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- Treatment of Infected Nonunion of Long Bone Shaft: Comparison between Fixation by Antibiotic-cement Loaded Intramedullary Nailing and Fixation by Antibiotic-cement Loaded External Monofixator
- Ki Ho Nah, Seong Jin Park, Suk Ku Han, Hyun Suk Song, Nam Yong Choi
- J Korean Soc Fract 2003;16(4):511-518. Published online October 31, 2003
- DOI: https://doi.org/10.12671/jksf.2003.16.4.511
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Abstract
PDF - PURPOSE
To evaluate the surgical results between fixations by antibiotic-cement loaded intramedullary nailing and antibiotic-cement loaded external monofixator in the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm.
MATERIALS AND METHODS
Among the 15 cases of infected nonunion of long bone shaft, 6 cases treated with fixation by antibiotic-cement coated intramedullary nailing and 3 cases treated with fixation by intramedullary nailing along with antibiotic-cement beads insertion were divided as group I (n=9), and other 6 cases treated with fixation by external monofixator along with antibiotic-cement beads insertion were divided as group II (n=6). There was no difference between the two groups in the degree of infection in the laboratory data and clinical feature and degree of bone loss and shortening. Male was in 7 and 5 patients, average age of the patients was 34.8 (26~53) and 37.2 (20~63) years old and average follow-up period was 15.9 (12~35) and 19.3 (15~41) months in group I and II respectively.
RESULTS
Among the nine cases of group I, 3 cases were newly convereted into fixation by antibiotic-cement coated intramedullary nailing at average 9.5 weeks. Radiologic union was gained at the average of 26 weeks from the time of initial nail fixation. Infection was responsive at 6.1 weeks by laboratoey data. Knee ROM of more than 100 degrees was gained in all case and average shortening was 9.2 mm in the last follow-up. And external rotation deformity of more than 5 degrees was noted in 1 case. Among the six cases of group II, radiologic union was gained at 14 weeks in 1 case without converting to internal fixation, and the other 5 cases were converted to antibiotic cement loaded intramedullary nailing at average 12.5 weeks because of delayed uinon or angulation deformity, and radiologic union was gained at average 44 weeks from the time of fixation by external fixator. Infection was responsive at 10.2 weeks by laboratoey data. Knee ROM of more than 100degrees was gained in 5 cases, and average shortening was 11.8 mm in the last follow-up.
CONCLUSION
In the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm, the fixation by intramedullary nailing with the use of antibiotic-cement prefers to the fixation by external monofixator with the use of antibiotic-cement in the velocity of union, control of infection, and in the clinical aspects such as alignment, early ambulation and joint stiffness.
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- External monofixator in open tibia fractures
- Soon Hyuck Lee, Seung Woo Suh, Young Soo Byun, Yoon Sung Chung
- J Korean Soc Fract 1994;7(2):571-579. Published online November 30, 1994
- DOI: https://doi.org/10.12671/jksf.1994.7.2.571
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Abstract
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- Tibia fracture is often accompanied by soft tissue injury. There is controversy about the treatment of open tibia fractures, but the extemal fixator is most widely used as a initial treatment. Especially in open tibia fractures treated by extemal fixator, early secondary conversion to internal fixation device are suggested by some authors, but without risks of complication. In contrast others suggest that bone union problems are not due to external fixator itself and different types of bone union are observed according to the stability of fracture site. The purpose of this study is to assess the clinical results with its affecting factors and to observe the morphological pattern of union in tibial open fractures treated by external fixator without significant soft tissue problems. Authors analyzed 16 cases with tibial open fracture managed by external fixator in Ansan hospital, College of medicine, Korea University from May, 1988 to Sept., 1993 with follow-up period more than 11 months. 1. The tibial open fractures are mainly occurred in young active age group(20-50 yrs). 2. The union rate in accurate reduction and stable fixation cases was 90%, in contrast non-union rate in unstable fixation was 50%, and these non-union cases were managed by additional procedure(intramedullary nailing or autogenous bone graft). 3. In stable fuation, mode of fracture healing was mainly primary osteonal bone healing mechanism. 4. External fixator could be used in open tibial fracture with accurate reduction and stable fixation not as a temporary fixation but as a treatment modality.
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