We herein report the long-term effect of valgus intertrochanteric osteotomy for nonunion after femoral neck fracture. In this report, we describe our experience using valgus intertrochanteric osteotomy to treat nonunion after femoral neck fracture in a 20-year-old woman. The patient was discharged from the hospital 10 days after the operation, the internal fixation device was removed 1 year after the operation, and the patient was then followed up for 18 years. Valgus intertrochanteric osteotomy can effectively treat nonunion after adductive femoral neck fracture. 相似文献
MATERIALS AND METHODS: Between 1987 and 2005, 55 patients were treated operatively to correct 44 malunions and 11 nonunion of the pelvic ring. These pathologies were the consequence of a nonoperative initial treatment for 38 cases, or of an inappropriate indication, such as the use of an external fixator as the definitive treatment of an unstable pelvic fracture in 15 and symphysis cerclage wiring in 2. Three patients had undergone ORIF of the lumbar spine performed by neurosurgeons, but the pelvic fractures below were ignored. On the basis of damaging mechanisms and of the main instability plane, initial lesions were classified as follows: 32 shearing lesions, 11 rotatory by antero-posterior compression, 7 by lateral compression, 5 mixed. In 23 cases the site of the posterior lesion was the sacrum, 4 of which were H fractures type; 13 were sacroiliac joint dislocations, or rotatory instability of the joint (in 2 cases the lesion was bilateral), 8 were sacroiliac dislocation fractures (crescent fractures); 7 were fractures of the iliac wing. Four patients only had pubic symphysis diastasis. Indications for surgery were pain associated with deformity or instability. Surgery was performed through a multistage procedure. Mean surgery time was 6h (range: 2-10h), with a mean blood loss of 700ml (range: 200-5000ml). Follow-up ranged from a minimum of 16 months to a maximum of 14 years (mean: 5.85 years). RESULTS: At the last follow-up, all patients but one had consolidated and were considered stable. All patients had improved walking ability. Six patients still report pain. Even if most of the deformity were corrected with a significant decrease of pre-operative symptoms achieved, deformity correction was considered satisfactory but not anatomic, in 12 patients (21%). Complications occurred in 24% of patients but most were temporary. CONCLUSIONS: The most frequent cause of pelvic malunion or nonunion was inadequate treatment. To reduce the number and the percentage of disabilities, it is necessary that specialised centres provide patients with early treatment that is adequate and definitive. 相似文献
Although clavicular fractures are common, nonunion of clavicle is a rare complication. Clavicular nonunion that occurs due to insufficient stabilization is usually painful and necessitates operative treatment. Seven cases with oligotrophic clavicular nonunion that developed after a conservative process were treated with Ilizarov between January 2000 and December 2002. In all of them, the middle one-third of the clavicle was affected. Details of the cases regarding sex, age information, reason of fracture, previous treatment methods that were applied, nonunion area, nonunion, and duration of frame application were recorded. Two of the cases were female and five of them were male with age mean of 27.1 (19–32 years). Five of these cases had right clavicular injury and two of them had left clavicular injury. Mean nonunion duration was 18 months (range was 6–36 months). All nonunion were fixed and went through acute compression by means of Ilizarov’s external fixators without grafting. The duration between the frame application and union was mean 2.7 months (range was 2.5–3.5 months). Mean follow-up period was 31 months (range was 22–48 months). Cases were evaluated in accordance with the Constant Scoring system. They were able to return to their normal daily activities in 10–15 days. All of them regained full shoulder movement and extension ability. Patients have also been evaluated by using Dash-Score. Union existed for all patients and none of them had any complaints of pain after treatment. Since circular external fixator allows acute compression, early shoulder movements, and requires no such additional procedure as grafting, it is an alternative method which can be used in treating nonunion of clavicle. 相似文献
Introduction Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. There are, however, no previous reports of BMP being used for ulnar nonunions. We report on five cases of resistant ulnar nonunions treated with a composite implant consisting of a biocoral frame, collagen carrier, and bovine BMP.Materials and methods Four diaphyseal and one olecranon ulnar nonunions were treated using BMP/coral implant combined with internal fixation. Additional autografting was used in three cases. All of the cases were challenging in their own ways: Three of the patients had been operated on earlier for their nonunion without success, one had a 40 mm bone loss, and one had a 9-month-old untreated olecranon fracture. After excision of the sclerotic surfaces of the nonunion, the gap was filled with autograft and a composite implant containing BMP. Fixation was done with a compression plate in the diaphyseal nonunions and with a tension band in the olecranon nonunion.Results Solid union was achieved in all five cases. No infections or other adverse effects were encountered.Conclusion These preliminary results suggest that BMP-containing implants might be a feasible alternative or superior to autografting in the treatment of resistant ulnar nonunions. 相似文献
Two cases of nonunion of the hook of the hamate were treated with low-intensity pulsed ultrasound. The patients were baseball players and had been injured as a result of hitting repeatedly. Nonunion was detected on computed tomography (CT) and was exposed to ultrasound for 20 min a day for 4 months. In both cases pain at the hypothenar eminence disappeared, and bone union was confirmed on CT at the end of the ultrasound treatment. 相似文献
Fractures account for significant morbidity and mortality among the elderly. Commonly, surgical procedures like internal fixation are not exempt of complications (infection, soft-tissue problems). In this study, we examined the use of external fixation (EF) in 28 patients aged more than 60 years with a total of 30 fractures. There were 16 men and 12 women with a mean age of 72 (61–85) years. The upper limb was involved in four cases and the lower limb in 26. In half of the cases, open fractures were present, which were classified according to Gustilo: eight type I, six type II, and one type III. Fracture healing, angular deviation and bone aspect in the pin site were accessed radiologically. Clinical criteria included fracture healing, pain and articular function. The average time for fracture union was 7 (2–18) months. The overall rate of complications was high (66.6%). The most common complications were malunion (20%), non-union or delayed union (20%) and superficial pin-tract infection (10%). However, severe complications were rare. No deep infection or soft-tissue problems occurred. We consider that EF can be used not only for open and comminuted fractures but also in closed and minimally comminuted fractures with a high risk of soft-tissue problem where no other fixation is suitable. 相似文献
During fracture healing and the resulting formation of new bone, an extensive amount of extracellular matrix is synthesized which subsequently undergoes enzymatic remodeling and then mineralization. The remodeling process of mostly collagenous molecules is largely attributable to matrix metalloproteinases (MMPs). A variety of members of this protease family and its respective inhibitors – termed tissue inhibitors of matrix metalloproteinases (TIMP) – have been found to be closely related to the fracture healing process. Delays in bone healing or even nonunion could be related to the concentrations of these enzymes or their behavior over time. In this study, serum samples were prospectively collected from patients who had undergone surgical treatment for limb fracture. Serum probes from 15 patients with nonunion of fractures 4 months after surgery have been compared to 15 matched patients with normal bone healing. Postoperative time courses of serum concentrations of MMP-1/-2/-3/-8/-9/-13 as well as TIMP-1/-2 were analyzed using commercially available enzyme immunoassays.
Comparison between both collectives revealed significantly elevated serum concentrations of proMMP-1 in the nonunion group at 2 and 24 weeks after surgery. Similar findings were found for MMP-8 at 2, 4 and 8 weeks. At 1 week after surgery, TIMP-1 serum concentrations were significantly lower in nonunion patients when compared to patients with normal bone repair.
We have been able to show for the first time the course of serum concentrations of MMPs and TIMPs during normal and delayed fracture healing. Characteristic time courses of systemic MMP- and TIMP-levels could be a reflection of local enzyme regulatory mechanisms during fracture healing. An altered balance of the MMP/TIMP system in favor of proteolytic activity as shown in our investigation may be involved in the pathophysiological processes leading to fracture nonunion. 相似文献