Ununited supracondylar fracture of the femur following Attenborough stabilized gliding knee arthroplasty treated by distal femoral replacement.
Explore the source record for details and available documents.
Aged↗
SEARCH · PubMed Health
Results for “FRACTURES, UNUNITED”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Homoplasty in ununited medial fractures and pseudarthroses of the femoral neck].
Explore the source record for details and available documents.
Aged↗
Treatment of scaphoid fractures with carpal instability.
Since 1981, I treated 81 scaphoid fractures: 14 wrists (group A) with acute unstable fracture, 37 (B) with ununited fracture accompanied by dorsiflexed intercalated segment instability (DISI), and 30 (C) with ununited fracture without DISI. The methods and results were evaluated retrospectively. Bone union occurred in 100% of group A wrists, 92% of group B, and 90% of group C. By a modification of Cooney's clinical scoring chart, mean scores were 91 in group A, 84 in group B, and 87 in group C. In 43% of group A, a scapholunate gap remained after surgery. Of 21 wrists in group B treated by bone graft and screw fixation, union was not achieved in one; in another 13, the R-L angle was corrected to within 10 degrees of the unaffected side. In group C, DISI did not develop if bone union occurred. There was correlation between shortness of the scaphoid and DISI remaining. The clinical scores of wrists with and without DISI were not different, except for patients who did hard manual labor, in half of whom the score was poor when DISI remained. Cineradiography of ununited fractures was done before and after surgery. For three wrists in group B, plain X-ray films showed that DISI improved, but cineradiography showed that DISI was present; even without static DISI, there may be dynamic DISI. Treatment of acute unstable fractures of the scaphoid by reduction and internal fixation generally gave satisfactory results. Perhaps when ligament injury may have caused instability, ligament repair or reconstruction is needed. For ununited fractures with DISI, correction of the DISI was needed as well as bone union. If union occurred with the scaphoid shorter than normal, DISI was present, so restoration of the length of the scaphoid during surgery is mandatory.
Adolescent↗
The Canadian experience with pulsed magnetic fields in the treatment of ununited tibial fractures.
A clinical survey of 56 patients was conducted at four different centers in Canada to evaluate the effect of extremely low frequency pulsed magnetic fields (PMF) on ununited fractures of the tibia. All ten patients with delayed union and 84% of the 44 patients with nonunion healed. One case with a traumatic pseudarthrosis and one with a congenital pseudarthrosis failed to respond to treatment. These results compare favorably to those reported by others using a system with different pulse characteristics. Prolonged immobilization is necessary and poses problems of rehabilitation. Nonunions with a gap between the tibial fragments and pseudarthroses are better treated with bone grafting and internal fixation prior to electrical stimulation.
Adolescent↗
[Autologous spongious iliac bone graft in the treatment of ununited diaphyseal fractures of the long bones].
In the treatment of ununited diaphyseal fractures the authors stick to three basic principles: rigid fragment stabilization, reduced fracture split and osteogenous stimulus addition. A multiple autologous spongious iliac bone graft was used as an ostogenous stimulus. This method was applied in 47 patients within the period 1978-1987. Healing occurred in 45 (95.7%) patients. Calus leading to healing has a form of external overbridging calus.
Adult↗
The efficacy of ununited tibial fracture treatment using pulsing electromagnetic fields: relation to biological activity on nonunion bone ends.
Thirty ununited tibial fractures with a median time since injury of 18+/-9 months were treated by electrical stimulation using pulsing electromagnetic field therapy. Union was achieved in 25 cases (83.3%) in a median interval of 8.6+/-3.2 months. Patient age and gender, the presence of surgical hardware, length of disability, and the number of surgical procedures did not affect the outcome. Ununited fractures that appeared to be hypertrophic or sclerotic type radiographically, indicating a good blood supply to the bone ends, all healed. Treatment failures occurred only among lesions with a poor blood supply, and in necrotic or defective radiopraphic types. Pulsing electromagnetic field therapy is an effective treatment for ununited tibial fractures with good blood supply to the bone ends.
Adult↗
Microvascular osteocutaneous groin flap in the treatment of an ununited tibial fracture with chronic osteitis. A case report.
A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. The bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.
Adult↗
Results of treatment of infected humeral nonunions: the Mayo Clinic experience.
Between 1987 and 2001, 15 infected humeral nonunions were treated of which nine were distal, four were proximal, and two were midshaft. One patient was lost to followup. The remaining 14 patients were followed up for a mean of 37 months (range, 8-156 months). All patients were treated with debridement and intravenous antibiotics. Ten patients had surgical attempts at achieving bony union: external fixation (four patients), plating (two patients), external fixation and plating (two patients), tension band wiring (one patient), and bone grafting with shoulder spica casting (one patient). Three patients were treated definitively with a functional brace because of low functional demands and one patient had resection arthroplasty followed by delayed total elbow arthroplasty. Of the 10 nonunions treated with surgical attempts at achieving bony union, only seven healed. None of those nonunions in patients treated with a functional brace healed. At final followup, 12 of 14 patients had minimal or no pain and two patients had moderate pain, both with ununited fractures. Complications included one seroma and two cases of posttraumatic elbow stiffness for which the patients required capsular release. This study documents the challenges in achieving bony union in the infected humeral nonunion in contradistinction to the predictable union rates reported for aseptic humeral nonunions. Although pain relief was predictable in most patients, functional results generally were poor and bony union was difficult to obtain.
Adolescent↗
Anatomico-radiological study of an ununited intracapsular fracture of the femoral neck dating back 47 years. Data relevant to osteoarthritis, bone infarct, and Paget's disease of the bone.
This is the anatomico-radiological study of a 47-year-old ununited intracapsular fracture of the hip. The femoral head was osteoporotic but its center contained a zone of osteomedullary necrosis in the form of a bone infarct. Its contour was reshaped and remnants of articular cartilage were covered by osteophyte-like bone formations; furthermore, an acetabular osteophyte was observed. Histological signs of Paget's disease of the bone were observed in the medial part of the femoral stump. The findings in this case provide the basis for a discussion of the pathogenesis of osteophytes in osteoarthritis, the pathogenesis of bone infarcts (and the distinction between this condition and another form of aseptic osteonecrosis), and the role of mechanical stresses in the development of Paget's disease of the bone.
Aged↗
Sternocostoclavicular hyperostosis. Radiological and pathological study of a specimen with ununited clavicular fracture.
Anatomico-radiological study of a sternocostoclavicular mass taken post-mortem from a man whose clinical history had shown bilateral sternocostoclavicular hyperostosis (SCCH) with plantar pustulosis for 27 years. The clavicle showed an ununited fracture attributable to a trauma sustained five years earlier. Both clavicular segments showed active remodelling with intraosseous granulation tissue and periosteal metaplastic ossification. The sternocostoclavicular region was fused in a bony block in which there were no signs of remodelling activity. The first rib and the distal extremity of the clavicle were histologically normal. These observations support the conclusions of a previous study of another case of SCCH. The condition might be due to a bone infection caused by an--as yet--unknown germ. Bone remodelling would explain the periosteal hyperostosis and the fragility of the underlying bone. Furthermore, the possibility that the condition might also be a joint disease related to the group of rheumatic diseases called spondyloarthropathies should be considered.
Adult↗
The treatment of fractures with a dynamic axial fixator.
The results obtained with a lightweight dynamic axial fixator in the treatment of fractures are reported. The apparatus comprises a single bar with articulating ends which clamp self-tapping screws and can be locked at an angle appropriate for axial alignment. A telescopic facility allows ready conversion from rigid to dynamic fixation once periosteal callus formation has commenced. Reduction and controlled distraction or compression are achieved by means of a detachable compressor unit. We treated 288 patients with fresh fractures and 50 with ununited fractures. The success rate for fresh fractures was 94%, with average healing times ranging from 3.4 to 6.5 months. In ununited fractures also, the success rate was 94% with average healing times ranging from 4.7 to 6.5 months. Complications were minimal. The device is versatile and can be applied in an average of 15 minutes. It permits ambulatory fracture care without sacrificing a sound anatomical result.
Adolescent↗
External fixation for the uninfected angulated nonunion of the tibia.
External skeletal fixation is an effective method of stabilizing angulated ununited fractures of the tibia. In 14 patients who were not infected, realignment was accomplished by: closed-fracture-site manipulation (five cases); fibular osteotomy and closed manipulation (six cases); or fibular osteotomy and open reduction (three cases). External fixation was selected instead of internal fixation for patients in whom there was: risk of reactivating quiescent sepsis; thin secondary epithelium adherent to bone that might slough after surgical dissection; a very proximal or a very distal nonunion, where internal fixation is technically difficult; or a bulky, angulated delayed union or nonunion or one in bayonet apposition that would require excessive plate contouring. On the average, patients were corrected from 17.3 degrees (either varus or valgus) to 2.3 degrees. Two patients did not unite with the fixator/orthosis treatment plan, but neither one lost correction during subsequent management. The technique is not suitable for atrophic nonunions.
Adolescent↗
Preoperative planning in the surgical correction of tibial nonunions and malunions.
Three typical cases demonstrate the achievement of precision in the reconstruction of ununited fractures of the tibia by preliminary planning with the aid of tracings on roentgenograms, templates, and goniometer measurements.
Adult↗
The infected nonunion of the tibia.
Ununited fracture of the tibia complicated by infection is not only a complex surgical problem but also a chronic and at times debilitating condition. The principle methods used to diagnose and stage posttraumatic tibial osteomyelitis are described. Infected nonunions of the tibia are characterized by the extent of bony loss and the presence of a functional ipsilateral fibula. Using this tibial staging criteria, a series of 37 infected nonunions of the tibia are reviewed. Twenty patients were male and 16 were female, with an average age of 33 years. The distal third of the tibia was involved in 19 patients, the middle third in 11, and proximal third in 7. Twenty three of the tibia were infected with > 1 organism. Thirty were Type 3 (tibial defect of 6 cm or less with a long and usable fibula), 4 Type 4 (tibial defect > 6 cm without usable fibula), and 3 Type 5 (tibial defect > 6 cm without usable fibula). The patients were evaluated at an average of 61 months after treatment. Union and eradication of infection were achieved in 35 of 37 patients. The results of the Health Impact Analysis suggest that the infected nonunion of the tibia represented a chronic and debilitating disorder with a lasting impact.
Adolescent↗
[Closed intramedullary nailing of fractures of the shaft of the humerus].
Fifty seven fractures of the shaft of the humerus were treated by closed intramedullary nailing without reaming of the proximal part of the bone. Fifty three of the fifty seven fractures healed promptly with an average time to union of 52 days. The technique of operation is described and the authors compare the results of their management with other methods of treatment. The indications for the use of closed nailing are discussed and its role in the treatment of pathological fractures and ununited fractures indicated.
Adolescent↗
Scaphoid nonunion treated by open reduction, anterior inlay bone grafting, and Kirschner-wire fixation.
Forty-three patients with ununited fractures of the scaphoid were treated by open reduction, anterior inlay bone grafting and Kirschner wire fixation. All but one achieved bone union. The one failure was successfully treated with a second anterior inlay bone grafting procedure. The average period of cast immobilization was 7 weeks. The presence of an unstable nonunion did not adversely affect the results. In cases with carpal instability, we used a longer corticocancellous graft to restore a more normal alignment of the scaphoid by opening up the volar cortex. Preoperatively, carpal instability was present in 25 patients. In these cases, carpal alignment demonstrated by the radiolunate and scapholunate angle was improved significantly after surgery: the radiolunate angle from 15 degrees before surgery to 2 degrees after surgery, and the scapholunate angle from 67 degrees to 54 degrees, respectively. Pain, restricted motion of the wrist, and the grip strength were improved after surgery.
Adolescent↗
The treatment of infected and uninfected non-union.
One hundred and sixteen patients with 129 ununited fractures were treated either by rigid internal fixation and bone grafting or, in 14 tibial non-unions, by posterolateral bone grafting. In 37 actively infected cases this was combined with sequestrectomy and appropriate antibiotics. The final success rate was 98.4%. Technical errors or inadequate immobilisation after operation in patients with severe osteoporosis led to some early failures. No patient had a discharge or evidence of osteomyelitis after removal of metal. Rigid internal fixation with or without bone grafting is the treatment of choice for established non-union with bone loss when true synovial pseudarthrosis is present, when malalignment or shortening needs correction, and when prolonged immobilisation is either difficult or would lead to unacceptable stiffness in adjacent joints. Active osteomyelitis is not a contra-indication to internal fixation.
Adolescent↗
Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion.
We reviewed 40 extensive destructive vertebral lesions in 35 patients with established ankylosing spondylitis. Of these, 31 had presented with localised pain while three had a neurological deficit. The radiographs suggested ununited fractures through either ankylosed discs (37) or vertebral bodies (3). Corresponding fractures were seen in the posterior column in 34 cases. Sixteen patients with 18 lesions underwent anterior spinal fusion, and pseudarthrosis was consistently proven by histopathology. Two pseudarthroses healed in conservatively treated patients. Thirteen of the operated patients were followed for an average of 7 years 7 months. There were two cases of non-union and one required an additional posterior fusion; in the remainder fusion was sound.
Adult↗