Fractures of the Tibial Shaft A Critical Evaluation of Treatment Alternatives

Karlström, Gunnar; Olerud, S

doi:10.1097/00003086-197411000-00006

Cited by 70 publications

(48 citation statements)

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“…In this study only nonunions with a radiolucent line were treated. While there was no detailed description about bone defects in previous series [4,5,10,11,12], theoretically, the amount of reaming bone graft should be not copious as it will affect union rate [8].…”

Section: Discussionmentioning

confidence: 98%

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Exchange nailing for aseptic nonunion of the femoral shaft

2002

International Orthopaedics

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Thirty-six nonunions of the femoral shaft were treated by closed removal of previous nails, reaming of marrow cavity as widely as possible, and reinsertion of stable intramedullary nail. Indications included femoral shaft aseptic nonunions with inserted intramedullary nail, nonunions with a radiolucent line, without segmental bony defects, and less than 1 cm shortening. They were followed up for a median of 2.9 (1-6) years. Thirty-three nonunions healed uneventfully within a median period of 4 (3-8) months. Except for three persistent nonunions, no other significant complications occurred.Résumé Trente-six pseudarthroses de la diaphyse fémo-rale ont été traitées par ablation à foyer fermé du clou précédent, et ré -insertion d'un clou centro-médullaire stable en alésant la cavité médullaire aussi largement que possible. Les indications étaient les pseudarthroses de diaphyse fémorale aseptique avec clou centro-médullaire, les pseudarthroses avec persistance de la ligne fracturaire sans perte osseuse segmentaire, et avec moins d'un centimètre de raccourcissement. Ils ont été suivis avec une médiane de 2.9 (1-6) années. Trente-trois pseudarthroses ont guéri dans une période moyenne de 4 (3-8) mois. À l'exception de 3 pseudarthroses persistantes, aucune autre complication notable ne s'est produite.

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Section: Discussionmentioning

confidence: 98%

“…Clinically, it seems impossible to use patients for testing. Factors favoring fracture healing are minimal gap, adequate stability, and sufficient nutrition supply [8]. Because the size of bone defects can affect union rate, open bone grafting should be considered if any doubt exists [15].…”

Section: Discussionmentioning

confidence: 99%

Exchange nailing for aseptic nonunion of the femoral shaft

2002

International Orthopaedics

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“…Factors favouring fracture healing include minimal gap, adequate stability and sufficient nutrition supply [11]. Once a non-union occurs, treatment principles include minimising the gap, providing stability and initiating osteogenic potential [15].…”

Section: Discussionmentioning

confidence: 99%

Speeded gradual lengthening and secondary angled blade plate stabilisation for proximal tibial shaft non-union with shortening

Lee

2007

International Orthopaedics (SICO

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Eighteen patients with proximal tibial shaft nonunion and shortening were treated. In each patient, the nonunion area was débrided, realigned and stabilised with an Ilizarov lengthening frame. The tibia was gradually lengthened by 1-1.5 mm per day. After achieving the desired length, external fixation was converted to an angled blade plate and packed with cancellous bone graft. Follow-up of 16 patients for a median of 2.4 (1.2-4.5) years revealed satisfactory outcomes in all. No wound infections were noted. The described technique has a high success rate, a short treatment course and reduces patient discomfort. This method may be considered preferential treatment for all patients with the specified indications.

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“…These speculations have been essential in the debate concerning internal fixation versus nonoperative treatment of tibial-shaft fractures (Karlstrom andOlerud 1974, Rommens andSchmit-Neurerburg 1987). Rosemeyer and Pforringer (1979) considered varus deformity exceeding 6" and a valgus deformity exceeding 12" to be "prearthrotic.…”

Section: Kristensen' Thomas Kiaer'and Jens Blicher2mentioning

confidence: 99%