RESUMEN
Pseudoarthrosis is defined as a non healing fracture 9 months after trauma and without radiological progression within the last three months. Osteoporotic fractures have a greater risk of chirurgical complications. The question of giving a medical treatment in the purpose of accelerating fracture healing is an increasing concern. There are data showing that with teriparatide (bone anabolic treatment derived from the parathyroid hormone) bone healing and functional status are improved, with or without surgery, in the case of either typical or atypical fractures. The risks of this treatment are low but health insurance agreement is needed in this indication. We report our experience with the use of this molecule, out of the official indication, in complex situations of non healing fractures.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Curación de Fractura/efectos de los fármacos , Seudoartrosis/tratamiento farmacológico , Teriparatido/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Óseas/tratamiento farmacológico , Fracturas Óseas/patología , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/tratamiento farmacológico , Fracturas Osteoporóticas/patología , Seudoartrosis/patologíaRESUMEN
A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol. At 3-month follow-up the patient still demonstrated poor knee function and pain. A plain X-ray and a CT scan of the left knee revealed a displaced fracture of the medial femoral condyle. Analysis of the postoperative imaging suggests that the fracture occurred during the insertion of the IM nail. The nail possibly hit the Steinmann traction pin in the distal femur causing the medial condyle fracture. The patient was reoperated; open reduction and internal plate and screw fixation were performed with satisfactory clinical progress postoperatively. The description and illustration of this case is intended to make trauma surgeons aware of this rare but serious complication of IM femoral nailing.
Asunto(s)
Clavos Ortopédicos/efectos adversos , Fracturas del Fémur/etiología , Fijación Intramedular de Fracturas/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Osteogenesis imperfecta (OI)-related femoral neck fractures are rare. This is rarely described in the literature. This article presents a way to surgically treat such a fracture. CASE REPORT: We describe the case of a 52-year-old patient with OI Type III with a displaced femoral neck fracture with varus deformity. We performed a hemiarthroplasty of the hip with valgus and shortening osteotomy of the proximal femoral shaft. CONCLUSION: The incidence of OI is 1 in 10,000-,000 births. People suffering from OI are known to be at more risk of fractures. Due to the bone deformity and weakness, treatment of fractures in patients with OI is a big challenge for orthopedic surgeons. Combined osteotomy and hemiarthroplasty is a reliable technique to treat a femoral neck fracture in a patient with typical OI-related varus deformity of the femora.
RESUMEN
Surgical indications in spinal trauma remain a controversial topic. In general, unstable cervical injuries such as displaced odontoid fractures, burst fractures or tear drop fractures require surgical intervention. Thoracolumbar compression injuries without posterior wall involvement or significant kyphosis can be treated conservatively. Surgery is indicated in fractures-dislocations and burst fractures with significant canal narrowing and/or major kyphosis. The role of emergency decompression as well as that of steroids remain uncertain since no study to date has convincingly proven their efficacy.
Asunto(s)
Descompresión Quirúrgica , Traumatismos del Cuello/cirugía , Traumatismos Vertebrales/cirugía , Fracturas Óseas/cirugía , Humanos , Inestabilidad de la Articulación , Cifosis/etiología , Cifosis/cirugíaRESUMEN
Although vertebroplasty was initially a treatment of vertebral haemangioma or metastases, this procedure is now frequent option to the treatment of osteoporotic vertebral fractures. In this review article, we will discuss the indication, the techniques and the follow-up of the vertebroplasty. This is a risky procedure, which should be performed by experimented physicians working with high-resolution fluoroscopic equipments, by biplane fluoroscopy, to reduce the risk and irradiation to the patient. According to the available follow-up studies, there is clear evidence of a strong improvement of quality of life after vertebroplasty by rapid decreasing of back pain at least during the first six months. Other new studies will analyze the long-term follow-up after vertebroplasty.
Asunto(s)
Procedimientos Ortopédicos , Fracturas de la Columna Vertebral/cirugía , Humanos , Osteoporosis/complicaciones , Selección de Paciente , Fracturas de la Columna Vertebral/etiologíaRESUMEN
INTRODUCTION: Periprosthetic femur fracture (PFF) is a serious complication after total hip arthroplasty that can be treated using different internal fixation devices. However, the outcomes with curved non-locking plates with eccentric holes in this indication have not been reported previously. The objectives of this study were to determine: (1) the union rate; (2) the complication rate; (3) autonomy in a group of patients with a Vancouver type B PFF who were treated with this plate. HYPOTHESIS: Use of this plate results in a high union rate with minimal mechanical complications. MATERIALS AND METHODS: Forty-three patients with a mean age of 79 years ± 13 (41-98) who had undergone fixation of Vancouver type B PFF with this plate between 2002 and 2007 were included in the study. The time to union and Parker Mobility Score were evaluated. The revision-free survival (all causes) was calculated using Kaplan-Meier analysis. The average follow-up was 42 months ± 20 (16-90). RESULTS: Union was obtained in all patients in a mean of 2.4 months ± 0.6 (2-4). One patient had varus malunion of the femur. The Parker Mobility Score decreased from 5.93 ± 1.94 (2-9) to 4.93 ± 1.8 (1-9) (P = 0.01). Two patients required a surgical revision: one for an infection after 4.5 years and one for stem loosening. The survival of the femoral stem 5 years after fracture fixation was 83.3% ± 12.6%. CONCLUSION: Use of a curved plate with eccentric holes for treating type B PFF led to a high union rate and a low number of fixation-related complications. However, PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates.
Asunto(s)
Placas Óseas , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Fracturas Periprotésicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Placas Óseas/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Reoperación , Estudios RetrospectivosRESUMEN
STUDY DESIGN: Twenty-one cases of chordoma arising in the mobile spine were retrospectively reviewed. OBJECTIVES: All the cases were submitted to oncologic and surgical staging to correlate treatment and outcome. SUMMARY OF BACKGROUND DATA: Excluding plasmacytomas, chordoma is the most frequent primary malignant tumor of the spine, occurring mainly in elderly men. The course of the disease is slow, metastases occur late, and death can result from complications related to local extension of the disease. Complete excision of the tumor according to oncologic criteria can be hampered by extension of the tumor and by anatomic constraints in the mobile spine. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Treatment was defined according to Ennekings criteria. All the patients were followed for determination of their status clinically and radiographically. RESULTS: Ten patients died (1 to 137 months after treatment, mean 65 months); four patients are alive with the disease; only seven patients (33%) are symptom free at the final follow-up (39 to 112 months after treatment, mean 65 months). Conventional radiation therapy was not effective in eradicating the tumor, even if associated with palliative or debulking surgery: of 15 cases, 12 were associated with recurrence or progression. Intralesional surgery also was not effective (two recurrences in two cases, 18 to 41 months later). En bloc excision of the lesion, sometimes combined with radiation therapy as an adjuvant, obtained the best results (four patients disease free at 39 to 112 months, mean 77 months). CONCLUSIONS: En bloc excision--even if marginal--is the treatment of choice of chordomas of the spine. Early diagnosis and careful surgical staging and planning are necessary. Megavoltage radiation can be administered as an adjuvant.
Asunto(s)
Cordoma/radioterapia , Cordoma/cirugía , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/cirugía , Adulto , Anciano , Tornillos Óseos/efectos adversos , Cordoma/mortalidad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Examen Neurológico , Complicaciones Posoperatorias , Recurrencia , Sacro , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/mortalidad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the use of the gamma nail in the treatment of pertrochanteric fractures. DESIGN: Prospective. SETTING: University. PATIENTS: Sixty-three fractures in sixty-three patients treated with gamma nails. RESULTS: Forty-five of the sixty-three patients (71 percent) were followed until the end of treatment, for an average follow-up period of 7.2 months. Of the remaining eighteen, eleven died and seven were lost to follow-up. Reduction was classified as good in thirty-eight cases, acceptable in nineteen, and unsatisfactory in six. CONCLUSION: The findings from this series indicate that, compared with other methods, the gamma nail enables the surgeon to treat more types of hip fractures with a less invasive technique and achieve equal or better results.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas/instrumentación , Fracturas de Cadera/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Fijación Intramedular de Fracturas/métodos , Curación de Fractura , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Radiografía , Rango del Movimiento ArticularRESUMEN
The authors describe the progressive correction of a deformed forearm and an ulnar deviation of the hand as a result of a bullet wound. The injury comprised a fracture of the two bones of the forearm, with deformed callus and after effects of a probable Volkmann syndrome. The correction was obtained after 10 months. This report illustrates the interest and the difficulty presented by osteogenesis by distraction and osteotomy with a minimal cutaneous wound. This allows the reduction of risk to the cutaneum and vessels involved in extemporaneous corrections.
Asunto(s)
Deformidades Adquiridas de la Articulación/cirugía , Fracturas del Radio/complicaciones , Fracturas del Cúbito/complicaciones , Adolescente , Alargamiento Óseo/métodos , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/etiología , Fijadores Externos , Humanos , Masculino , Radio (Anatomía)/cirugía , Fracturas del Radio/etiología , Cúbito/cirugía , Fracturas del Cúbito/etiología , Heridas por Arma de Fuego/complicaciones , Articulación de la MuñecaRESUMEN
Several physiological and anatomical methods of scoring severely injured patients have been developed since the 1970s, based on very large series of patients. In this study, 59 patients are assessed by the ISS (Injury Severity Score) and the RTS (Revised Trauma Score). The mean ISS is 28, and the mean RTS is 6; the overall evolution shows a 42.4% mortality. Analysis by the TRISS method shows 12 out of 18 "unexpected" deaths, the majority of which can be explained by the fact that the ISS underestimates severe neurological trauma, and that the RTS is not consistently obtained in the early patient notes in our emergency care system.
Asunto(s)
Índices de Gravedad del Trauma , Heridas y Lesiones/clasificación , Heridas y Lesiones/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Heridas y Lesiones/mortalidadRESUMEN
PURPOSE OF THE STUDY: External fixation is often the treatment of choice for open complex fractures of the tibia. For closed tibial shaft fractures, it is generally a second choice alternative. The purpose of this study was to determine whether fusion of closed and open fractures of the tibia can be successfully achieved with a one-side external fixator equipped with strain gauges and to evaluate complications of this type of treatment. MATERIAL AND METHODS: A consecutive series of 11 mid shaft fractures of the tibia (4 closed fractures and 7 Gustilo grade I and II open fractures) in 11 patients (mean age 29 years) were treated with a one-side external fixator. Strain was measured weekly to adjust the treatment. A Sarmiento walking cast was applied in all cases 4 weeks after removal of the external fixator. RESULTS: All 11 fractures healed without complications and without pin tract infection. Mean delay to consolidation was 20.5 weeks (range 13 - 29.5 weeks). One patient required a revision procedure for decortication and bone graft at 12 weeks. Weight bearing (50% of body weight on the injured limb) was achieved at 6.7 weeks (mean) and total weight bearing at 11.9 weeks. The external fixator's strain curves were compatible with normal healing in 3 cases, with slow healing in 3 and with retarded healing in 3 others. Two of the curves did not show recognizable patterns despite a favorable clinical and radiological course to healing. DISCUSSION: Early detection of a pathological pattern of fracture healing followed with a strain gauge enabled adaptation of treatment in all cases. Decortication with bone grafting was necessary in one patient. In two other cases, compression of the fracture with the external fixator or dynamic locking were sufficient to achieve a favorable healing pattern. This small series demonstrated that bone healing can be achieved within usual delays with external fixation and without major complications. Use of strain gauges on the external fixator allowed early detection of retarded healing and subsequent modification of the treatment protocol. This type of treatment might be an interesting therapeutic alternative for the treatment of closed fractures of the tibial shaft.
Asunto(s)
Fijadores Externos , Curación de Fractura , Fracturas Cerradas/cirugía , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Diáfisis/lesiones , Fracturas Cerradas/diagnóstico por imagen , Fracturas Abiertas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Estrés Mecánico , Fracturas de la Tibia/diagnóstico por imagen , Factores de Tiempo , TransductoresRESUMEN
An in vitro assessment of the mechanical performance of 10 types of external femoral stabilization allowed the amplitudes of fracture site displacements during the initial loading phase of a comminuted fracture treated by external fixation to be established. The largest displacement to load ratios were observed in the sagittal plane for all tested configurations. The highest fixator stiffnesses were obtained by using large diameter tubes and pins. The most rigid fixators have a derigidification system which creates the problem of choosing the ideal time to change the rigidity.
Asunto(s)
Fijadores Externos , Fracturas del Fémur/cirugía , Fijación de Fractura/métodos , Fracturas Abiertas/cirugía , Humanos , Proyectos de InvestigaciónRESUMEN
INTRODUCTION: The purpose of this study was to review the literature concerning Necrotizing Fasciitis (N.F.) and to discuss a typical case where late diagnosis led to severe consequences. MATERIAL AND METHODS: A young male patient with no pertinent medical history, progressively developed a large swelling of his foot and severe pain 3-4 days following a simple contusion. The absence of an entry site lead to local incision without microbiological study. The patient developed blistering on the leg, then septic shock necessitating amputation. DISCUSSION: N.F. is an infectious necrosis of the sub-cutaneous tissue appearing frequently in surgical or post traumatic contexts. Streptococcal origin is classical but multibacterial anaerobic infection is more and more frequently observed. An entry site is not always found while the affected site becomes red, hot and painful. Evolution is extremely rapid with the appearance of blisters and cutaneous necrotic sites and a severe alteration in the general condition of the patient. The extent of sub-cutaneous necrosis is larger than the affected area of skin. N.F. is a surgical emergency. Treatment consists of complete debridement, sometimes very extensive and mutilating. High dose intra-venous antibiotic therapy is necessary while the benefits of hyperbaric therapy are discussed. Because of the lack of specific clinical signs, diagnosis is difficult and is often made too late. The rapidity of the evolution shows that vital and functional prognosis is better with early diagnosis and treatment even for patients without associated pathology. The rate of mortality is approximately 50 per cent. CONCLUSION: Better information of practitioners allowing a rapid clinical diagnosis could improve the prognosis which is still life-threatening in 1994.
Asunto(s)
Amputación Quirúrgica , Fascitis/cirugía , Enfermedades del Pie/cirugía , Adulto , Desbridamiento , Urgencias Médicas , Fascitis/complicaciones , Humanos , Masculino , Necrosis , PronósticoRESUMEN
The authors present the case of an open fracture of femur Cauchoix type II with an infection due to Escherichia coli, Clostridium perfringens, Enterococcus and Aspergillus fumigatus. After several sequestrectomies and five hyperbaric sessions, apyrexia was attained at the end of the third month, the femur having been stabilised with an external fixator. The 15 cm gap due to loss of bone substance, filled at each dressing with an antiseptic iodine based ointment, closed itself finishing as continuous bone five months after the accident, the granulation tissue having been recovered by thin skin grafts. A repeated fracture occurring forty-eight hours after the removal of the Hoffmann frame was treated by fitting an Ilizarov fixator arriving at consolidation in seven months. The authors examine different possibilities of accelerating osteogenesis and highlight the potential role of iodine ointment as inductive to osteogenesis stemming from a periosteal layer seemingly held in place.
Asunto(s)
Fracturas del Fémur/cirugía , Fracturas Abiertas/cirugía , Osteomielitis/cirugía , Adulto , Callo Óseo/fisiología , Fijadores Externos , Fracturas del Fémur/complicaciones , Fracturas del Fémur/diagnóstico por imagen , Fracturas Abiertas/complicaciones , Fracturas Abiertas/diagnóstico por imagen , Humanos , Masculino , Osteomielitis/etiología , Radiografía , Cicatrización de HeridasRESUMEN
PURPOSE OF THE STUDY: Fracture of the tibial pilon is a rare injury and its treatment remains difficult. The aim of this study was to report the complications and long term results of internal fixation using a technique which respects soft tissues and in which little material was used. MATERIAL: From 1985 to 1990, 48 patients with 51 fractures of the tibial pilon were treated by open reduction and internal fixation. All patients were submitted to a clinical and radiological review. METHODS: Both the Rüedi/Allgöwer and the AO-classification were used and determined by standard X-rays. Surgical procedure was performed with a 2 or 3 1/3 tube AO-plates and the peroneus was always fixed if fractured. Intraoperative reconstruction was analyzed. Subjective and objective scoring were used according to Olerud and Molander and the ankle arthritis was scored according to the classification determined by the SOFCOT in 1992. RESULTS: A minimal follow-up of 1 year for all cases was obtained, based on our own files. Thirty-eight patients (40 fractures) were evaluated after an average period of 88 months (56 to 124 months). Five patients developed cutaneous infection, three developed deep infection and four developed superficial skin necrosis. One aseptic non-union necessitated reoperation after 14 months. Two ankles had joint fusion after 19 and 25 months respectively due to severe arthritis. In six cases infectious and non-infectious complications led to surgical revision. According to the Olerud and Molander score, 15 per cent of the results were excellent, 45 per cent were good, 30 per cent were fair and 10 per cent poor. DISCUSSION: Literature shows a wide range of results following this surgical procedure. This is due to the difference in the type of trauma, classification system used, material used for the internal fixation and method of evaluation. The classification system of Rüedi and Allgöwer is the most commonly used but has a rather subjective tendency, especially between type II and type III. Treatment is difficult, especially for comminutive fractures associated with soft tissue damage. In this case, open reduction and internal fixation could increase iatrogenic lesions. For this reason surgical procedure can be delayed for several days, little material is used and soft tissue manipulation is reduced to minimum. In other study reports, the use of external fixation with or without minimal internal fixation have produced less complications without improving long term results. CONCLUSION: Analysis and comparison of study reports are difficult because of the absence of consensus in classification system and evaluation methods. The AO-classification, apparently the most objective, will probably be more and more used in the future. Treatment must be adapted to the bony lesion and soft tissue damage. Open reduction and internal fixation must be reserved for a specific group of lesion.
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Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adulto , Trasplante Óseo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteítis/etiología , Estudios Retrospectivos , Fracturas de la Tibia/clasificación , Resultado del TratamientoAsunto(s)
Coagulantes/uso terapéutico , Factor VIII/uso terapéutico , Hemofilia A/complicaciones , Osificación Heterotópica/complicaciones , Heridas no Penetrantes/complicaciones , Adulto , Hematoma/etiología , Articulación de la Cadera , Humanos , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/lesiones , Osificación Heterotópica/diagnóstico por imagen , Dolor/tratamiento farmacológico , Dolor/etiología , Pelvis , Tomografía Computarizada por Rayos XAsunto(s)
Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Adolescente , Adulto , Anciano , Fascia Lata/trasplante , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Ligamentos Articulares/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Transferencia Tendinosa/métodosRESUMEN
One of the most demanding steps of an intramedullary nailing is the distal locking. The aim of this study is to evaluate clinically and prospectively a new targeting guide. Twenty-five patients were treated consecutively in two different trauma centres (level one and one general hospital) by two different surgeons who were instructed on using the new device. Reduction of the fracture, intramedullary nailing and proximal locking are performed according to standard procedures. Then the new targeting device is used for distal locking. Evaluations are focused on the time it takes to perform the distal locking, the duration of the irradiation exposure and the duration of the complete procedure. In terms of duration, our results are comparable to those reported in the literature but this new device has more advantages than any other system. This new device is fully mechanical and is solidly linked to the patient. It can be used with any existing radioscopic equipment in any hospital. The guide is manually adjustable out of the X-ray field avoiding the surgeon being irradiated. The procedure is easy to learn and reproducible.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fracturas Óseas/cirugía , Fracturas de la Tibia/cirugía , Tornillos Óseos , Diseño de Equipo , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fijación Intramedular de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fracturas de la Tibia/diagnóstico por imagen , Factores de TiempoRESUMEN
The aim of this retrospective study was to evaluate the effectiveness of circular external fixator according with Ilisarov technique for the treatment of diaphyseal pseudarthrosis. The union rate obtained in our serie was 91%. We assessed the complications related to surgery and analysed the reasons for failed technique. Between january 1986 and february 1996, 23 patients were included in this study with a mean follow-up of 65 months. The period of external fixation was 209 days on average. 21 patients had united fractures. The failures were attributed to inadequate interfragmentary contact. The main problem during treatment was pin tract infection. The late complications included axial deformities, re-fractures and joint stiffness. Circular external fixator proved to be useful for the treatment of diaphyseal pseudarthrosis, particularly those complicated by infection or post-traumatic shortening.
Asunto(s)
Fijadores Externos , Fracturas del Fémur/cirugía , Fracturas del Húmero/cirugía , Técnica de Ilizarov , Seudoartrosis/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Fracturas del Fémur/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Fracturas del Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Seudoartrosis/diagnóstico por imagen , Radiografía , Reoperación , Fracturas de la Tibia/diagnóstico por imagen , Insuficiencia del TratamientoRESUMEN
From June 1992 to July 1993, we treated 10 consecutive open tibial fractures (6 III A and 4 III B according to the classification of Gustilo). All fractures were treated by external fixation (9 Hoffmann external fixators and 1 Orthofix). Only one patients needed a primary facsiocutaneous flap; the remaining patients were treated by skin grafting (7 cases), secondary wound (1 cases) and granulation (1 case). In 8 cases we realised a decortication and autologous bone grafting. Consolidation time was inferior or equal to 6 months in 5 patients, equal to 8 months in one and equal to 11 months in one. One patient was lost to follow-up and one ist still in treatment. In 2 patients we changed the stabilisation system and we used the Ilizarov technique, once for pseudoarthosis at 7.5 months from injury and once for bone-transfer at 3.5 months. We do not deplore any other case of pseudoarthrosis nor any case of osteitis. None of our patients needed amputation. Early and adequate soft tissue treatment is essential and decoration and bone grafting, which we used 8 times at mean of 12 weeks from injury, should be done earlier.