Six cases of old fracture of the tibia with large sear, bony defect, and shortening deformity of the limb were treated by elongation osteotomy at epiphysis and compression fixation of the fracture with external semilunar fixation frame. The bony defect ranged from 3cm to 6cm. Bony healing developed in all patients 4-7 months after operation. Early postoperative movement was suggested. The results revealed that there was an obvious improvement of the joint function and the shortened legs were corrected. The advantages of this method are that there is no need of bone grafting and operative treatment of the scar prior to treatment of the bone.
ObjectiveTo investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. MethodsBetween March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years (range, 22-46 years). Nonunion was found at 10-29 months (mean, 16 months) after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/hyperplastic type, and 4 cases of unstable/atrophic type. ResultsAll incision healed at first stage. Twenty-six patients were followed up 10-28 months (mean, 14 months). A total of 16 (61.5%) fractures healed at 4-11 months after deferred dynamization (7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type); the other 10 fractures failed to heal. The healing rate was 100% (7/7) in patients with stable/hyperplastic type nonunion, 75% (9/12) in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. ConclusionDeferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.
In order to investigate the blood supply of osteo-periosteal flap of lateral inferior part of tibia, 40 lower limbs of adult cadavers were observed. The result showed that the superior malleolar branch was the biggest branch on the lateral inferior part of tibia and served as the main blood supply to the above area. It originated from the anterior tibial artery, 3.1 +/- 0.8 cm above the intermalleolar line. During its way to the anterior border of the tibia, it gave out the ascending and descending branches. The ascending branch was along the anterior border upward and anastomosed with the musculo-periosteol branch of the anterior tibial artery at the level of 6.3 +/- 1.3 cm above the intermalleolar line. The decending branch was anastomosed with the anterior medial malleolar artery. For the anastomosis between the superior malleolar branch with the peripheral vessels, the osteo-periosteol flap could be designed at the lateral side of the lower part of tibia in size of 8-10 cm x 4-6 cm. This was a new donor area of osteo-periosteol flap for repair of non-union of bone in lower end of tibia or arthrodesis of the ankle joint.
Objective To explore the cl inical effects of different operative procedures in treatment of upper humerus fracture nonunion. Methods From May 2001 to September 2007, 43 cases of upper humerus fractures nonunion were treated, including 31 males and 12 females with an average age of 37 years (range, 20-57 years). The causes were trafficaccident injury in 14 cases, fall ing injury from height in 11 cases, tumbl ing injury in 7 cases, heavy pound injury in 6 cases, machine injury in 4 cases, and pathological injury in 1 case. The time from fracture to hospital ization was 10-52 months (23 months on average). After open reduction, patients were treated respectively by bone-graft plus locking compression plate fixation (9 cases), scapula flap rotation displacement plus locking compression plate fixation (15 cases), and scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation (19 cases). Results All incisions healed by first intention. The X-ray films showed good fracture reduction. No symptoms of infection and nerve injury occurred. Forty-three patients were followed up 12 to 25 months with an average of 18 months. All of them achieved radiographic union within 3.0 to 7.5 months (4.9 months on average). According to comprehensive assessing standard of X-ray film and functions of shoulder and elbow, the results were excellent in 21 cases, good in 15 cases, fair in 4 cases, and poor in 3 cases; the excellent and good rate was 83.7%. Conclusion In the treatment of upper humerus fractures nonunion, locking compression plate can provide stable fixation. It can achieve satisfactory results so long as the right method of bone graft is chosen according to fracture site situation. But for patients undergoing repeated surgery or having nonunion for long times and poor fracture site situation, after open reduction, scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation has good outcome.