Tag Archive for: Nonunion

The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw

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Vol 4 | Issue 1 | May – Aug 2018 | page: 29-33 | Wasudeo mahadeo Gadegone, Bhaskaran Shivashankar, Rajendra Chandak, Piyush Gadegone.

doi-10.13107/ti.2018.v04i01.063

Author: Wasudeo mahadeo Gadegone [1], Bhaskaran Shivashankar [2], Rajendra Chandak [3], Piyush Gadegone [4].

[1] GMC Chandrapur, Maharashtra, India.
[2] Iyer Orthopaedic Hospital, Solapur, India
[3] Chandak Nursing Home Nagpur Maharashtra India.
[4] Sion Hospital, Mumbai, India

Address of Correspondence
Dr. W.M. Gadegone,
Vivek Nagar Mul-Road Chandrapur 442402, Maharashtra, India.
Email: gadegone123@yahoo.co.in

Abstract

Introduction: The aim of the present study was to evaluate the outcomes of displaced intracapsuar fracture neck femur managed by dynamic hip screw (DHS) with derotation screw treated within ten days of injury in patients younger than 60 years.
Materials and methods: This was a prospective study, carried out between December 2010 to December 2016. A total of 42 patients younger than 60 yrs of age with displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with the comminution) presenting to the hospital within 2-10 days were included in the study. Data analysis and statistical analysis was done by using SPSS using appropriate tests.
Results: There were 27 males and 15 females, age ranging from 21 to 60 years (mean42.4±10.2 years). There were twenty seven Garden III while fifteen fractures were Garden IV. In forty fractures (95.2 %) average time to union was 3.7 months [3-5 months]. Radiographic evidence of avascular necrosis was seen in four cases(9.5%) and two patients(4.7%) developed non-union of the fracture .There were no cut-outs and breakage of implant .Two patients developed isolated coxa vara ( 120-124°) with backing of screws. Mean shortening of the injured limb was 2 -4 mm in twenty four patients without any functional impairment. Functional results were evaluated by Harris Hip Score. Excellent results were achieved in thirty four (81%), good/fair in six (14.2%) and poor in two (4.8%)patients.
Conclusion: Dynamic Hip Screw (DHS) with derotation screw is a good implant for the fixation of the displaced fracture neck femur with excellent to good radiological and functional outcome.
Keywords: Fracture neck femur, transcervical/ subcapital fracture, cannulated cancellous screw, dynamic hip screw, avascular necrosis, nonunion.

References

1. Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, Lian YT. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013;95:61-69
2. Deneka DA, Simonian PT, Stankewich CJ, et al ;Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma. 1997;11:337–343.
3. Wei J, Mao YJ, Jia ZZ (Treatment of 212 cases of fresh femoral neck fracture with compressed hollow screws. Chin J Traumatol 2000 16: 142-144 4
4. Makki D, Mohamed AM, Gadiyar R, Patterson M ;Addition of an anti-rotation screw to the dynamic hip screw for femoral neck fractures. Orthopedics. 2013;36:865–868.
5. Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury. 2002;33 Suppl 3:C24–C32.
6. W.-C. Chen, S.-W. Yu, I.-C. Tseng, J.-Y. Su, Y.-K. Tu, and W.-J. Chen, “Treatment of undisplaced femoral neck fractures in the elderly,” Journal of Trauma, 2005 vol. 58, no. 5, pp. 1035–1039
7. Gurusamy K, Parker MJ, Rowlands TK. ;The complications of displaced intracapsular fractures of the hip: The effect of screw positioning and angulation on fracture healing. J Bone Joint Surg [Br] ;2005 87-B:632–634
8. Baumgaertner MB, Solberg BD .Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hips. J Bone Joint Surg [Br] 1997;79-B:969–971.
9. Ly, T. V., &Swiontkowski, M. F. Treatment of femoral neck fractures in young adults. Journal of Bone and Joint Surgery. American Volume,2008 90, 2254–2266
10. Haidukewych, G. J., Rothwell, W. S., Jacofsky, D. J., Torchia, M. E., & Berry, D. J. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. The Journal of Bone & Joint Surgery, 2004 86, 1711–1716.
11. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am. 1974;5:683-712.
12. Liporace, F., Gaines, R., Collinge, C., &Haidukewych, G. J. Results of internal fixation of pauwels type-3 vertical femoral neck fractures. The Journal of Bone & Joint Surgery, 2008. 90: 1654–1659.
13. Shabnam Samsami,Sadegh Saberi,Sanambar Sadighi,Gholamreza Rouh; Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations .Journal of Medical and Biological Engineering. 2015 October, Volume 35, Issue5, pp 566–579
14. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. ClinOrthop RelatRes.2002 ;59-71.
15. Karaeminogullari O, Demirors H, Atabek M, Tuncay C, Tandogan R, Ozalay M. Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery. Adv Ther.2004 ;21:335-342. Andreas Panagiotopoulos
16. AndreaPiccioli,Peter V. Giannoudis;Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome;Injury 2015 March Volume 46, Issue 3, Pages 459–466
17. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, Ravikumar K. Time to internal fixation of femoral neck fractures in patients under sixty years–does this matter in the development of osteonecrosis of femoral head? International orthopaedics ;2012;36:2127-2132.Slobogean GP
18. 1, Sprague SA2, Scott T3, Bhandari M2; Complications following young femoral neck fractures. Injury.2015. Mar;46(3):484-91.
19. Stiasny J., Dragan S., Kulej M., Martynkiewicz J., Płochowski J., Dragan S.ŁComparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws. OrtopTraumatolRehabil.2008 ;10(4):350–361.
20. Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK;Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint SurgBr. 2004;86:1035–1040.
21. Lee CH, Huang GS, Chao KH, Jean JL, Wu SS.Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg.;2003.123:527-33 Lu-Yao GL
22. 1, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.J Bone Joint Surg Am. 1994. Jan;76(1):15-25.
23. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. Aug. 2005.87(8):1680-8. Barnes R
24. Brown JT, Garden RS, Nicoll EASubcapital fractures of the femur. A prospective review. J Bone Joint Surg Br.1976 Feb;58(1):2-24.

How to Cite this article:  Gadegone WM, Shivashankar B, Chandak R, Gadegone P. The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw. Trauma International JMay-Aug 2018;4(1):29-33.

 

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Role of Antibiotic Cement-coated Nailing in Infected Nonunion of Tibia

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Vol 4 | Issue 1 | May – Aug 2018 | page: 18-21 | Clevio Desouza,Vinod Nair, Amit Chaudhary, Harshal Hurkat, Shiju George.

Author: Clevio Desouza [1],Vinod Nair [1], Amit Chaudhary [1], Harshal Hurkat [1], Shiju George [1].

[1] Department of Orthopaedics, Dr D.Y.Patil Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Clevio Desouza,
Department of Orthopaedics, Dr D.Y.Patil Hospital, Pune, Maharashtra, India.
E-mail: ceviod@gmail.com

Abstract

Introduction: The infection of long bones along with its nonunion is a chronic and debilitating disorder. It becomes difficult to deal with the situation in which the implant which is used for internal fixation itself becomes a potential media for infection because of the formation of biofilms and adhesions. Traditionally, this situation is managed by a two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement-coated nailing as a single stage treatment modality for achieving stability and treating of the infection at the same time.
Materials and Methods: 20 patients (above 18years of age) with nonunion of tibia associated with infection with bone gap <2 cm were managed using antibiotic cement-coated Kuntscher nail. Antibiotics used were a combination of vancomycin and teicoplanin.
Results: Infection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Bone grafting or exchange nailing type additional procedures were required in the remaining eight patients, and this was done in six patients, with union of the fracture. Two patients refused to undergo further procedures. The various complications encountered during this study were difficult nail removal in three cases, broken nail in two cases, and bent nail in 1 case. Recurrence of infection was observed in two patients. The average period of follow-up was 12 months.
Conclusion: Antibiotic cement impregnated nailing is a simple, economical, and effective single-stage procedure for the management of infected nonunion of the tibia. It has many advantages over external fixators, as it eliminates the complications and has good patient compliance. The method utilizes existing easily available instrumentation and is technically demanding and therefore can be performed at any hospital.
Keywords: Nonunion, infected, antibiotic, cement, nailing.

References

1. Toh CL, Jupiter JB. The infected nonunion of the tibia. ClinOrthopRelat Res 1995;315:176-191.
2. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: Current management concepts. J Am AcadOrthopSurg 2005;13(6):417-427.
3. Stoodley P, Ehrlich GD, Sedghizadeh PP, Stoodley LH, Baratz ME, Altman DT, et al. Orthopaedic biofilm infections. CurrOrthopPract2011;22(6):558-563.
4. Nelson CL. The current status of material used for depot delivery of drugs. ClinOrthopRelat Res 2004;427:72-78.
5. Cierny G, Mader J. The surgical treatment of adult osteomyelitis. In: CMC Evarts, editor. Surgery of the Musculoskeletal System. New York, USA: Churchill Livingstone; 1983. p. 4814-4834.
6. Court-Brown CM. Fractures of the tibia and fibula. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 2080-2146.
7. Beals RK, Bryant RE. The treatment of chronic open osteomyelitis of the tibia in adults. ClinOrthopRelat Res 2005;433:212-217.
8. Ueng SW, Chuang DC, Cheng SL, Shih CH. Management of large infected tibial defects with radical debridement and staged double-rib composite free transfer. J Trauma 1996;40(3):345-350.
9. Chen CE, Ko JY, Wang JW, Wang CJ. Infection after intramedullary nailing of the femur. J Trauma 2003;55(2):338-344.
10. Wu CC, Shih CH. Distal tibial nonunion treated by intramedullary reaming with external immobilization. J Orthop Trauma 1996;10(1):45-49.
11. Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: Preliminary results in nine cases. J Orthop Trauma 2002;16(10):723-729.
12. Qiang Z, Jun PZ, Jie XJ, Hang L, Bing LJ, Cai LF. Use of antibiotic cement rod to treat intramedullary infection after nailing: Preliminary study in 19 patients. Arch Orthop Trauma Surg 2007;127(10):945-951.
13. Madanagopal SG, Seligson D, Roberts CS. The antibiotic cement nail for infection after tibial nailing. Orthopedics 2004;27(7):709-712.
14. Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma 2007;21(4):258-268.
15. Sancineto CF, Barla JD. Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: Nineteen consecutive cases with a minimum of 12 months follow-up. J Trauma 2008;65(6):1416-1420.
16. Nelson CL, Hickmon SG, Harrison BH. Elution characteristics of gentamicin-PMMA beads after implantation in humans. Orthopedics 1994;17(5):415-416.
17. Nizegorodcew T, Palmieri G, Marzetti E. Antibiotic-coated nails in orthopedic and trauma surgery: State of the art. Int J ImmunopatholPharmacol 2011;24 1 Suppl 2:125-128.
18. Riel RU, Gladden PB. A simple method for fashioning an antibiotic cement-coated interlocking intramedullary nail. Am J Orthop (Belle Mead NJ) 2010;39(1):18-21.
19. Dhanasekhar R, Jacob P, Francis J. Antibiotic cement impregnated nailing in the management of infected nonunion of femur and tibia. Kerala J Orthop2013;26(2):93-97.
20. Kim JW, Cuellar DO, Hao J, Seligson D, Mauffrey C. Custom-made antibiotic cement nails: A comparative study of different fabrication techniques. Injury 2014;45(8):1179-1184.
21. Akinyoola AL, Adegbehingbe OO, Aboderin AO. Therapeutic decision in chronic osteomyelitis: Sinus track culture versus intraoperative bone culture. Arch Orthop Trauma Surg 2009;129(4):449-453.
22. Beals RK, Bryant RE. The treatment of chronic open osteomyelitis of the tibia in adults. ClinOrthopRelat Res 2005;433:212-217.
23. Henry SL, Ostermann PA, Seligson D. The prophylactic use of antibiotic impregnated beads in open fractures. J Trauma 1990;30(10):1231-1238.
24. Chen CE, Ko JY, Wang JW, Wang CJ. Infection after intramedullary nailing of the femur. J Trauma 2003;55(2):338-344.
25. Tunney MM, Ramage G, Patrick S, Nixon JR, Murphy PG, Gorman SP. Antimicrobial susceptibility of bacteria isolated from orthopedic implants following revision hip surgery. Antimicrob Agents Chemother 1998;42(11):3002-3005.
26. Chang Y, Chen WC, Hsieh PH, Chen DW, Lee MS, Shih HN, et al.In vitro activities of daptomycin-vancomycin-and teicoplanin-loaded polymethylmethacrylate against methicillin-susceptible, methicillin-resistant, and vancomycin-intermediate strains of Staphylococcus aureus. Antimicrob Agents Chemother 2011;55(12):5480-5484.
27. Öztemür Z, Sümer Z, Tunç T, Pazarcé Ö, Bulut O. The effect of low dose teicoplanin-loaded acrylic bone cement on biocompatibility of bone cement. ActaMicrobiolImmunol Hung 2013;60(2):117-125.
28. Green SA. Complications of external skeletal fixation. ClinOrthopRelat Res 1983;180:109-116.
29. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. ClinOrthopRelat Res 1990;250:81-104.
30. Shyam AK, Sancheti PK, Patel SK, Rocha S, Pradhan C, Patil A. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones. Indian J Orthop 2009;43(4):396-402.
31. Pradhan C, Patil A, Puram C, Attarde D, Sancheti P, Shyam A. Can antibiotic impregnated cement nail achieve both infection control and bony union in infected diaphyseal femoral non-unions? Injury. 2017 Aug;48 Suppl 2:S66-S71
32. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG Jr, Singh J. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma 2012;26(3):184-188.
33. Kendall RW, Duncan CP, Smith JA, Ngui-Yen JH. Persistence of bacteria on antibiotic loaded acrylic depots. A reason for caution. ClinOrthopRelat Res 1996;329:273-280.

How to Cite this article:  Desouza C, Nair V, Chaudhary A, Hurkat H, George S. Role of Antibiotic Cement-coated Nailing in InfectedNonunion of Tibia. Trauma International May-Aug 2018;4(1):18-21.

 

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