Clinical reliability of closed techniques and comparison with open strategies to achieve union at the docking site

Primary and definitive fixation with the TSF is effective. Advantages include continuity of device until union, reduced risk of infection, early mobilization, restoration of primary defect caused by bone loss, easy and accurate application, convertibility and versatility compared with a monolateral fixator, and improved union rate and range of motion for lower extremity long-bone fractures in patients with multiple traumatic injuries.

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“…The mean ISS was 23 6 4.9 (range, scores of [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Section: Resultsmentioning

confidence: 99%

“…19,20 The TSF was newly applied frame because of the hospital's policy that disallows the recycling of frames.…”

Section: Complicationsmentioning

confidence: 99%

Taylor Spatial Frame Fixation in Patients With Multiple Traumatic Injuries

Sala

Elbatrawy

Thabet

et al. 2013

Journal of Orthopaedic Trauma

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“…Union at the docking site can be hastened and cross-section area widened using iliac crest bone grafting 50. Injection of bone marrow aspirate at the nonunion site helps if iliac crest graft sites are exhausted.…”

Section: Docking Sitementioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.

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“…1,2 This bone transport technique is used for treatment of a variety of conditions leading to bone loss. [3][4][5] The traditional Ilizarov approach consisted of simple compression of these soft tissues after bone transport was completed; others have added periods of distraction to stimulate osteogenesis and increase rates of healing, but this is time-consuming and uncomfortable for the patient.…”

Section: Introductionmentioning

confidence: 99%