presents technical difficulties. Closed treatment usually results in nonunion. A case illustrating this disabling complication is reported and a literature review is presented that summarizes the classification, treatment options, and complications of these uncommon fractures. ( info) |
| Fractures of the medial third of the clavicle are the rarest of all clavicle fractures. We present two cases of medial clavicle fracture nonunions that were initially thought to be chronic anterior sternoclavicular dislocations and describe the entity of pseudo-dislocation of the sternoclavicular joint. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular region to ensure differentiation between fracture and dislocation. ( info) |
10/395. Five case studies of soldiers with painful clavicular fracture non-union. We report a short case series of 5 servicemen who had sustained closed clavicular fractures, 4 of whom presented to our clinic with a painful non-union, and 1 required primary fixation for tenting of the skin. Our treatment consisted of open reduction and internal fixation of these non-unions. This resulted in all these men returning to duties with painfree shoulder girdles within 6 months. A complication in these cases was one of a prominent plate which rubbed on straps and required removal of the plate after union had occurred resulting once again in a painfree shoulder girdle and a return to full duties. We advocate early orthopaedic referral in cases of painful clavicular non-union and where appropriate, open reduction and internal fixation with the expectation of an early return to full duties with a pain free shoulder girdle. ( info) |