Treatment of Femoral Shaft Pseudarthrosis, Case Series and Medico-Legal Implications

Basile, Giuseppe; Fozzato, Stefania; Petrucci, Quirino Alessandro; Gallina, Mario; Prevot, Luca Bianco; Accetta, Riccardo; Zaami, Simona

doi:10.3390/jcm11247407

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…showed that unstable fractures according to AO/OTA were accompanied by early device failure that required reoperation and mortality after trochanteric hip fractures. It should also be considered that the surgical method employed and its proper execution affects the subsequent outcomes 55 . Several studies comparing the gamma nail and DHS have indicated that DHS seems to be a better method for treatment of trochanteric fractures 56 , 57 .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

Ramezani,

Babagoli,

Ghaseminejad-Raeini

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Intertrochanteric fractures, which make up the majority of hip fractures, are a common and serious injury that can greatly impact quality of life. Treatment of such fractures comprises nearly half of the costs contributed to hip fractures. Identifying the factors affecting the functional outcomes of patients after intertrochanteric fracture can help to reduce burden of disease for the patient and healthcare system. The present study investigated the factors underlying the worsening of SF-36 scores for intertrochanteric fracture patients. Materials and Methods: This retrospective cohort study was designed based on data from our clinic. All consecutive patients with intertrochanteric fractures from November 2016 to September 2020 were reviewed. The exclusion criteria included patients having a second injury or having had previous surgery related to the hip and those with incomplete data. Baseline characteristics of patients were extracted from annotated records. The lab data were acquired from the electronic hospital system. The outcomes were SF-36 scores obtained by phone contact with patients or their families. Statistical analysis was conducted in SPSS. Results: A total of 310 patients were included in the current study. The female gender, advanced age, history of diabetes, thyroid malfunction, cancer, osteoporosis, anticoagulant use and blood transfusion were identified as risk factors for lower SF-36 scores. Low levels of hemoglobin before surgery, Blood Urea Nitrogen (BUN), BUN/Creatinine, and white blood count (WBC) values correlated with lower SF-36 scores. Conclusion: Numerous contextual variables affected the functional outcomes of the patients. Consideration of these factors could be helpful in reducing costs and improving the quality of life for intertrochanteric fracture patients.

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Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

Ramezani,

Babagoli,

Ghaseminejad-Raeini

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Pseudarthrosis in femoral fractures is one of the most difficult-to-treat complications, occurring in less than 1% of operated patients [1]. Nonunion (NU) is a condition characterized by incomplete healing within 9 months of injury or no signs of bone callus formation on subsequent radiographs within 3 months; nonunion can be classified as hypertro-phic NUs.…”

Section: Introductionmentioning

confidence: 99%

What Is the Best Treatment of the Femoral Shaft Nonunion after Intramedullary Nailing? A Systematic Review

Bianco Prevot,

Nannini,

Mangiavini

et al. 2023

Life

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Nonunion (NU) is one of the most feared complications of femoral shaft fracture treatment. Femoral shaft fracture treatment is often linked with poor bone stock and reduced bone metabolism. In this paper, the goal is to carefully analyze the best treatment options for patients who developed nonunion after the intramedullary nailing of a femoral shaft fracture. A systematic review of the literature available in the PubMed, EMBASE and Cochran library databases was carried out, and 16 studies were included. Exclusion criteria included case reports and case series that do not have data about clinical outcomes or functional outcomes and included fewer than 10 patients. The reviewed data provide evidence for very good results about the treatment of this pathology with exchanging intramedullary nails or the implantation of a plate and screws (general healing rate of 96.3%). Moreover, the data support the utilization of autologous bone graft in order to stimulate the healing process. In conclusion, the choice between these two types of treatment must be guided by the type of pseudarthrosis that the patient presents. Additionally, bone grafting or growth factors promote bone regenerative processes, especially in patients with oligo-atrophic pseudoarthrosis.

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“…Osteosynthesis, bone reduction, bone grafting, and fixation were not considered as solutions because of previous failures and the possibility of large avascular distal fragments of the humeral shaft that made bone integration unlikely. [5][6][7][8]. The patient underwent general anesthesia, in the supine position, with her left arm crossing her body.…”

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confidence: 99%

“…The deep layers of the triceps muscle were sutured with non-absorbable suture and then the deep layer of the skin and the skin, in a multilayered fashion (f). [5][6][7][8]. The patient underwent general anesthesia, in the supine position, with her left arm crossing her body.…”

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confidence: 99%

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Elbow Reconstruction with Megaprosthesis: An Effective Strategy for Salvage Surgery in Trauma Patients

Dragosloveanu,

Petre,

Gherghe

et al. 2024

Diagnostics

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Delayed fracture healing can have devastating functional consequences, including pseudoarthrosis. Many factors can contribute to delayed healing, including decreased vascularity, micro-motion at the fracture site, large fracture gaps, multiple traumas at the same site, compromised metabolic status, surgical complications, and other conditions. A 61-year-old female patient was referred to our hospital with left distal humeral pseudarthrosis, accompanied by chronic pain and disability. Two years prior, the patient suffered a traumatic incident. At another medical facility, the patient underwent open reduction and internal fixation surgery with simultaneous ulnar nerve transposition. She showed favorable postoperative recovery. Unfortunately, approximately one year later, the patient sustained a second trauma to the same arm. This led to peri-implant fracture and post-traumatic aseptic degradation of the osteosynthesis system which was subsequently removed. Twelve months after the last surgery, the patient was referred to our hospital and, after thorough consideration of the therapeutic options, we decided to perform left elbow arthroplasty with left distal humeral reconstruction by using Zimmer’s Comprehensive Segmental Revision System. This approach is generally reserved for tumors, and only a handful of cases of megaprostheses for non-tumoral indications have been previously reported. The surgery and perioperative care of our patient were optimal, there were no complications, and the patient recovered arm functionality following rehabilitation.

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Treatment of Femoral Shaft Pseudarthrosis, Case Series and Medico-Legal Implications

Cited by 7 publications

References 41 publications

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

What Is the Best Treatment of the Femoral Shaft Nonunion after Intramedullary Nailing? A Systematic Review

Elbow Reconstruction with Megaprosthesis: An Effective Strategy for Salvage Surgery in Trauma Patients

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