Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity

Bilgili, Mustafa Gökhan; Tanrıverdi, Bülent; Edipoğlu, Erdem; Hürmeydan, Önder Murat; Bayrak, Alkan; Duramaz, Altuğ; Kural, Cemal

doi:10.5606/ehc.2020.75293

Cited by 3 publications

(8 citation statements)

References 19 publications

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“…Six (29%) studies [ 10 , 17 , 20 – 23 ] did not provide this information. In the remaining 11 studies [ 9 , 16 , 24 – 32 ] patients had undergone at least one prior surgical procedure.…”

Section: Resultsmentioning

confidence: 99%

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Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Wagner,

van Trikt,

Visser

et al. 2023

Arch Orthop Trauma Surg

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Introduction In pre-operatively presumed aseptic nonunions, the definitive diagnosis of infection relies on intraoperative cultures. Our primary objective was to determine (1) the rate of surprise positive intraoperative cultures in presumed aseptic long-bone nonunion (surprise positive culture nonunion), and (2) the rate of surprise positive cultures that represent infection vs. contamination. Secondary objectives were to determine the healing and secondary surgery rates and to identify cultured micro-organisms. Materials and Methods We performed a systematic literature search of PubMed, Embase and Cochrane Libraries from 1980 until December 2021. We included studies reporting on ≥ 10 adult patients with a presumed aseptic long-bone nonunion, treated with a single-stage surgical protocol, of which intraoperative cultures were reported. We performed a meta-analysis for: (1) the rates of surprise positive culture nonunion, surprise infected nonunion, and contaminated culture nonunion, and (2) healing and (3) secondary surgery rates for each culture result. Risk of bias was assessed using the QUADAS-2 tool. Results 21 studies with 2,397 patients with a presumed aseptic nonunion were included. The rate of surprise positive culture nonunion was 16% (95%CI: 10–22%), of surprise infected nonunion 10% (95%CI: 5–16%), and of contaminated culture nonunion 3% (95%CI: 1–5%). The secondary surgery rate for surprise positive culture nonunion was 22% (95%CI: 9–38%), for surprise infected nonunion 14% (95%CI 6–22%), for contaminated culture nonunion 4% (95%CI: 0–19%), and for negative culture nonunion 6% (95CI: 1–13%). The final healing rate was 98% to 100% for all culture results. Coagulase-negative staphylococci accounted for 59% of cultured micro-organisms. Conclusion These results suggest that surprise positive cultures play a role in the clinical course of a nonunion and that culturing is important in determining the etiology of nonunion, even if the pre-operative suspicion for infection is low. High healing rates can be achieved in presumed aseptic nonunions, regardless of the definitive intraoperative culture result.

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Section: Resultsmentioning

confidence: 99%

“…Six (29%) studies [ 3 , 20 , 28 – 30 , 32 ] did not report on infection history. In the nine remaining studies patients with history of infection were not included [ 9 , 10 , 16 , 22 – 24 , 26 , 27 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Wagner,

van Trikt,

Visser

et al. 2023

Arch Orthop Trauma Surg

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“…89, 2022, No. 2 ORIGINAL PAPER PŮVODNÍ PRÁCE Many fixation methods have been recommended for nonunion of the humeral shaft, including single or dual plates fixation augmented with autologous bone graft, the intramedullary device with bone morphogenetic proteins, cortical augmentation with the fibular strut, and fixation with Ilizarov apparatus (6,11,14,20,26).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Atrophic nonunions are characterized with a low amount of callus formation, circulatory insufficiency of the bone, and low chance for recovery. This type of nonunion requires debridement of the necrotic tissue, stable fixation and additional biological stimulation (6,14). tional result, 80-60 as good, 60-40 as moderate, 40-20 as poor and 20-0 as very poor (7).…”

Section: Introductionmentioning

confidence: 99%

Is Compressive Intramedullary Nailing an Effective Method in Aseptic Humerus Nonunions without Bone Defects?

İnci¹,

V²,

Duygun³

et al. 2022

ACHOT

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PURPOSE OF THE STUDYTreatment of nonunion of humerus continues to be a matter of debate. For this purpose, many treatment methods have been reported. The aim of this retrospective cohort study is to evaluate the results of patients who underwent revision surgery with compressive intramedullary nailing implemented a single type of surgical technique in aseptic humeral nonunions without bone defects. MATERIAL AND METHODSData of 15 patients with humerus nonunion, all were treated with compressive intramedullary nailing between 2000 and 2019 were retrospectively evaluated. Three patients were hypertrophic and 12 were atrophic types. The mean ages of patients at the surgery was 47.3±18 years. In all cases, maximal bone contact was created between the proximal and distal bone fragments after reaming and debridement, and fixation was performed with compressive intramedullary nailing. Radiological assessment of union was performed based on the RUSHU criteria, and functional outcomes were assessed according to Constant-Murley scoring criteria. RESULTSThe ten out of 15 patients were male. The radiological union was achieved at a mean duration of 16.6±2.3 weeks in 14 patients. The average time of follow-up after nonunion treatment was 25.2±8.8 months. Twelve out of 15 patients implemented bone grafting taken form iliac bone with spongiosa obtained via reaming. The functional results were made according to the Constant-Murley score and excellent functional results were obtained in nine patients, good in four patients and poor functional results in one patient. Implant failure was not observed. One patient has had post-operative transient ulnar nerve palsy and another patient developed transient radial nerve palsy. CONCLUSIONSCompressive intramedullary nailing is a useful method that provides excellent union in the surgical treatment of aseptic non-union of the humerus, without bone defects.

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“…[ 1 ] Surgical treatment with a reamed intramedullary nail (IMN) is a widely preferred treatment option for those fractures such as in nonunion and delayed union of tibial fractures. [ 2 , 3 ] Pseudoarthrosis of the femoral shaft after IMN is still a serious problem that occurs in 0 to 57%. [ 4 ] Treatment of the nonunions that occur after IMN of the femoral diaphysis fractures are very challenging.…”

Section: Introductionmentioning

confidence: 99%

A comparison of exchange nailing and plate augmentation over a retained intramedullary nail in aseptic oligotrophic and atrophic femoral shaft pseudoarthrosis

et al. 2023

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This study aims to evaluate the success of plate augmentation over a retained intramedullary nail (IMN) against exchange nailing performed with autologous bone grafting in oligotrophic and atrophic pseudoarthrosis of the femoral shaft.Patients and methods: Between May 2005 and October 2020, a total of 42 of 56 patients (28 males, 14 females; mean age: 47.3±17.2 years; range, 19 to 84 years) with aseptic atrophic or oligotrophic femoral nonunion were retrospectively analyzed. The patients, 20 were operated with plate over a retained IMN, and the rest (n=22) by exchange nailing. Data including demographic and clinical characteristics of the patients, treatment success, duration of surgery, blood loss during surgery, infection rates, length of hospital stay, time to bridging of the nonunion site, and time to obliteration of the fracture line (solid union) were recorded. Results:The mean follow-up was 23.8±20.4 (range, 12 to 96) months in the plate over an IMN group and 34.7±27.4 (range, 12 to 90) months in the exchange nailing group. At the final follow-up, solid union occurred in all of the patients in the plate augmentation over a retained IMN group, and 21 of 22 (95.45%) patients in the exchange nailing group. Blood loss during surgery was significantly less in the plate augmentation over IMN group (p=0.027). There was no statistically significant difference in the other variables between the two groups (p>0.05). Conclusion:Our study results demonstrate that plate over a retained IMN is effective as exchange nailing in the surgical treatment of oligotrophic and atrophic pseudoarthrosis of the femoral shaft. However, it can be speculated that plate application over IMN is more advantageous in terms of blood loss during surgery.

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Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity

Cited by 3 publications

References 19 publications

Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Is Compressive Intramedullary Nailing an Effective Method in Aseptic Humerus Nonunions without Bone Defects?

A comparison of exchange nailing and plate augmentation over a retained intramedullary nail in aseptic oligotrophic and atrophic femoral shaft pseudoarthrosis

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