Bone transport for the treatment of infected forearm nonunion.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the treatment of infected forearm nonunion by bone transport. MATERIALS AND METHODS: We retrospectively reviewed 16 patients with infected forearm nonunion treated by bone transport. Our study included 10 males and 6 females with a mean of age 38.25 years. The site of bone defects involved 9 radius and 7 ulna. The average length of the bone defects after radical debridement was 3.81cm (range 2.2-7.5cm). RESULTS: The mean follow-up after removal of the frame was 39.63 months (range 26-55 months). No patient was lost to follow-up. All the patients had bone union and no recurrence of infection was observed. The mean external fixation time was 6.19 months (range 3-10 months), and the mean external fixation index was 1.63 months/cm (range 1.14-2.00 months/cm). The mean degrees of wrist flexion were 49.69° (range 45-55°), and the mean degrees of wrist extension were 50.63° (range 40-60°). The mean degrees of elbow flexion were 143.12° (range 135-150°), and the mean degrees of elbow extension were 4.69° (range 0-20°). The mean degrees of forearm pronation were 82.50° (range 70-90°), and the mean degrees of forearm supination were 83.75° (range 75-90°). CONCLUSION: Our study suggested that bone transport in the treatment of infected forearm nonunion acquired satisfied functional results. Radical debridement is the key step to control bone infection.

Infected forearm nonunion treated by bone transport after debridement.

BACKGROUND: This is a therapeutic study to evaluate the results of the management of forearm infected nonunion using bone transport with external fixators after debridement. METHODS: We have retrospectively reviewed a consecutive series of 21 patients from October 1994 to June 2010 in our institution who were treated for the forearm infected nonunion by bone transport with external fixator after debridement. There were 12 males and 9 females. The mean age of the patients was 27.1 years. Of the initial fractures, nonunion of the radius alone invovled in 7 patients, nonunion of the ulna alone invovled in 12, and nonunion of the radius and ulna invovled in 2. Nineteen limbs (85.7%) were in active infected state with sinus and drainage. The mean amount of bone defect was 3.1 cm (range 1.8-4.6 cm) as measured on plain radiographs. RESULTS: The mean follow-up was 77.5 months. All patients achieved bony union and were satisfied with the functional and cosmetic outcome. All the infection had been controlled. The mean external fixation index was 42.5 day/cm. The average time for wound healing was 42 days. The mean length gained was 3.5 cm (2.1-5.3 cm). CONCLUSIONS: The technique of bone transport after debridement is a safe, effective, and minimally invasive treatment for forearm infected nonunion.

[Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident]. / Fascitis necrotizante por Saksenaea vasiformis en una paciente inmunocompetente tras un accidente de tráfico.

BACKGROUND: Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. CASE REPORT: A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. CONCLUSIONS: This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region.

Acute contaminated open forearm fractures treated with VersaJet Hydrosurgical Débridement.

The ideal method of irrigation and débridement for severe extremity wounds has yet to be determined. This report demonstrates the use of hydrosurgical débridement in the treatment of highly contaminated acute forearm fractures in a 22-year-old man ejected during a motor vehicle crash in a farm area. The result was rapid, selective, and effective débridement of deeply embedded material, which allowed for expeditious reconstruction with internal fixation, tendon transfers, and groin flap coverage while avoiding infection and injury to vital structures. The technique is described in detail and the current literature is reviewed.

The role of biofilm formation in percutaneous Kirschner-wire fixation of radial fractures.

This study examines the formation of bacterial biofilms on percutaneous wires used for fracture fixation. Twelve control (clinically uninfected) wires and ten infected wires were collected and examined using broth culture and scanning electron microscopy. Three of the 12 control wires grew Staphylococcus spp. with very low bacterial counts in their percutaneous portions. In the clinically infected wires, six wires in four subjects had positive cultures in their percutaneous portions and four of these also had positive cultures in their deep portions with much higher bacterial counts than the controls. In two patients (four wires) treated with antibiotics, cultures were negative except for the percutaneous portion of one wire. Scanning electron microscopy did not reveal bacterial biofilm formation, but biological deposit without bacteria was noted on most wires. During the 6 weeks of fracture fixation, some bacterial colonization of wires occurred, but bacteria did not form biofilms which may increase bacterial resistance to systemic antibiotics, cause implant loosening and act as a source of late infection.