Closed Unassisted Reduction in Emergency: A Technique for Unassisted Closed Reduction of Colles Fractures Without Equipment.

BACKGROUND: Colles fractures are fractures of the distal radius that are often encountered in the emergency department. They result from accidents and sport injuries in the young but are a common outcome of falls in the elderly population. While Colles fractures are frequently expected to heal with good results, improper reduction, malunion, or later displacement are related to poor functional outcomes in the long term. Treatment is usually by closed reduction either manually or using longitudinal traction. The disadvantage of this is the need for either trained assistants or equipment. We propose a technique for closed unassisted reduction without the use of equipment that can be useful in acute settings where there is shortage of assistance and tools. DISCUSSION: Fifty-two patients with distal radius fractures were treated with closed unassisted reduction in emergency. The steps of the technique are explained in detail and shown in the accompanying videos. The key lies in the placement of the patient, the use of the doctor's thigh as a lever for the reduction, and positioning of the arm to support the reduction using its own weight. All 52 reductions were successful, while the duration of the reduction process was in all cases under 10 min. CONCLUSIONS: Closed unassisted reduction in emergency for Colles fractures is a reliable and simple technique, its major advantage being that it can be performed quickly by 1 physician without equipment.

Combined Bone Transportation and Lengthening Techniques for the Treatment of Septic Nonunion of the Forearm Followed by Tendon Transfer.

Infected nonunion of a forearm fracture complicated by a considerable skin-muscle defect poses a great challenge to orthopaedic surgeons. The treatment strategy comprises eradication of the infection, ensuring bony union and soft tissue coverage along with functional restoration. We report a case of a 23-year-old man with an open Gustilo-Anderson IIIb fracture complicated by infected nonunion after internal fixation. After thorough surgical debridement, a considerable soft tissue defect, extensor muscle loss, and posterior interosseous nerve laceration had to be addressed. He was finally treated with bone transportation and bone lengthening followed by tendon transfers.

Lengthening Over an Existing Intramedullary Nail In Cases of Post-traumatic Femoral Shortening. Technical Note. Case Series Study.

BACKGROUND: Intramedullary (IM) nailing is the method of choice for the treatment of most femoral shaft fractures. However, despite successful solid union, great initial fracture comminution can lead to significant leg length discrepancy affecting normal gait mechanics. Femoral osteotomy and distraction osteogenesis over the pre-existing IM nail could restore this limb inequality. METHODS: Five patients with an average post-traumatic femoral shortening of 3.83 cm were presented in our department with the nail in situ. Limb lengthening was achieved with the application of a distal hybrid external rail frame over the pre-existing nail. We assumed that the choice of a distal external fixator ring with wires could facilitate the procedure and minimize the possibility of friction-contact problems with the large diameter nail. RESULTS: The amount of length discrepancy, calculated preoperatively, was restored in all patients. The mean time in frame was 57.6 days and the external fixator index 16.978 d/cm. The mean time of total healing was 152.6 days and the average bone-healing index 44.9d/cm. No deep infection or hardware loosening was observed. One superficial pin track infection was treated successfully with oral antibiotics. CONCLUSION: This technique utilizes the principles and advantages of lengthening over an IM nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery.

Autologous bone marrow grafting combined with demineralized bone matrix improves consolidation of docking site after distraction osteogenesis.

BACKGROUND: Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation. We further sought to clarify whether the application of autologous bone marrow cells combined with demineralized bone matrix would substantially improve docking site consolidation. METHODS: Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the "docking site procedure" used: closed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed. RESULTS: The median "healing time" required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation. CONCLUSIONS: The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.

Distraction osteogenesis as a salvage method in infected knee megaprostheses.

Infection of total knee replacement represents a severe complication. Especially in cases of infected megaprostheses, treatment options are limited and even amputation may become unavoidable. We present two cases of infected knee hinged megaprostheses. Both were treated by prosthesis removal and debridement of all surrounding infected bone and soft tissue, followed by distraction osteogenesis for the bridging of the large bone defect which had resulted. Implant removal and surgical debridement were combined with Ilizarov frame application and femoral and tibial osteotomies in a one-stage procedure, for commencing distraction osteogenesis. After bone transportation was completed, arthrodesis of the knee in both cases was successful. Two years after completion of the treatment, both patients demonstrate a stable knee arthrodesis and a satisfactory clinical result. The described treatment plan represents an effective salvage method in cases of infected knee megaprostheses that can successfully address both the need for a stable arthrodesis and the avoidance of a severe leg-length discrepancy by bridging the extensive bone defect.

Parecoxib has non-significant long-term effects on bone healing in rats when administered for a short period after fracture.

INTRODUCTION: Selective and non-selective cyclo-oxygenase (COX) inhibitors impair bone healing by inhibiting prostaglandin synthesis. The purpose of this study was to evaluate the long-term effect of parecoxib, a selective COX-2 inhibitor, on bone healing in rats, when it is applied in a pattern similar to clinical treatment patterns, that is, in a high dose and for a short period after bone fracture. METHOD: Closed non-displaced mid-diaphyseal fractures in the middle of the left femoral shaft were generated in each animal. In the study group, parecoxib sodium (1.06 mg/kg) was administered intra-peritoneally every day for 7 days. In the control group, normal saline was administered intra-peritoneally every day for 7 days. In both groups fracture healing (bone union and callus formation) was evaluated with X-rays 28 and 42 days after surgery. RESULTS: Bone healing was lower in the study group (60 vs. 80% in the control group 28 days after fracture and 80 vs. 90% 42 days after fracture) but this difference was not statistically significant (P > 0.05). CONCLUSION: Parecoxib does not have a significant long-term effect on bone healing in rats, when it is administered in a high dose and for a short period after bone fracture.