Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases.

PURPOSE: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. METHODS: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. RESULTS: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. CONCLUSIONS: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.

Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment.

BACKGROUND: Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. METHODS: To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. RESULTS: Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. CONCLUSIONS: These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.

[Preoperative Disability and Its Influencing Factors in Patients With Lumbar Spondylolisthesis].

BACKGROUND: Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures. PURPOSE: To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis. METHODS: A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale. RESULTS: The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life.

A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty.

BACKGROUND: Pneumatic tourniquet is widely used in lower limb surgery to provide a bloodless operating field. Previous studies on total knee arthroplasty (TKA) in which tourniquets have been applied during surgery have reported some vascular and soft-tissue complications. Nevertheless, it is still not well known exactly how use of tourniquets contributes to hemodynamics of the lower limb and its clinical relevance following TKA. In this prospective study, we wished to determine whether tourniquet affects the hemodynamics and postoperative healing of the lower limb in the first few weeks and its clinical relevancies following TKA. METHODS: We prospectively collected consecutive 110 patients with advanced osteoarthritis of the knee. All the subjects were randomly assigned to one of two TKA procedures: TKA with (Group T) or without (Group O) tourniquets. The hemodynamics of each operated leg was assessed by Doppler, first before the operation, then postoperatively on days 2, 6, 14, and 28. The operative and postoperative managements were done the same as those described in the papers done by the author. Parameters during the operative and postoperative course, including, demography, pre- or postoperative knee score, tourniquet time, operation time, estimated blood loss, perioperative blood transfusion, hospital course, and complications will all be recorded and compared in detail. All patients were measured for all response variables, which included demographic variables, results of Doppler, and important surgical outcomes. Fisher's exact test was used to compare differences between the two groups for each discrete variable, and a Mann-Whitney Rank Sum Test was used to analyze each continuous variable. The p value was set for each test at 0.05 before analysis took place. In accordance with the repeated measures, the venous hemodynamic parameters were checked. If any significant differences appeared in the overall test, values were then compared in pairs using two sample t-tests for all statistical tests. The level of significance was set at p < 0.05. RESULTS: In our 110 patients (55 with tourniquet, 55 without), all checked clinical parameter were without significant difference except postoperative quadriceps muscle recovery. This implied tourniquet use influenced postoperative rehabilitation program. Blood loss amount were similar in both groups. There was only one DVT found. CONCLUSION: Tourniquet use in TKA must be managed very carefully. Not only because of immediate complication resulted from tourniquet but also influence on post-operational functional recovery, especially in quadriceps muscle function. According to this study, TKA without tourniquet use preserves better quadriceps muscle function to provide faster recovery and less transfusion need. It avoids complications from tourniquets as well.

Reduction in the Incidence Density of Pressure Injuries in Intensive Care Units after Advance Preventive Protocols.

(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014-2016) and post-bundle (2017-2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149-0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health.

The Effect of the Knowledge, Skills, and Attitudes from Nurse Training Using In Situ Simulation in an Intensive Care Unit.

BACKGROUND: In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. METHODS: This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. RESULTS: The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. CONCLUSIONS: In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field.

The effects of a care map for total knee replacement patients.

AIMS: The aim of this study was to establish and evaluate the effectiveness of a care map for total knee replacement patients. BACKGROUND: Bureau of National Health Insurance in Taiwan is about to launch a diagnosis-related group. This major reform has seriously affected the running of medical institutions, which are facing unprecedented management pressure. DESIGN: A quasi-experimental control group design was carried out. METHODS: Eighty-three patients were recruited, with 39 experimental group patients received nursing care based on a care map, while 44 patients who were in control group received routine nursing care. An interdisciplinary team designed the care map, which included items required for patient care from outpatient to postdischarge. RESULTS: (1) The mean age of patients was 72·73 (SD 8·42) years. Mean length of stay was 4·92 (SD 0·77) days for the experimental group and 7·09 (SD = 1·09) for the control group. Difference between groups was significant (t = -10·285, p < 0·001). The medical cost for the experimental group was less than that for the control group (t = -6·03, p < 0·001). (2) The self-care efficacy score before discharge for the experimental group was higher than that for the control group (t = 5·90, p < 0·001). (3) Significant improvements were observed in activities of daily living for both groups with the passage of time after discharge (F = 229·034, p < 0·001), and the experimental group was better than the control group (F = 40·895, p < 0·001). The instrumental activities of daily living abilities of both groups were also significant improvements with the passage of time after discharge (F = 46·568, p < 0·001), and the experimental group was better than the control group (F = 32·163, p < 0·001). CONCLUSIONS: A care map for total knee replacement patient can shorten length of stay, save medical cost and improve patient's functional recovery. RELEVANCE TO CLINICAL PRACTICE: Results of this study can be used as a basis for practical implementation of care map in total knee replacement patients.

Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates.

BACKGROUND: The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. METHODS: From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. RESULTS: The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. CONCLUSION: For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.

Visiting in disguise: Analysis of inpatient companions in the time of COVID-19.

BACKGROUND: As outbreak of COVID-19 infection, on April 3, 2020, it is stipulated that the number of inpatient companions is limited to one in Taiwan. All companions are required to register their real personal data with 14 days of travel history, occupation, contact history, and cluster history. We would like to evaluate the impact of the new regulations to the accompanying and visiting culture in Taiwan, via analyzing the appearance and characteristics of inpatient companions in this period. METHODS: Using intelligent technology, we designed a novel system in managing the inpatient companions (InPatients Companions Management System [IPCMS]), and the IPCMS was used to collect data about characteristics of inpatients and companions between April 27 and May 3, 2020. The database is built using MySQL software. Microsoft Excel 2016 and SPSS version 20.0 statistical software were used for data analysis, including the basic data of the companions, differential analysis of companions' gender, person-days and cumulative time, differential analysis of accompaniment-patient relationship, and frequency of accompaniment and cumulative hours. RESULTS: During study period, daily inpatient admissions ranged from 2242 to 2514, the number of companions per day ranged from 2048 to 2293, and the number of companions for one inpatient is 1 to 9 per day, with an average of 1.20 to 1.26. The companions were mostly family members, and most of them were the inpatients' children (32.9%), and spouse (26.13%). More females than males were noted in all categories of companionship with statistical significance. CONCLUSION: The data obtained in this study could be an important basis for the transformation and reform of the companions culture in Taiwan's hospitals and will also provide a glimpse into the attitudes and culture of companions who have long been ignorant and neglected. The experience gained in our IPCMS could also serve as a reference for other hospitals in Taiwan and worldwide.

Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis.

BACKGROUND: We elucidated the effect of open reduction and internal fixation with locking plate for acute isolated displaced greater tuberosity fractures of humerus in elder adults (aged >60 years). METHODS: From 2009 to 2015, data from 32 patients, aged between 60 and 88 years, who had acute unilaterally displaced greater tuberosity fractures of humerus were collected and evaluated retrospectively. All the fractures were managed with open reduction and internal fixation with locking plate. The follow-up period was 50.8 months on an average (range 22-80 months). Finally, 25 patients were available for final evaluation of radiographic and functional results. RESULTS: All the 32 fractures had union with the average union time of 14 weeks (range 10-18 weeks) and with no complications. The average of preoperative Visual Analogue Scale (VAS) was 6.2 (range 4-8), ASES was 30.4 (range 13-45), and Constant score was 30.4 (range 20-45). At the last follow-up, the mean VAS was 1.3 (range 0-2.5), the mean ASES score was 90.1 (range 72-100), and the mean Constant score was 90.3 (range 80-100). There were statistically significant differences between preoperative and final follow-up in VAS, ASES, and Constant score. Hundred percent of patients had good or excellent results by Constant score, with excellent results (86-100) in 17 (68%) patients and good result (71-85) in 8 (32%). CONCLUSION: In conclusion, open reduction and internal fixation with locking plate is an effective treatment for acute displaced greater tuberosity fractures of humerus in elder adults.

Care needs and level of care difficulty related to hip fractures in geriatric populations during the post-discharge transition period.

The objective of this study was to understand the following: (1) the specific care needs of geriatric hip fracture patients; (2) the level of care difficulty during the transition period following discharge; and (3) the correlation amongst demographics, the physical function status of the elderly, and care needs. Purposive sampling was used, and a total of 71 hip fracture cases and their caregivers were selected. A survey was carried out to collect data just before discharge and one week following discharge. Statistical methods included descriptive statistics, correlation analysis, one-way ANOVA, and a paired t-test. Results were as follows: Most geriatric patients depended upon care from family members before discharge, with an average physical function status score of 6.99 (0 to 18) that improved significantly after one week to 10.27; paired t = -7.956 (p < .000). The mean age of primary caregivers was 51.72 years old (SD = 14.05). Most caregivers (47, or 66.2%) were female. The relationship between elderly participants and their primary caregiver was predominantly that of husband and wife (22 people; 31.0%). Participant care needs identified included return visit assistance, awareness of safety at all times, assistance with cleaning and maintaining living quarters, and so on. Caring tasks that were identified as more difficult for the primary caregivers includes providing stair climbing assistance, emotional problems management assistance, walking training assistance, rehabilitation assistance, and emergency disease management assistance. The care needs of the elderly in this study and level of execution difficulty for caregivers was found to be negatively related to the physical function status of the elderly. The study results suggest that providing patient-related home care knowledge to primary caregivers prior to discharge from the hospital and enhancement of the social support system are both needed.

Cementless Acetabular Reconstruction for Arthropathy in Old Acetabular Fractures.

This study was conducted to identify the factors influencing mechanical failure of cementless acetabular reconstruction for arthropathy after operative treatment of acetabular fractures. Fifty-six patients (56 hips) undergoing cementless total hip arthroplasty were enrolled and followed for a mean of 120 months (range, 60-180 months). The 10-year survival rate, with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the endpoint, was analyzed with respect to sex, age, body mass index (BMI), acetabular bone deficiency, sclerotic changes to the acetabulum, and use of the Trabecular Metal (TM) cup (Zimmer, Inc, Warsaw, Indiana). Mean 10-year survival rates of the acetabular component were as follows: 80% (range, 65%-96%) in males and 100% in females (P=.032); 77% (range, 60%-95%) in patients younger than 50 years and 91% (range, 82%-100%) in older patients (P=.027); 88% (range, 78%-98%) in patients with a BMI less than 30 kg/m(2) and 81% (range, 74%-89%) in patients with a BMI of 30 kg/m(2) or higher (P=.068); 54% (range, 32%-76%) in patients manifesting large acetabular deficiency and 90% (range, 78%-100%) in the remaining patients (P<.001); 78% (range, 65%-91%) in patients with the presence of sclerotic acetabulum and 92% (range, 86%-100%) in patients with the absence of sclerotic acetabulum (P=.022); and 82% (range, 73%-100%) in patients who received a conventional shell and 100% in patients who received the TM cup (P=.039). Male sex, age younger than 50 years, large acetabular deficiency, and sclerotic changes of the acetabulum were significant factors contributing to the mechanical failure of cementless acetabular reconstruction performed for old acetabular fractures treated with open reduction and internal fixation. Use of the TM cup seemed able to prolong the endurance of the acetabular component in the subsequent reconstruction.

Concomitant hip and distal radius fractures.

BACKGROUND: Concomitant ipsilateral hip and distal radius fractures are uncommon, and little research has been published about these injuries. Our aim was to evaluate the characteristics and results of treatment for these injuries. METHODS: Between 2006 and 2012, 35 concomitant hip and distal radius fractures were identified, comprising the study group. The characteristics and results of treatment for these injuries were evaluated and analyzed. Another matched control group with isolated hip fractures was collected for comparison of patient characteristics, fall mechanism, fracture pattern, bone density, and functional recovery. RESULTS: For the patients with concomitant fractures, the average age was 77.6 years, and the female-to-male ratio was 6:1 (30:5). The majority (91.4%) of patients sustained ipsilateral injuries. Among the controlled pairs, 20 (57.1%) patients in the study group sustained a backward fall, and 25 (71.4%) patients in the control group had a sideways fall. With respect to the pattern of hip fracture, 22 (62.9%) patients in the study group had femoral neck fractures and 20 (57.1%) patients in the control group had pertrochanteric fractures. The average hospital stay was 15.3 days in the study group versus 10.2 days in the control group. Twenty-five (71.4%) patients in the study group and 27 (77.1%) patients in the control group had osteoporosis. The average Barthel index score was 75.1 in the study group and 75.7 in the control group. CONCLUSION: Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.

Noncemented total hip arthroplasty for osteonecrosis of the femoral head in elderly patients.

The results of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) in elderly patients (80 years or older) has not been well defined. The purpose of this retrospective study was to evaluate the clinical course of and the results in noncemented THA for ONFH in elderly patients.Between 1998 and 2007, one hundred seven consecutive hips with ONFH in 103 patients were evaluated. The causes of ONFH were traumatic in 46 (43%) hips and nontraumatic in 61 (57%) hips. All hips were treated with noncemented THA. Average follow-up was 72 months (range, 60-144 months). The functional results improved to statistical significance after THA. However, no significant differences existed between 6 months, 1 year, and 5 years postoperatively. Nine (8.4%) postoperative complications occurred in these 107 hips, including 1 stem loosening, 1 liner wearing, 4 postoperative infections, 2 postoperative dislocations, and 1 pulmonary embolism. Fifteen (14.6%) deaths occurred during follow-up. The progression of ONFH in elderly patients was so rapid and the result of core decompression was so poor that a salvage procedure seemed to have no role in the treatment. Harris Hip Score, Short Form 36 physical function score, and Western Ontario and McMaster Universities Osteoarthritis Index scores significantly improved after noncemented THA. Ninety-two hips had a complete follow-up, and the survivorship of prosthesis was 95% (88/92) with minimal 5-year follow-up. Noncemented THA was effective in the treatment of ONFH in this group of patients.

The impact of exsanguination by Esmarch bandage on venous hemodynamic changes in total knee arthroplasty - A prospective randomized study of 38 knees.

Elastic (Esmarch) bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set. We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch bandage before knee arthroplasty.

Cerclage wiring in displaced associated anterior column and posterior hemi-transverse acetabular fractures.

PURPOSE: The effects of cerclage wiring in the open reduction and internal fixation of displaced associated anterior column and posterior hemi-transverse acetabular fractures were evaluated. METHODS: This is a retrospectively clinical study of such cases where the main surgical strategy was open reduction and internal fixation with cerclage wire and reconstruction plates. Data on 12 cases treated between 1992 and 2011 were collected. The mean follow-up period was 32 (12-132) months. RESULTS: Reduction with a fracture gap of less than 2 mm without articular stepping and solid union was achieved in all 12 cases. Postoperative complication developed in one case of symptomatic arthritis. Excluding the case with symptomatic arthritis, the other cases had good to excellent final D'Aubigne and Postel functional results. CONCLUSIONS: Cerclage wiring is very useful and effective in the reduction and fixation of displaced associated anterior column and posterior hemi-transverse acetabular fractures, and supplemental fixation with reconstruction plates and screws is necessary.

The role of autologous bone graft in surgical treatment of hypertrophic nonunion of midshaft clavicle fractures.

BACKGROUND: This study was conducted to evaluate the results of treating hypertrophic nonunion of mid-shaft clavicle fracture with a limited contact dynamic compression plate (LC-DCP) without autologous cancellous bone graft. METHODS: From 1995 to 2008, 51 cases of hypertrophic nonunion of mid-shaft clavicle fracture were managed with open reduction and internal fixation by LC-DCP without bone graft involvement. Of these 51 cases, 30 had nonunion after failure of initial surgical treatment (Group 1), and 21 had nonunion after failure of conservative treatment (Group 2). Preoperative and postoperative case management were the same for both groups, with the average follow-up period being 20.4 months (range 18-36). Our study evaluated the radiographic results and functional outcomes of these cases according to the quick disability of arm, shoulder, and hand score. RESULTS: All 51 cases resulted in uneventful unions. There was no statistically significant difference between the two groups regarding patient demography, cause of injury, preoperative and postoperative functional scores, length of operation, union time, and duration of hospitalization (p>0.05). CONCLUSION: LC-DCP fixation is an effective method for treating hypertrophic nonunion of mid-shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.

Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture.

We evaluated the effect of revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral shaft fracture. Fifty patients with aseptic nonunion of femoral shaft fracture after intramedullary nailing were reviewed and analyzed retrospectively between 1996 and 2007. There were 40 men and 10 women with an average age of 44 years (range, 19-76 years). Thirty-five were diaphyseal fractures, 8 were distal fractures, and 7 were proximal fractures. Twenty-eight fractures were defined as atrophic nonunion, 13 fractures were hypertrophic nonunion, and 9 fractures could not be defined clearly. All fractures were managed by retaining previous implants, open reduction and internal fixation with dynamic compression plate, and supplementation by cancellous bone graft. The average follow-up period was 76 months (range, 24-128 months). Functional evaluations were done by Harris Hip score and Hospital for Special Surgery knee score. All nonunions united on average at 24 weeks (range, 18-32 weeks). One superficial wound infection occurred. At follow-up, each patient was evaluated to have satisfactory function results, with near normal hip/knee functions without noticeable pain, and full return to preinjury activities/work without pain.Augmentative dynamic compression plate with cancellous bone graft is a reliable and effective treatment for revision of aseptic nonunion of femoral shaft fracture after intramedullary nailing.