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Introduction: Humerus shaft fractures account for 3% of all adult fractures. Union rate after surgical management is around 84-97% with no difference between compression plating and intramedullary (IM) nailing. Non-union of humeral shaft fracture is not unusual complication of both conservative and operative treatment. IM nailing has been known to have several benefits from its relative stability with minimal soft-tissue dissection but with drawbacks such as less perfect reduction with higher risk of distraction, inability to take down interpositional tissue, risk of radial nerve injury and technical difficulty to pass guide wire and locking of nail. Many methods have been described for nonunion of humeral fracture with good results. However, treatment of a long-standing nonunion of the humerus with bone defect is challenging, as it may be complicated by broken implants. Very less research documented for long standing nonunion of humeral bone with diaphyseal bone defect. Case Report: We report a case report of middle-aged female who suffered a closed traumatic humeral shaft fracture which was managed with open reduction and fixation with IM nailing with some distraction and distal locking screw missing the nail making it an unstable construct traditionally called Wind shield, wiper effect was noticed in this patient and was the cause of nonunion in this case at some other institute 5 years back lending up in to nonunion with diaphyseal bone defect showing peri-implant expansile benign lesion treated at our institute with implant removal, excision of lytic lesion, and stabilized with extra articular distal humerus locking plate after strut fibular auto bone grafting . Conclusion: Humerus shaft non-union in a middle-aged patient is heterogeneous entity and has to be managed after ruling out neoplastic (metastasis) as well as infective etiology, and locking plate is the gold standard for its management along with strut grafting being osteoporotic bone with some bony defect.
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Introduction: Peritrochanteric fractures are common injuries occurring in elderly patients. Surgeries for these fractures are associated with significant blood loss. Intravenous tranexamic acid has a proven track record in many orthopaedic surgeries including trauma, arthroplasty and spine surgeries. Objective: To study the effect of local subfascial and intramuscular infiltration of tranexamic acid in reducing blood loss and the requirement for blood transfusion in intertrochanteric fracture surgery. Study Design: Single centre prospective analytical study. Materials and Methods: One hundred and thirty seven patients above 65 years of age were included in the study, divided into two groups: the intervention group received subfascial and intramuscular infiltration of 2g tranexamic acid before wound closure and the control group of alternate patients did not receive any tranexamic acid infiltration. The postoperative drain output was recorded, as well as the haemoglobin level and the patients needing blood transfusion. Results and Conclusions: The preoperative and postoperative haemoglobin values were recorded. The mean preoperative haemoglobin was 10.9% and 10.8% (p=0.79) in the trial and control groups respectively. The mean postoperative haemoglobin was 9.5gm% and 9.2gm% (p=0.36) in the two groups. The total postoperative blood loss in the tranexamic acid group and the control group was 190.3ml and 204.3ml respectively (p=0.25). Ten patients (14.9%) in the intervention group and 12 patients (17.1%) in the control group required blood transfusion. We conclude that tranexamic acid does not play a significant role in reducing postoperative blood loss and blood transfusion when used locally in peritochanteric fracture surgery. However a larger double blinded study comparing various modalities of use of tranexamic acid is needed to conclusively establish its role.
RESUMO
INTRODUCTION: Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. OBJECTIVES AND STUDY DESIGN: To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design. MATERIALS AND METHODS: Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned. RESULTS AND CONCLUSIONS: Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group (p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group (p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.