Management of tibial non-unions: Prospective evaluation of a comprehensive treatment algorithm

Ferreira, Nando; Marais, LC; Aldous, Colleen

doi:10.17159/2309-8309/2016/v15n1a6

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…5,[10][11][12][13] The complications encountered in this study offered some key learning points. The pin-site infection rate in this study was 33%, which is significantly higher than the 17.9% incidence of pin-site sepsis found by Ferreira et al in their study involving tibias, 12 but also lower than the 41.6% pin-site sepsis rate quoted by Al-Sayyad in his study of TSFs of the upper limb in a paediatric population. 13 The majority (80%) of the problematic pin sites were related to the proximal pins, presumably as they traverse a thicker soft-tissue envelope than the distal pins.…”

Section: Discussionmentioning

confidence: 99%

Circular frames of the humerus: salvage surgery case series

et al. 2019

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Introduction: High energy fractures like gunshot-related injuries or high velocity road traffic accidents are often complex to treat and have been associated with a higher non-union rate, especially when there is extensive bone loss. Fractures with severe comminution may not heal due to bone loss and an inability to achieve adequate fracture stability. Treatment of fractures that are not amenable to plating or nailing may lead to non-unions, septic or aseptic, that need repeat surgeries. Stabilisation with external fixation is a reliable option to maintain stability and provide a suitable environment for union. Materials and methods: This retrospective study used medical records of all patients with complex mid-shaft humerus fractures, as well as their complications, that were treated with hexapod circular external fixation between January 2009 and September 2015. All the patients in this case series presented with severe humerus fractures or complications thereof which were not amenable to conventional therapy. Results: Union was achieved in ten out of the 12 cases (83.3%). Union was achieved without bone graft or any other interventions at the fracture site except implant removal where indicated. The median time in external fixation was 196 days (interquartile range: 112-228). The most common complication encountered in this series was pin-site infection. Fixation points were noted to be infected in 33% of cases at some time during the treatment period. Conclusion: This study suggests that humeral non-unions and complex humerus fractures that are not amenable to conventional fixation methods, such as intramedullary nails and plates, can successfully achieve union when treated with a hexapod circular external fixator.

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Section: Discussionmentioning

confidence: 99%

Circular frames of the humerus: salvage surgery case series

et al. 2019

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“…We recorded non-unions as mobile or stiff, and whether they were atrophic, oligotrophic or hypertrophic. [26][27][28][29][30] Chronic osteomyelitis was defined as osteomyelitis with radiological evidence of sequestra, involucrum, radiolucency, and clinical evidence of infection in the form of a sinus or fistula. 31 Deep infection was defined as an infection involving any tissue (including bone) deep to the dermis at any point in time.…”

Section: Methodsmentioning

confidence: 99%

An audit of circular external fixation usage in a tertiary hospital in South Africa

Walt¹,

Ferreira²

2018

SA orthop. j.

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Background: Circular external fixation is a well-known treatment modality in reconstructive orthopaedic surgery and is frequently used for deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. The current use of this treatment modality in the South African context remains largely unknown. This retrospective review aims to describe the indications, outcomes and complications of the use of circular external fixation in a tertiary hospital in South Africa. Materials and methods: We retrospectively reviewed the records of 480 patients treated with circular external fixation in a specialist limb reconstruction unit. We report on patient demographics, comorbidities, indications and outcomes. Results: The final cohort consisted of 346 men and 134 women with a mean age of 35.5 years (SD 14.9, range: 5-73). Comorbidities were identified in 163 (34.0%) patients. These included diabetes in 14 (2.9%) patients and smoking in 102 (21%) patients. HIV infection was diagnosed in 120 patients (25%) with a mean CD4 count of 425 cells/mm 3 (SD: 223, range: 82-1056). The mean time in external fixator was 24.6% weeks (SD: 15.3, range 4-159). The treatment objective was achieved in 441 patients (92%). The overall complication rate excluding pin-site infection was 26%. Pin-site infection occurred in 88 patients (18.3%) but had no impact on the outcome of treatment. Conclusion: Circular external fixation treatment objectives can be achieved in a high percentage of patients in the context of a South African specialist reconstruction unit. This study shows favourable outcomes in deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. Comorbid factors, including HIV, diabetes and smoking had no effect on achieving the planned outcomes, but smoking did increase the overall time in external fixator.

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“…21 Non-union was classified according to several criteria including: atrophic or hypertrophic, stiff or mobile, with or without deformity, with or without bone loss, and septic or not. 22…”

Section: Table I: the Melis Classification Of Segmental Tibia Fracturesmentioning

confidence: 99%

Outcomes of segmental tibia fractures treated with circular external fixation at a single centre in a developing world setting

2018

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Background: Segmental tibia fractures historically are treated with special consideration due to their complexity, high complication rate and the propensity for associated injuries. Circular external fixators (CEFs) offer several potential advantages in this situation due to their modularity and minimally invasive application. These advantages have been demonstrated in several developed countries but not as yet in the developing world. This analysis aimed to evaluate if these beneficial outcomes are reproducible in a developing world environment. Methods: We retrospectively assessed the data pertaining to skeletally mature patients who sustained segmental tibia fractures and were treated with CEFs between January 2008 to December 2015. These cases were performed in our tertiary hospital and overseen by a consultant with limb reconstruction experience. Union rates, time to union and complications encountered over a median of 10 months (range 6-20 months) follow-up period were among the outcomes measured. Results: Fourteen male and three female patients with a median age of 34 years were included. Sixteen patients (94%) were injured as a result of high energy trauma, nine patients (53%) had associated injuries, fourteen cases (83%) were compound injuries and there were no cases of compartment syndrome. Fifteen patients (88%) united with the use of the initial CEF at a median of 25 weeks (16-52 weeks), the two cases of non-union were treated with adjustments to the CEF and distraction across the affected fracture site with ultimate union. Two cases (12%) of superficial pin infection were encountered and one case (6%) of deep infection occurred after union of the fractures necessitating removal of the CEF. Three cases (18%) developed malunion. Conclusion: Circular external fixators used for segmental tibia fractures, when applied in a developing setting by clinicians with limb reconstruction experience, display a satisfactory union rate and acceptable complication frequency, as compared to that achieved in developed countries.

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Management of tibial non-unions: Prospective evaluation of a comprehensive treatment algorithm

Cited by 6 publications

References 36 publications

Circular frames of the humerus: salvage surgery case series

Circular frames of the humerus: salvage surgery case series

An audit of circular external fixation usage in a tertiary hospital in South Africa

Outcomes of segmental tibia fractures treated with circular external fixation at a single centre in a developing world setting

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