Management of Infected Nonunion of the Forearm by the Masquelet Technique.

PURPOSE: Infected nonunion of the forearm bones is a challenge for the orthopedic surgeon on several fronts. The forearm itself is unique as the difficulties include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, and the risk of elbow and wrist stiffness related to prolonged immobilization. The problem of infection is complex due to the presence of bone necrosis, segmental bone loss, sinus tract formation, fracture instability, and scar adhesion of the soft tissues. The ideal management method for these situations is still debated. MATERIALS AND METHODS: We used the two-stage-induced membrane technique devised by Alain Masquelet for the management of these infected nonunion of 12 forearm bones. RESULTS: All 12 bones united uneventfully. The bones united in a period ranging from 6 to 12 months with a mean of 7.8 months. CONCLUSION: Our results show that this technique addresses several of the challenges pertinent to the forearm nonunion simultaneously and results are uniformly predictable. HOW TO CITE THIS ARTICLE: Dhar SA, Dar TA, Mir NA. Management of Infected Nonunion of the Forearm by the Masquelet Technique. Strategies Trauma Limb Reconstr 2019;14(1):1-5.

Antibiotic Impregnated Cement Coated Ilizarov Rod For The Management Of Infected Non Union Of Long Bone.

The infected non union of the long bones in the presence of the intramedullary nail is a dreaded complication of fracture management. Around 7% patients may develop an infected non union of the long bones in intramedullary nailing. Amongst the various grades of infection, grade three infection is the most difficult to cure and manage as it involves an osteomyelitic bone. Amongst an array of therapeutic modalities, the two stage methods are commonly used with the first stage aimed at controlling the infection and the second stage at inducing union. This increases the number of surgical procedures. We used an Ilizarov threaded rod coated with antibiotic impregnated cement to replace the intramedullary nail with the idea of delivering higher concentration of antibiotic locally as well as provide stability. We achieved a union rate of 91% in a relatively small number of patients with this single procedure. The antibiotic impregnated cement coated Ilizarov rod that we used in our study achieves both infection control and union simultaneously and does not allow cement debonding at removal.

Walnut tree falls as a cause of musculoskeletal injury--a study from a tertiary care center in Kashmir.

BACKGROUND: Fall from height is one of the important causes of musculoskeletal injuries. Fall from walnut trees constitutes an important entity that leads to a significant mortality and morbidity amongst those engaged in fruit collection. The present study aimed to determine the prevalence of different musculoskeletal injuries in these victims and to highlight the importance of recognizing this incident as an occupational injury. METHODS: A retrospective study of all patients admitted to the Orthopedic Department of the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Medical College from January 2003 to December 2007 was conducted. The medical records were studied for the different types of bony injuries, associated injuries and delay in the referral of patients. RESULTS: 94% of falls occurred from August to October. Of the 115 patients, 63 (54.7%) had associated non-orthopedic injuries. Head injury was the most common associated injury, presenting in 34 patients (29.5%). Thoracolumbar (16.5%), calcaneum (10.5%) and distal radius (8.7%) fractures constituted the common fractures encountered in the victims. CONCLUSION: Walnut tree injuries mostly involve young males who form the productive group of the population. Being a seasonal injury, it puts a considerable load on the health resources of the region over a small period of time.