[Conservative treatment of inveterate and ununited fractures of the navicular bone].
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Adult↗
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Results for “FRACTURES, UNUNITED”
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Non-invasive treatment of ununited fractures of the tibia using electrical stimulation.
A non-invasive method of electrical stimulation of healing in ununited fractures of the tibia by pulsed magnetic fileds has been evaluated. In a series of 17 patients all but two of the fractures united within 4 to 10 months, with an average time of just under six months. The method is sufficiently promising to merit further clinical investigation.
Adolescent↗
Partial fibulectomy for ununited fractures of the tibia.
Despite the improved rate of union reported with early weight-bearing in tibial shaft fractures, there continues to be a small number of patients with delayed union and non-union who present a dilemma to the surgeons. Partial fibular ostectomy (fibulectomy) is one means of promoting union in ununited fractures of the tibia. Fifty-one patients at our hospital underwent that treatment between December 1, 1971 and June 30, 1979, at twenty to fifty-nine weeks after the date of injury. Following the partial fibulectomy, 77 per cent of the tibial fractures healed. Failure of union after fibulectomy was associated with either failure of the patient to bear weight postoperatively, the presence of a true pseudarthrosis at the fracture site, or previous prolonged treatment of the initial fracture with external fixation. Partial fibulectomy proved to be a relatively effective and simple method for the treatment of ununited fractures of the tibial shaft.
Adult↗
[Surgical treatment of ununited fractures and pseudarthroses of the femoral diaphysis].
The article analyses experience in the treatment of 125 patients with ununited fractures and pseudarthrosis of the humeral diaphysis by osteosynthesis with massive compressing metal plates. The possibility of creating the necessary reserve of mechanical stability at the expense of the massive plates and strained fixation allows immobilization in a plaster cast to be avoided in most cases and early motor rehabilitation of the patients to be undertaken. The results were positive in 96.8% of cases, which makes it possible to consider the method to be sufficiently effective in the management of fractures of the humeral diaphysis and their sequelae.
Adult↗
The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients.
Twenty-two elderly patients (average age, seventy-two years) who had an atrophic, unstable, ununited fracture of the humeral diaphysis were managed with plate-and-screw fixation and application of an autogenous bone graft from the iliac crest. Fifteen of the patients had had at least one previous operation in an attempt to obtain union of the fracture. One patient had an active infection and two had a quiescent infection, all with Staphylococcus epidermidis. The average duration of nonunion before the patients were first seen by us was two years and four months (range, five months to sixteen years). Fifteen of the nonunions were synovial. In each patient, at least one modification of the standard technique of plate-and-screw fixation was needed as a result of osteopenia. In order to enhance fixation, the standard protocol incorporated the use of a long plate (with an average of eleven holes and an average length that was 76 percent of that of the bone), a plate with a blade (used in thirteen patients), and replacement of loose, 4.5-millimeter cortical-bone screws with 6.5-millimeter cancellous-bone screws (twelve patients). Spiked nuts (Schuhli nut; Synthes, Paoli, Pennsylvania) that lock the screws to the plate, creating a solid point of fixation analogous to a blade, were incorporated into the protocol when they became available (used in six patients). In five limbs, the nonunion was associated with an osseous defect that could not be addressed by shortening of the bone alone. Three of these limbs were stabilized with a bridge plate that had been contoured to stand away from the bone at the site of nonunion (so-called wave-plate osteosynthesis), and the remaining two limbs were stabilized with a combination of intramedullary and extramedullary plates. In one of these two limbs, the extramedullary plate was contoured (that is, a wave plate). The fracture united in twenty (91 percent) of the patients. There was no progressive loosening or breakage of a fixation device, even in two patients who had radiographs that were suggestive of an incomplete union. Five of the patients were followed for a limited duration (average, one year and six months) as a result of death or illness. They had two excellent results, two good results, and one poor result according to a modification of the rating system of Constant and Murley. The remaining seventeen patients, including the two who had a persistent nonunion, were followed for an average of three years and one month (range, two years to five years and ten months). They had significant improvements in all of the functional scores at the most recent follow-up evaluation: the average score according to the modified system of Constant and Murley increased from 9 to 72 points (p < 0.001), the average score according to the Enforced Social Dependency Scale decreased from 39 to 9 points (p < 0.001), and the average score based on the Disabilities of the Arm, Shoulder, and Hand Questionnaire decreased from 77 to 24 points (p < 0.001). According to the scores based on the Disabilities of the Arm, Shoulder, and Hand Questionnaire, nine of the seventeen patients who had been followed for more than two years had an excellent result, four had a good result, two had a fair result, and the two who had a persistent nonunion had a poor result. Complications included postoperative delirium, a stitch abscess, transient radial nerve palsy, a fracture distal to the plate, and the need for a blood transfusion, in one patient each. Two patients had a fibrous union. There were no major medical complications. An unstable, united fracture of the humeral diaphysis can be extremely disabling and may threaten the ability of an elderly patient to function independently. Operative treatment can be very successful when the techniques of plate-and-screw fixation are modified to address osteopenia and relative or absolute loss of bone. Healing of the fracture substantially improves function and the degree of independence
Activities of Daily Living↗
[Ununited fractures of the femoral neck treated by cervicocephalic impaction. A report of two cases (author's transl)].
Two cases of ununited fracture of the femoral neck, treated by a technique described by Brackett (1927) and modified by Merle d'Aubigné (1968) are reported. The femoral head was partly evacuated, care being taken to preserve its blood supply and then impacted onto the femoral neck. The results were found to be satisfactory.
Adult↗
[Ununited fractures of the femoral neck treated by cervicocephalic impaction. A report of two cases (author's transl)].
The cases of ununited fracture of the femoral neck, treated by a technique described by Brackett (1927) and modified by Merle d'Aubigné (1968) are reported. The femoral head was partly evacuated, care being taken to preserve its blood supply and then impacted onto the femoral neck. The results were found to be satisfactory.
Adult↗
Ununited fracture of the lateral condyle of the humerus. A 50 year follow-up.
This is a case report of a 74-year-old man with an ununited fracture of the lateral condyle of the humerus of 50 years duration. There was minimal loss of motion, a moderate cubitis valgus deformity, and a definite ulnar nerve palsy. Despite the deformity and ulnar palsy, he was able to provide for himself and to perform satisfactorily as a laborer.
Aged↗
The development and application of pulsed electromagnetic fields (PEMFs) for ununited fractures and arthrodeses.
This article deals with the rational and practical use of surgically noninvasive pulsed electromagnetic fields (PEMFs) in treating ununited fractures, failed arthrodeses, and congenital pseudarthroses (infantile nonunions). The method is highly effective (more than 90 per cent success) in adult patients when used in conjunction with good management techniques that are founded on biomechanical principles. When union fails to occur with PEMFs alone after approximately four months, their proper use in conjunction with fresh bone grafts insures a maximum failure rate of 1 to 1.5 per cent. Union occurs because the weak electric currents induced in tissues by the time-varying fields effect calcification of the fibrocartilage in the fracture gap, thereby setting the stage for the final phases of fracture healing by endochondral ossification. The efficacy, safety, and simplicity of the method has prompted its use by the majority of orthopedic surgeons in this country. In patients with delayed union three to four months postfracture, PEMFs appear to be more successful and healing, generally, is more rapid than in patients managed by other conservative methods. For more challenging problems such as actively infected nonunions, multiple surgical failures, long-standing (for example, more than two years postfracture) atrophic lesions, failed knee arthrodeses after removal of infected prostheses, and congenital pseudarthroses, success can be expected in a large majority of patients in whom PEMFs are used. Finally, as laboratory studies have expanded knowledge of the mechanisms of PEMF action, it is clear that different pulses affect different biologic processes in different ways. Selection of the proper pulse for a given pathologic entity has begun to be governed by rational processes similar, in certain respects, to those applied to pharmacologic agents.
Arthrodesis↗
The development and application of pulsed electromagnetic fields (PEMFs) for ununited fractures and arthrodeses.
This article deals with the rational and practical use of surgically noninvasive pulsed electromagnetic fields (PEMFs) in treating ununited fractures, failed arthrodeses, and congenital pseudarthroses (infantile nonunions). The method is highly effective (more than 90 per cent success) in adult patients when used in conjunction with good management techniques that are founded on biomechanical principles. When union fails to occur with PEMFs alone after approximately four months, their proper use in conjunction with fresh bone grafts insures a maximum failure rate of 1 to 1.5 per cent. Union occurs because the weak electric currents induced in tissues by the time-varying fields effect calcification of the fibrocartilage in the fracture gap, thereby setting the stage for the final phases of fracture healing by endochondral ossification. The efficacy, safety, and simplicity of the method has prompted its use by the majority of orthopedic surgeons in this country. In patients with delayed union three to four months postfracture, PEMFs appear to be more successful and healing, generally, is more rapid than in patients managed by other conservative methods. For more challenging problems such as actively infected nonunions, multiple surgical failures, long-standing (for example, more than two years postfracture) atrophic lesions, failed knee arthrodeses after removal of infected prostheses, and congenital pseudarthroses, success can be expected in a large majority of patients in whom PEMFs are used. Finally, as laboratory studies have expanded knowledge of the mechanisms of PEMF action, it is clear that different pulses affect different biologic processes in different ways. Selection of the proper pulse for a given pathologic entity has begun to be governed by rational processes similar, in certain respects, to those applied to pharmacologic agents.
Adult↗
[111InCl3 uptake in ununited fractures: a case report].
111InCl3 scintigraphy was performed in a 37-year-old male with pancytopenia. Intense tracer uptake in the ununited rib fractures was recognized. There are few descriptions of 111InCl3 uptake in ununited fracture, and this case indicated that ununited fracture should be added to the differential diagnosis of 111InCl3 uptake.
Adult↗
[Surgical treatment of chronic post-traumatic osteomyelitis of the femur in pseudarthrosis, ununited fractures and defects].
The authors have analyzed the results of treatment for chronic posttraumatic osteomyelitis of the femoral bone in 69 cases of ununited fractures, false joints ad femoral bone defects. The treatment included surgical sanation of the osteomyelitic nidus together with aspiration lavage drainage and extranidal osteosynthesis by external fixation as well as local and general antibacterial therapy. In 13 cases free bone autoplasty of the osteomyelitic cavities or defects was used together with spongious structures of iliac bone (crest and wing), in 2 of these patients it was applied for replacement of the large defects of the diaphysis of the femoral bone (8 and 12 cm). In 57 patients surgical treatment was carried out in one stage, a major requisite for this was the opportunity for joining bone fragments inside the open wound after sequestrectomy as well as stable external fixation by the apparatus. This treatment gave successful results in 97% of patients.
Adolescent↗
Failure of treatment of ununited fractures of the carpal scaphoid. The role of non-compliance.
We studied the results in thirty patients who had grafting of an ununited fracture of the carpal scaphoid bone. Psychiatric evaluations revealed that the thirteen patients who had a non-union of the initial scaphoid bone graft had significant psychiatric problems, whereas the seventeen patients in whom the non-union had healed after initial bone-grafting of the scaphoid did not have psychiatric abnormalities. Technically successful surgical revisions in the first group of patients did not result in significant clinical improvement. We concluded that most failures of the bone grafts were related to non-compliance on the part of the patient and that some of the operations could have been avoided if the underlying psychiatric problems had been recognized preoperatively.
Bone Transplantation↗
Treatment of ununited fractures of the carpal scaphoid by iliac bone grafts and Herbert screw fixation.
Internal fixation with a Herbert screw was used to treat 70 ununited fractures of the carpal scaphoid. Bone grafts were utilised in all cases of nonunion (56) and in 10 out of 14 with delayed union. The results were assessed at a mean time of 13 months. Definite radiographic union was achieved in 90% of patients after a mean period of postoperative immobilisation of 5.4 weeks. Although the rate of union was basically the same as in Russe's series, the final functional results were better than those obtained by using his technique. The use of an image intensifier is essential to avoid technical problems.
Adolescent↗
[Treatment of ununited fractures and pseudarthroses of long tubular bones complicated by suppurative infection].
The work is based on the analysis of examination and treatment (external +transosseous osteosynthesis) of 172 patients with ununited fractures and false joints of the long tubular bones complicated by purulent infection and posttraumatic osteomyelitis. All patients were divided into 4 clinical groups according to the activity of the purulent wound infection and choice of the surgical tactics. Some risk factors were taken into consideration in choosing the tactics of treatment and predicting the outcomes. The clinical course of the wound process in the groups of the patients studied and the errors and complications of operative treatment are analysed. The necessity for active postoperative management of patients and endolymphatic and +intra-arterial administration of antibiotics is substantiated. Good and satisfactory results of treatment were produced in 85.6% of patients.
Anti-Bacterial Agents↗
Treatment of ununited fracture of the hook of hamate by low-intensity pulsed ultrasound: a case report.
A patient presented 4 months after sustaining a fracture of the hook of hamate. X-rays and computed tomography scanning of the carpal tunnel confirmed the presence of an ununited fracture. Low-intensity ultrasound was applied to the fracture site. After 4.5 months of exposure to ultrasound, union was confirmed by both x-rays and computed tomography scanning of the carpal tunnel. (J Hand Surg 2000; 25A:77-79.
Accidents, Traffic↗
[Stable metal osteosynthesis in ununited fractures and pseudarthroses of the tibia].
The plunge nailing osteosynthesis with the Küntscher nail through the tibia tuberosity and with the Bogdanov nail through the medial malleolus provide stable fixation of the fragments. When combined with decortication of the bone diaphysis and autoplasty with translocated bone transplants the method gives consolidation in ununited fractures and false joints of the tibia within 17-21 weeks. The method was used in operations of 20 patients. The follow-up observation of 18 patients lasted longer than a year. All of them resumed their working capacity.
Adult↗
Pulsing electromagnetic field treatment in ununited fractures and failed arthrodeses.
Pulsing electromagnetic fields (PEMFs) induce weak electric currents in bone by external coils on casts or skin. This surgically noninvasive, outpatient method, approved by the Food and Drug Administration in November 1979, produced confirmed end results in 1,007 ununited fractures and 71 failed arthrodeses, worldwide. Overall success at Columbia-Presbyterian Medical Center was 81%; internationally, 79%; and in other patients in the United States, 76%. Treatment with PEMFs was effective in 75% of 332 patients (a subset) with an average 4.7-year disability duration, an average of 3.4 previous operative failures to produce union, and a 35% rate of infection. Eighty-four percent of carpal naviculars and 82% of femoral neck-trochanteric nonunions were united. After attempted arthrodeses could not salvage a failed total-knee prosthesis, PEMFs promoted healing in 85% of patients. When coils were unsuccessful alone, combining them with surgical repair was effective.
Ambulatory Care↗