Cases reported "Fractures, Ununited"

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1/8. Treatment of traumatic radial clubhand deformity with bone loss using the Ilizarov apparatus.

    Radial clubhand deformity secondary to atrophic nonunion of an open distal radius fracture with bone loss is a challenging reconstructive problem. Two patients with this deformity had staged reconstruction using the Ilizarov apparatus. After gradual realignment of the distal radius metaphyseal fragment, a proximal to distal bone transport of the radial shaft was done. At completion of the bone transport, the docking site was augmented with autologous iliac crest bone graft. Both patients achieved radiographic union at the proximal and distal ends of the bone transport site and were satisfied with the outcome. At 3 years followup, full finger and elbow mobility were maintained. The wrist had improved appearance with limited painless mobility. Posttraumatic radial club hand deformities with associated bone loss can be treated successfully with staged reconstruction using the Ilizarov apparatus and methodology.
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keywords = transport
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2/8. Atrophic femoral nonunion with bone loss: treatment with monorail transport: a case report.

    Nonunions are an uncommon outcome of femoral fractures. Atrophic nonunions with a leg length discrepancy secondary to bone loss are often the most difficult to treat, and the treatment options are limited. We present a case that uses concomitant monolateral external fixation and intramedullary nailing to heal a nonunion and perform a simultaneous 7-cm lengthening procedure in a 33-year-old female.
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keywords = transport
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3/8. Treatment of infected tibial nonunions with debridement, antibiotic beads, and the Ilizarov method.

    This study of 10 patients presents the early results of a protocol of debridement, antibiotic bead placement, and use of the Ilizarov method with a circular external fixator for treatment of infected nonunions of the tibia in a military population. The nonunions resulted from high-energy fractures in nine cases and an osteotomy in one. The Ilizarov techniques used were transport (five cases), shortening and secondary lengthening (two cases), minimal resection with compression (one case), and resection with bone grafting (two cases). Flap coverage was required for five patients. There were two recurrences of infection (20%) among patients with the most compromised soft tissue. Only 50% of patients were able to perform limited duties while wearing the external fixator. Only four patients returned to active duty; however, three patients from special operations units were able to return to jump status. Six patients underwent medical retirement because of insufficient function, resulting from decreased ankle or knee range of motion and arthrosis or muscle weakness.
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keywords = transport
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4/8. Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.

    BACKGROUND: Nonunions of a juxta-articular lesion with bone loss, which represent a challenging therapeutic problem, were treated using external fixation and distraction osteogenesis. methods: Seven juxta-articular nonunions (five septic and two aseptic) were treated. The location of the nonunion was the distal femur in four patients, the proximal tibia in one patient, and the distal tibia in two patients. All of them were located within 5 cm from the affected joints. Preoperative limb shortening was present in six cases, averaging 2.9 cm (range, 1-7 cm). The reconstructive procedure consisted of refreshment of the nonunion site, deformity correction, stabilization by external fixation, and lengthening to eliminate leg length discrepancy or to fill the defect. Shortening-distraction was applied to six patients and bone transport to one patient for reconstruction. Intramedullary nailing to reduce the duration of external fixation was simultaneously performed in two cases. All the patients had at least 1 year of follow-up evaluation. RESULTS: Osseous union without angular deformity or leg length discrepancy greater than 1 cm was achieved in all patients. The mean amount of lengthening was 5.8 cm (range, 2.2-10.0 cm). The mean external fixation period was 219 days (range, 98-317 days), and the mean external fixation index was 34.4 days/cm (range, 24.5-47.6 days/cm). All patients reported excellent pain reduction. There were no recurrences of infection in five patients with prior history of osteomyelitis. The functional results were categorized as excellent in two, good in three, and fair in two. CONCLUSION: Despite the length of postoperative external fixation, distraction osteogenesis can be a valuable alternative for the treatment of juxta-articular nonunions.
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keywords = transport
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5/8. Tibial defects. Reconstruction using the method of Ilizarov as an alternative.

    Although used in the ussr since the 1950s, the method of Ilizarov has only recently been employed in north america to manage bone defects. Seven cases of patients with tibial bone defects are presented (five with deep infection) that were treated by gradual compression at the defect with one or two transported tibial segments that not only filled the tibial defect but preserved or regained the original bone length. Six of the seven patients had their defect obliterated while leg length was maintained. The method is minimally invasive, allows immediate weight-bearing and permits modifications in strategy while treating the bone defects but requires close attention to detail and has a steep learning curve.
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ranking = 0.33333333333333
keywords = transport
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6/8. The ilizarov technique in the treatment of infected tibial nonunions.

    Five patients with infected tibial nonunions and segmental defects were treated with the method of Ilizarov: application of circular small-wire fixator, corticotomy and bone transport to fill the segmental defect. Four of the five patients developed regenerate bone at the corticotomy distraction site. The one failure was related to a previous surgery--reamed locked nailing of the tibia. Three of the four patients with regenerate bone required open reduction and internal fixation at the nonunion site following bone transport. Superficial pin tract infections, broken wires and psychological intolerance of the frame were frequent but minor problems.
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keywords = transport
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7/8. Reconstruction of the lower extremity after grade III distal tibial injuries using combined microsurgical free tissue transfer and bone transport by distraction osteosynthesis.

    Five patients each with grade IIIB or IIIC distal tibial injuries are presented. All patients were treated initially by multiple debridements and external fixation of the tibial fracture. After failure of the primary treatment, each patient underwent microsurgical free muscle transfer and bone transport of the proximal tibia to reconstruct the lower leg. Soft tissue loss ranged from 8 to 20 cm. Segmental tibial loss ranged from 8 to 18 cm. Free flaps used included rectus abdominis, latissimus dorsi, and combined latissimus dorsi-serratus anterior muscles. Bone transport was accomplished by callus distraction after corticotomy. All patients are ambulatory, fully weight bearing, and without pain (range, 17-34 mo). This treatment method has obviated the need for below-the-knee amputation in all of our patients.
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ranking = 2
keywords = transport
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8/8. Treatment of a bone defect of the forearm by bone transport. A case report.

    The technique of bone transport has been used in the lower extremities to treat acute and chronic bone defect. It has not been applied to the upper extremities. An 8.0-cm defect of the ulna was treated with this technique, using a unilateral bone transport system. At completion of the transport, bone graft was brought to the docking site. A 4.0-cm radius defect was treated with free fibula graft and intramedullary nailing. Treatment was completed with removal of the external fixator at 10 months. Complication was limited to transient superficial pin site infection.
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ranking = 2.3333333333333
keywords = transport
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