Atrophic, aseptic, tibial nonunion: how effective is modified Judet’s osteoperiosteal decortication technique and buttress plating?

Bijukachhe, Binod; Singh, Nagmani; Bhandari, Bigyan; John, Rakesh; Prabha, Adhikari

doi:10.1007/s00402-016-2488-7

Cited by 6 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pseudarthrosis of the tibia can be stabilized with the use of external fixators, bone plates, or intramedullary nails [2,[17][18][19][20]. There are no large population studies evaluating treatment outcomes in aseptic pseudarthrosis of the tibia and comparing the Ilizarov method with internal osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

“…Binod et al presented the results of pseudarthrosis treatment via a modified Judet approach in a group of 35 patients. Bone union was achieved in 100% of patients after a mean of 8.24 months [2]. Megas et al reported the results of 50 patients with nonunion of the tibia being treated with intramedullary nails placed with the use of drilling.…”

Section: Discussionmentioning

confidence: 99%

“…A lack of callus formation between bone fragments results in pain, deformity, and pathological mobility in the limb. The estimated proportion of disturbed tibial union is 2.5-11% of all tibia fractures, which is the highest percentage in all long bones [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia—a retrospective comparative analysis

et al. 2020

View full text Add to dashboard Cite

Introduction This study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia. Material and methods In a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity. Results Union rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827). Discussion Our study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia—a retrospective comparative analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Currently, there is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions. While many studies have shown excellent outcomes in patients following reamed exchange nailing for aseptic tibial shaft nonunions, with a reported union rate of 76% to 96% [5], many other studies suggest the use of newer novel techniques such as plating along with osteoperiosteal decortication or more conventional compressive plating with bone grafts [6].…”

Section: Introductionmentioning

confidence: 99%

Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence

Bhan

Tyagi

Kainth

et al. 2020

Cureus

View full text Add to dashboard Cite

One of the most dreaded complications of fracture management is a nonunion. Nonunions are usually difficult to manage and can be a source of significant mental, physical, and financial distress to the patient. The incidence of nonunion is dependent on multiple factors including degree of comminution, open versus closed, concomitant infection, and vascular status, and therefore the management of such nonunions continues to be an often debated topic. Currently, there is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions. While reamed exchange nailing for aseptic tibial shaft nonunions has shown promising results, with very high union rates, many surgeons prefer newer novel techniques such as plating along with osteoperiosteal decortication or the use of more conventional compressive plating with bone grafts. The aim of this article is to critically review and understand the available evidence base on reamed exchange nailing in nonunion of tibial shaft fractures and to explore the other options available and their indications.

show abstract

“…Tibial fractures are the most common long-bone fracture (36.7% of all long-bone fractures in adults) and also happen to be the most common site of long-bone nonunion 1 . Patients with nonunion are more likely to have additional fractures during follow-up, to require various types of in-patient and surgical care (including amputation), to be prescribed pain medications (especially strong opioids), and to use more outpatient physical therapy than those with proper bony union 2 .…”

Section: Introductionmentioning

confidence: 99%

Implantable strain sensor to monitor fracture healing with standard radiography

Pelham

Benza

Millhouse

et al. 2017

Sci Rep

View full text Add to dashboard Cite

Current orthopaedic clinical methods do not provide an objective measure of fracture healing or weight bearing for lower extremity fractures. The following report describes a novel approach involving insitu strain sensors to objectively measure fracture healing. The sensor uses a cantilevered indicator pin that responds to plate bending and an internal scale to demonstrate changes in the pin position on plain film radiographs. The long lever arm amplifies pin movement compared to interfragmentary motion, and the scale enables more accurate measurement of position changes. Testing with a human cadaver comminuted metaphyseal tibia fracture specimen demonstrated over 2.25 mm of reproducible sensor displacement on radiographs with as little as 100 N of axial compressive loading. Finite element simulations determined that pin displacement decreases as the fracture callus stiffens and that pin motion is linearly related to the strain in the callus. These results indicate that an implanted strain sensor is an effective tool to help assess bone healing after internal fixation and could provide an objective clinical measure for return to weight bearing.While a variety of fracture stabilization therapies are available to surgeons for internal fixation, the inability to directly evaluate healing remains a limiting factor when assessing patient recovery and return to a pre-injury activity level. Tibial fractures are the most common long-bone fracture (36.7% of all long-bone fractures in adults) and also happen to be the most common site of long-bone nonunion 1 . Patients with nonunion are more likely to have additional fractures during follow-up, to require various types of in-patient and surgical care (including amputation), to be prescribed pain medications (especially strong opioids), and to use more outpatient physical therapy than those with proper bony union 2 . Median total costs of care for patients with nonunion were found to be more than double those without ($25,556 vs. $11,686 according to 2006 data) 2 . To help prevent complications such as non-union or malunion, refracture and implant failure, physicians often limit weight bearing for an extended time, often 12 weeks or longer, to allow for adequate bone growth 3 . While premature weight bearing can increase the rate of complications, unnecessarily delaying weight bearing results in productivity loss with indirect costs from lost wages and places additional burdens on the healthcare system. Identification of post-operative complications (non-union, infection, implant loosening, etc.) throughout the recovery process, while critical to effective treatment, is often difficult with existing internal fixation methods.Current clinical methods of monitoring bone healing and identifying complications following an open-reduction and internal fixation (ORIF) are typically limited to a combination of symptomatic, physical examination, and radiographic findings. Interpretation is subjective, influenced both by the patient's candid description of symptoms and by the treati...

show abstract

Atrophic, aseptic, tibial nonunion: how effective is modified Judet’s osteoperiosteal decortication technique and buttress plating?

Abstract: Level II.

Cited by 6 publications

References 20 publications

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia—a retrospective comparative analysis

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia—a retrospective comparative analysis

Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence

Implantable strain sensor to monitor fracture healing with standard radiography

Contact Info

Product

Resources

About