Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series

Perisano, Carlo; Greco, Tommaso; Polichetti, Chiara; Inverso, Michele; Maccauro, Giulio

doi:10.3390/jfmk6040097

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…Contrarily, tibial shaft fractures are often open due to its anteromedial aspect is only skin-covered. Therefore, a septic nonunion is very common [ 24 , 25 ]. In the literature, the treatment principle had been largely established.…”

Section: Discussionmentioning

confidence: 99%

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

2022

J Orthop Surg Res

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Background Closed reamed locked intramedullary nailing has been the treatment of choice for most of femoral shaft fractures. A high union rate with a low complication rate is generally predictable. For an aseptic femoral shaft nonunion with a prior inserted intramedullary nail, exchange nailing is one of favored surgical techniques for treatment. However, a greatly varied success rate of 72–100% has been reported. To improve the success rate of exchange femur nailing, a modified bone grafting technique was developed. The purpose of this retrospective study intended to evaluate outcomes of such a revised technique. Methods From July 2011 to March 2019, 48 consecutive adult patients (average, 38 years; range, 19–67 years) with aseptic femoral shaft nonunions after intramedullary nailing treatment were studied. All femoral shaft fractures were initially caused by traffic accidents, which were treated by a closed or open intramedullary nailing technique at various hospitals. The current revision treatment was performed after an average of 2.2 years (range 1.1–6.2 years) from initial injuries. In the surgery, the prior nail was removed and the marrow cavity was reamed widely (at least 2 mm as possible). Sufficient cancellous bone grafts harvested on the trochanteric marrow wall from the inside were placed in the marrow cavity of the junction of nonunion fragments. A new 1-mm smaller size locked intramedullary nail was inserted. Whether the dynamic or static mode of nails were used mainly depended on the nonunion level. Postoperatively, protected weight bearing with crutches was allowed for all patients. Results Forty-one patients were followed for an average of 2.8 years (85.4%; range, 1.9–4.5 years) and all fractures healed. The union rate was 100% (41/41, p < 0.001) with a union time of an average of 3.4 months (range, 2.5–5.0 months). There were no complications of deep infection, nonunions, malunions, implant failures or an avulsed trochanter tip fracture. The satisfactory knee function improved from 73.2% (30/41) preoperatively to 92.7% (38/41) at the latest follow-up (p = 0.019). Conclusions The described modified bone grafting technique may effectively improve a union rate of exchange femur nailing while the surgical procedure is not complicated. It may therefore be used concomitantly in all aseptic femoral shaft nonunions when exchange nailing is performed.

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Section: Discussionmentioning

confidence: 99%

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

2022

J Orthop Surg Res

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“…While some surgeons prefer to use IMNs augmented with poller screws to treat tibial plateau fractures, which may assist in reducing deformity in the axis and reducing fractures more effectively by directing the IMN during insertion. [18][19][20] Numerous studies reported nonunion, 21 coronal malalignment, 22 sagittal malalignment, 23 complication of superficial 24 /deep infection, 22,[25][26][27] and the need for secondary surgical procedures 21 in the treatment of difficult reduction tibial shaft fractures. It still remains controversial whether this is the best surgical approach when you take into account the increased difficulty of fracture reduction and the poor postoperative results.…”

Section: Discussionmentioning

confidence: 99%

Use of a Minimally Invasive Traction Repositor versus Conventional Manual Traction for the Treatment of Tibial Fractures: A Comparative Study from a Tertiary Hospital in China

Zha¹,

Zhang²,

Wang³

et al. 2022

TCRM

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Background Closed reduction and intramedullary nail fixation of tibial fractures may not utilize a fracture table or reduction aids like a femoral distractor, and only manual traction will help aid the reduction process. This study aimed to describe and further investigate the effectiveness of an originally designed minimally invasive traction repositor (MITR) for the treatment of tibial fractures. Methods From January 2018 to April 2021, a total of 119 eligible patients with tibial shaft fractures were included and retrospectively assigned to two groups according to different reduction methods: MITR group vs conventional manual traction (CMT) group. The baseline characteristics between the two groups were comparable, including age, gender, BMI, residence, smoking history, drinking history, injury mechanism, fracture type, ASA, method of anesthesia, and surgical delay (all P > 0.05). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of intraoperative fluoroscopies, VAS, HSS, fracture healing time, and complications were compared. Results All patients completed the follow-ups with an average of 18.5 months (range 12–42 months). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, and number of fluoroscopies were significantly decreased in the MITR group (all P < 0.05). At one month postoperatively, the VAS score was statistically lower in the MITR group (1.8±0.8) than in the CMT group (2.6±1.5). At 6 months postoperatively, the HHS score was statistically higher in the MITR group (90.8±2.3) than in the CMT group (86.4±3.8). We observed no statistical difference in the mean fracture healing time, bone nonunion, implant failure, and infection between the two groups (all P > 0.05). Conclusion Compared with CMT, MITR facilitates the minimally invasive treatment of tibial fractures and has the advantages of operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of fluoroscopies, and satisfactory VAS and HSS scores.

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“…Although an aseptic NU of the femoral shaft after IMN is rather rare compared to other bone localizations [ 5 , 6 , 7 ], recent studies suggest that it may occur in the range of 1.1% to 14% [ 8 , 9 ]. On average, 200 cases of long bone nonunion occur per million population, estimating a total of 150,000 cases in Europe each year [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review

et al. 2022

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Background: Femoral shaft fractures (FSFs) are a frequent injury in traumatology for which intramedullary nailing (IMN) is considered the gold standard treatment. Nonunion (NU) is one of the most frequent complications in FSF treated with IMN, with a percentage from 1.1% to 14%. Plate augmentation (PA), the addition of a compression plate and screws, with or without bone graft has been described as an effective option for the treatment of NU, improving the biomechanical conditions at the fracture site. The aim of this review was to analyze the literature relating to the use of PA in NU after IMN in FSFs to assess the efficacy of the technique. Methods: An electronic search on PubMed, Google Scholar, and Web of Science was conducted to search for all studies concerning PA of femoral shaft NUs after IMN. Results: Twenty-four studies were included in the review comprising a total of 502 patients with a mean age of 39.5 years. Of these, 200 hundred patients had atrophic pseudoarthrosis and 123 had hypertrophic pseudoarthrosis, while in 179, the type of pseudoarthrosis was not reported. The most frequently used plate for PA was the dynamic compression plate (DCP); in 87.1% of the cases, the authors added a bone graft to the plate fixation. In 98.0% of the patients, a complete bone union was achieved in a mean time of 5.8 ± 2.12 months. Conclusion: The patients treated with PA included in this review showed a good rate of consolidation in the femoral shaft NUs, with good functional recovery and a low incidence of complications.

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Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series

Cited by 18 publications

References 26 publications

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

Use of a Minimally Invasive Traction Repositor versus Conventional Manual Traction for the Treatment of Tibial Fractures: A Comparative Study from a Tertiary Hospital in China

Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review

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