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Hazem Alkhawashki - One of the best experts on this subject based on the ideXlab platform.
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shock wave therapy of Fracture Nonunion
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Hazem AlkhawashkiAbstract:We have used the principles of extracorporeal shock wave therapy (ESWT) in the treatment of Nonunion of Fractures in 44 patients (49 bones).There were 35 males and 9 females with a mean age of 34 years(range14-70). Clinical and radiological assessment was performed at regular time intervals with a minimum follow up of 18 months. Most common sites involved were the femur and tibia. The average time from initial Fracture treatment to intervention with ESWT was 11.9 months (6 months to 5 years). Thirty eight non-union sites had one session of treatment and the rest (11) had more than one session. Union was successful in 75.5% of cases at a mean time of 10.2 months (range 3-19). Failure in the remaining cases was due to more than 5mm gap, instability, compromised vascularity (type of bone) and deep low grade infection; which was discovered at the time of surgical intervention when no signs of radiological healing occurred after 6 months from treatment. Failing sites were shaft of femur, scaphoid, neck of humerus and neck of femur. No local complications were observed.
Mohamed El-barody - One of the best experts on this subject based on the ideXlab platform.
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Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist Fracture Nonunion using corticocancellous iliac bone graft: randomized clinical trial
International Orthopaedics, 2020Co-Authors: Galal Hegazy, Ehab Alshal, Mohamed Abdelaal, Mohamed Abdelaziz, Mohamed Moawad, Yasser M. Saqr, Ibrahem El-sebaey, Mokhtar Abdelazeem, Mohamed El-barodyAbstract:Purpose The study compared the impact of the Kirschner wires versus Herbert screw fixation on the rate of union, time to union, correction of deformity, and clinical outcome in adults with unstable scaphoid waist Fracture Nonunions without avascular necrosis. Methods We prospectively randomized 122 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. Radiographs, clinical outcome measures (pain, range of motion, and grip strength), and the Quick DASH score were taken pre- and post-operatively. Results The rate of the scaphoid union in the Kirschner wire group was 91% versus 88% in the Herbert group. No difference was detected between the two groups with respect to the time to union, deformity correction, pain analysis, range of motion, grip strength, return to work, and complications. Conclusion Using of multiple Kirschner wires as a fixation method for unstable scaphoid waist Fracture Nonunion that was treated by open reduction and corticocancellous iliac bone grafting had a shorter operative time and lower cost as compared with the Herbert screw fixation. Herbert screw fixation was technically more demanding in terms of technique than K-wires. However, because of easy application of Kirschner wires, and low cost, especially in developing countries, it may be a good alternative to Herbert screw.
Kenneth A Egol - One of the best experts on this subject based on the ideXlab platform.
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Femoral Periprosthetic Fracture Nonunion Management and Outcomes with Nonunion Repair and Retention of Primary Components.
Bulletin of the Hospital for Joint Disease, 2020Co-Authors: Jessica Mandel, Sanjit R Konda, Anthony Christiano, Kurtis D. Carlock, Roy I. Davidovitch, Kenneth A EgolAbstract:Introduction Nonunion of a femoral periprosthetic Fracture is a rare occurrence in orthopedic practice. Failure of a periprosthetic Fracture to heal can lead to substantial disability and pain for patients as well as the potential need for component revision. Relatively little literature exists describing their management and outcome. Methods Eleven patients with femoral periprosthetic Fracture Nonunion who presented for tertiary care were enrolled in a prospective data registry. Patients were considered to have developed Nonunion following failure of progression in radiographic and clinical healing for a 6-month period. All patients were seen at standard postoperative intervals, and outcomes were recorded using the Short Musculoskeletal Function Assessment (SMFA), visual analog scale (VAS) for pain, physical examination, and radiographic examination. Preoperative radiographs were reviewed for classification. Results Eleven patients had periprosthetic femoral Fracture Nonunion associated with prior hip (five patients) or knee (six patients) arthroplasty and were included in our study. Mean follow-up time was 30 months. Mean age at time of Nonunion surgery was 64.5 years (range: 41.8 to 78.2 years). All patients underwent removal of previous Fracture hardware at time of Nonunion surgery. Ten (91%) of 11 received autogenous iliac crest bone grafting at time of Nonunion surgery. Ten (91%) of the 11 patients went on to union without further intervention. Mean time to union was 7.9 months (SD: 8.0). The one patient that developed a persistent Nonunion was complicated by infection requiring multiple irrigation and debridement procedures and total hip explant. The mean improvement in total SMFA score from baseline to final follow-up was 22.6 (p = 0.030). The greatest functional improvement was in the bothersome index at 28.0 (p = 0.028). The mean improvement in VAS pain score from baseline to final follow-up was 4.5 (p = 0.013). Discussion Periprosthetic Fracture Nonunions can be successfully treated with operative intervention aimed at compression plating with bone graft and retention of primary components. In addition, successful periprosthetic Nonunion repair improves function and pain in these patients.
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posteromedial approach to tibial plateau Fracture Nonunion
Journal of Orthopaedic Trauma, 2020Co-Authors: Charlotte N Shields, Nima Eftekhary, Kenneth A EgolAbstract:Tibial plateau Fractures can involve planes that require reduction and stabilization from a posterior approach. This includes posteromedial, posterolateral, and posterior column shear type injuries. This video outlines the prone posteromedial approach to the tibial plateau for posterior column Fracture exposure, reduction, and fixation.
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Predicting Functional Outcomes Following Fracture Nonunion Repair - Development and Validation of a Risk Profiling Tool.
Journal of Orthopaedic Trauma, 2019Co-Authors: Sanjit R Konda, Kurtis D. Carlock, Kyle R. Hildebrandt, Kenneth A EgolAbstract:OBJECTIVES To develop a tool that can be used preoperatively to identify patients at risk of poor functional outcome following operative repair of Fracture Nonunion. DESIGN Retrospective analysis of prospectively collected data. SETTING Academic medical center. PATIENTS/PARTICIPANTS Three hundred twenty-eight patients who underwent operative repair of a Fracture Nonunion were prospectively followed for a minimum of 12 months post-operatively. INTERVENTION After randomization, 223 (68%) patients comprised an experimental cohort and 105 (32%) patients comprised a separate validation cohort. Within the experimental cohort, forward stepwise multivariate logistic regression was applied to 17 independent variables to generate a predictive model identifying patients at risk of having a poor functional outcome [Predicting Risk of Function in Trauma-Nonunion (PRoFiT-NU) Score]. MAIN OUTCOME MEASUREMENTS Functional outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA). Poor outcome was defined as an SMFA function index greater than 10 points above the mean at 12 months post-operatively. RESULTS Significant predictors of poor outcome were lower extremity Nonunion [odds ratio (OR) = 3.082; P = 0.021], tobacco use (OR = 2.994; P = 0.009), worker's compensation insurance (OR = 3.986; P = 0.005), radiographic bone loss (OR = 2.397; P = 0.040), and preoperative SMFA function index (OR = 1.027; P = 0.001). The PRoFiT-NU model was significant and a good predictor of poor functional outcome (χ(5) = 51.98, P < 0.0005; area under the receiver operating curve = 0.79). Within the separate validation cohort, 16% of patients had a poor outcome at a PRoFiT-NU score below 25% (low risk), 39% of patients had a poor outcome at a PRoFiT-NU score between 25% and 50% (intermediate risk), and 63% of patients had a poor outcome at a PRoFiT-NU score above 50% (high risk). CONCLUSIONS The PRoFiT-NU score is an accurate predictor of poor functional outcome following Fracture Nonunion repair. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence description of levels of evidence.
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Autogenous Iliac Crest Bone Grafting for the Treatment of Fracture Nonunion Is Equally Effective in Elderly and Nonelderly Patients.
Journal of The American Academy of Orthopaedic Surgeons, 2019Co-Authors: Kurtis D. Carlock, Sanjit R Konda, Kyle R. Hildebrandt, Kenneth A EgolAbstract:INTRODUCTION Autogenous iliac crest bone graft (ICBG) is considered the benchmark graft for Nonunion repair. However, ICBG harvest is invasive and may provide reduced benefit to elderly patients. The purpose of this study was to compare the clinical and functional outcomes of ICBG use in fixation of Fracture Nonunions between elderly and nonelderly patients. METHODS Over a 13-year period, 242 patients who underwent operative repair of a long bone Fracture Nonunion and received autogenous ICBG were enrolled in a prospective research registry and followed. Data collected included patient demographics, injury information, and Nonunion management. All patients had a minimum of 12 months of postoperative follow-up. Patients at least 65 years of age were classified as elderly, whereas younger patients were classified as nonelderly. Functional outcomes were evaluated at routine intervals postoperatively using the short musculoskeletal function assessment (SMFA) and visual analog scale pain scores. Bony union was determined radiographically. All postoperative complications were recorded. RESULTS Of the 242 patients included, 44 were elderly and 198 were nonelderly. No differences were found between groups with respect to postoperative pain scores or SMFA scores. Furthermore, time to union, rate of union, and postoperative complication rate did not differ between groups. Multivariate linear regression demonstrated that older age was not associated with time to union, postoperative pain scores, or postoperative SMFA scores after controlling for possible confounding variables. DISCUSSION The use of ICBG in Nonunion repair among elderly patients is as effective as use in younger patients with a long bone Nonunion. Concerns of increased postoperative complications and decreased rate of union in elderly patients receiving ICBG for treatment of Fracture Nonunion should be alleviated. ICBG remains the benchmark graft for Nonunion repair among all age groups.
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The use of regional anaesthesia for surgical intervention has minimal effect on functional outcomes following Fracture Nonunion repair.
Injury-international Journal of The Care of The Injured, 2019Co-Authors: Kurtis D. Carlock, Sanjit R Konda, Kyle R. Hildebrandt, Kenneth A EgolAbstract:Abstract Purpose The purpose of this study was to determine the effect of regional anaesthesia as compared to general anaesthesia on clinical, functional, and radiographic outcomes following long bone Fracture Nonunion repair. Methods 262 patients who underwent operative repair of a long bone Fracture Nonunion and had at least 12 months of post-operative follow up were included in this study. Functional outcomes were assessed prospectively using the Short Musculoskeletal Function Assessment (SMFA) and Visual Analog Scale (VAS) pain scores prior to Nonunion repair and at routine intervals post-operatively. Patients were divided into two matched groups based upon the type of anaesthetic method used in surgery. The regional anaesthesia cohort was composed of all patients who received regional anaesthesia (spinal anaesthesia or peripheral nerve block) alone or in addition to general anaesthesia, while patients who received general anaesthesia alone made up the general anaesthesia cohort. Univariate and multivariate analyses were performed to examine the effect of anaesthesia type on functional outcome scores, post-operative pain, bony healing, and complication rate. Results The regional anaesthesia and general anaesthesia cohorts each consisted of 131 patients. Multiple linear regression demonstrated there to be no significant association between anaesthetic method and total SMFA scores at all post-operative time points. Additionally, anaesthetic method was not associated with post-operative VAS pain scores, time to union, or the rate of post-operative complications. Conclusion In this cohort, the use of regional anaesthesia during operative repair of long bone Fracture Nonunion was associated with no significant difference in functional outcome scores or pain levels at all post-operative time points. Furthermore, the use of regional anaesthesia had no effect on the rate of post-operative complications. Either type of anaesthetic appears to be safe and effective in performing these surgeries.
Galal Hegazy - One of the best experts on this subject based on the ideXlab platform.
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Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist Fracture Nonunion using corticocancellous iliac bone graft: randomized clinical trial
International Orthopaedics, 2020Co-Authors: Galal Hegazy, Ehab Alshal, Mohamed Abdelaal, Mohamed Abdelaziz, Mohamed Moawad, Yasser M. Saqr, Ibrahem El-sebaey, Mokhtar Abdelazeem, Mohamed El-barodyAbstract:Purpose The study compared the impact of the Kirschner wires versus Herbert screw fixation on the rate of union, time to union, correction of deformity, and clinical outcome in adults with unstable scaphoid waist Fracture Nonunions without avascular necrosis. Methods We prospectively randomized 122 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. Radiographs, clinical outcome measures (pain, range of motion, and grip strength), and the Quick DASH score were taken pre- and post-operatively. Results The rate of the scaphoid union in the Kirschner wire group was 91% versus 88% in the Herbert group. No difference was detected between the two groups with respect to the time to union, deformity correction, pain analysis, range of motion, grip strength, return to work, and complications. Conclusion Using of multiple Kirschner wires as a fixation method for unstable scaphoid waist Fracture Nonunion that was treated by open reduction and corticocancellous iliac bone grafting had a shorter operative time and lower cost as compared with the Herbert screw fixation. Herbert screw fixation was technically more demanding in terms of technique than K-wires. However, because of easy application of Kirschner wires, and low cost, especially in developing countries, it may be a good alternative to Herbert screw.
Keiichi Muramatsu - One of the best experts on this subject based on the ideXlab platform.
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role of conventional and vascularized bone grafts in scaphoid Nonunion with avascular necrosis a canine experimental study
Journal of Hand Surgery (European Volume), 2000Co-Authors: Toru Sunagawa, Allen T Bishop, Keiichi MuramatsuAbstract:The effectiveness of vascularized and conventional bone grafts in the treatment of carpal Fracture Nonunion with avascular necrosis was evaluated in 12 adult dogs. The proximal third of the radiocarpal bone was removed bilaterally and frozen in liquid nitrogen. Its replacement, leaving a 4-mm gap, simulated a scaphoid Fracture Nonunion with avascular necrosis. A dorsal radius inlay graft was placed across the gap. The graft was nonvascularized, or conventional on one side, and vascularized with a reverse-flow arteriovenous pedicle on the other. Following a healing period, quantitative assessment of bone blood flow, Fracture healing, and bone remodeling was conducted. Seventy-three percent of the vascularized grafts and none of the conventional grafts healed. At 6 weeks, bone blood flow in the proximal pole was significantly higher on the side of the vascularized graft. Quantitative histomorphometry of the avascular proximal segment demonstrated significantly higher levels of fluorochrome-labeled osteoid- and osteoblast-covered trabecular surfaces on the vascularized graft side. These experimental data support the potential clinical application of pedicled reverse-flow vascularized grafts in the treatment of carpal Fracture Nonunions with avascular necrosis, including proximal pole scaphoid Nonunions.
