1/205. A metallurgical examination of fractured stainless-steel ASIF tibial plates.Between 1970 and 1973 99 tibial fractures were treated by rigid internal fixation with ASIF plates. The fractures were all regarded as sufficiently stable for exercise without weight bearing, thus needing no additional external support during the healing period. Four of the plates broke late in the healing period, after the onset of weight bearing. These fractures had some degree of delayed union with slight resorption of the bone ends, resulting in cyclical bending of the plate. Examination of 2 of the fractured plates by scanning electron microscopy, electron microprobe analysis and optical metallography revealed that the primary cause of plate fracture was fatigue. There was no evidence that corrosion fatigue or inclusion content were factors leading to plate fracture.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/205. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
3/205. The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique.We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
4/205. Remission of idiopathic thrombocytopenic purpura after femoral lengthening. Clinical case followed for 5 years.We report on a patient with chronic idiopathic thrombocytopenic purpura (ITP) who went into remission after femoral lengthening. Although it is possible that spontaneous remission (frequency 5%-10%) of chronic ITP coincided with the femoral lengthening, limb lengthening could also have caused the thrombocytosis. This case suggests a close relationship between osteogenesis and hematopoiesis during regenerate bone formation. Limb lengthening can therefore be defined as the formation not only of bone and soft tissue but also of hematopoietic tissue.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
5/205. pseudarthrosis of the capitate.Nonunion of an isolated fracture of the capitate is an infrequent condition. The authors present a patient who had few symptoms. Computed tomography showed more bone destruction than the standard X-ray. The nonunion healed with the use of a cancellous bone graft.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
6/205. Reconstruction plate fixation with bone graft for mid-shaft clavicular non-union in semi-professional athletes.From 1993 to 1997, 22 semi-professional athletes (14 men and 8 women), aged 18-33 years (mountain bike racers, soccer players, handball players, swimmers, and short distance runners) with a non-union of the middle third of the clavicle were treated operatively by reconstruction plating and bone grafting. Fourteen clavicular non-unions were caused by falls. Eight non-unions were the result of a car, motorcycle, or bicycle accident. There were 19 atrophic and 3 hypertrophic non-unions. In all patients, initially a figure-of-eight strap or a sling was used for immobilization and no radiographic union was documented within 5 months. None of the athletes had gone back to their sports and all had pain and limitation of shoulder function. For open reduction and internal fixation, an AO 3.5-mm seven-hole reconstruction plate was used. The sclerotic bone ends were freshened and a cortical bone transplant or cancellous bone from the iliac crest (depending on the shortening of the clavicle) was packed around the fracture or between the reduced fracture ends. In all athletes, radiographic consolidation was achieved after an average of 14 weeks (range, 11-16 weeks) and the average increase in the Constant and Murley Score was from 79 points preoperatively to 97 points after surgery. No operative or postoperative complications occurred and all athletes returned to their sports.- - - - - - - - - - ranking = 8keywords = bone (Clic here for more details about this article) |
7/205. Nonunion following subcapital (neck) fractures of the proximal phalanx of the thumb in children.Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
8/205. The application of arthroscopic principles to bone grafting of delayed union of long bone fractures.The purpose of this study was to explore the potential of applying arthroscopic techniques to autogenous bone grafting of long bone fracture delayed union. There were 9 patients in this initial series, including 4 patients (average age, 37 years) with humeral lesions and 5 patients (average age, 25 years) with tibial fractures. There were 6 men and 3 women. Techniques customarily employed in arthroscopy were used to visualize, expose, and deliver the onlay cancellous bone grafts. Bony union occurred in all but 1 patient in an average of 4 months. This patient had a fibrous union and sustained a reinjury that led to successful repeat open bone graft surgery. The arthroscopic approach for bone grafting of certain long bone delayed union appears to be a safe and effective procedure. The procedure is best suited for patients with mechanically stabilized fragments, and it lends itself to those with overlying skin or soft tissue compromise. There are some relative contraindications: grossly unstable fragments, severe malunion, and/or infection.- - - - - - - - - - ranking = 14keywords = bone (Clic here for more details about this article) |
9/205. Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure.We describe a case of infected nonunion of the radius with extensive bone loss in an 11-year-old boy treated by centralization of the ulna. The technique used differs from the original Hey Groves procedure in that it preserves the distal end of the ulna with its important triangular fibrocartilage complex, thereby retaining stability and contour of the wrist joint. Our patient obtained a functionally and cosmetically satisfactory, stable forearm and wrist. We present the technique as a useful armament in the management of extensive bony defect of the radius arising from trauma or infection.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
10/205. Nonunion in a fracture of the proximal phalanx of the thumb.We describe the management of atrophic nonunion in a fracture of the proximal phalanx of the thumb in a patient who presented one and a half years after the injury. By using threaded external fixators applied across the fracture nonunion, stability for active mobilization of the metacarpophalangeal joint was achieved. The gradual distraction resulted in correction of the deformity and the shortening, as well as creation of an adequate space between the bone ends. Bone grafting and compression of the fracture with the same fixators followed. Consolidation of the fracture occurred within five months. Follow-up examination two and a half years postoperatively revealed complete remodeling of the fracture and excellent function of the hand.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
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