Treatment of Infected Tibia Non-union Using a Novel Solid Intramedullary Nail Custom-Made for Antibiotic-Impregnated Cement Coating.

The chronic and incapacitating condition of infected non-union of the long bones continues to be a challenging issue for surgeons in terms of efficient and economical treatment. A number of variables, such as open fractures, soft tissue or bone loss, infection following internal fixation, persistent osteomyelitis with pathologic fractures, and surgical debridement of infected bone, can result in infected non-unions. An infected non-union is typically treated in two stages. To transform an infected non-union into an aseptic non-union, the initial step involves debridement, either with or without the insertion of antibiotic cement beads and systemic antibiotics. In order to ensure stability, external or internal fixation - with or without bone grafting - is carried out in the second stage. There is a wealth of literature supporting the use of antibiotic-impregnated cement-coated intramedullary (IM) nailing for infected non-union of tibia and femur fractures. In contrast to cement beads, the cement nail offers stability throughout the fracture site, and osseous stability is crucial for the treatment of an infected non-union. When using antibiotics for this purpose, they should possess unique qualities, including low allergenicity, heat stability, and a broad spectrum of activity. The most commonly utilised medication has been gentamicin, which is followed by vancomycin. Furthermore, it has been discovered that solid nails are more resistant to local infection than cannulated IM nails. In this case study, the patient was treated with a solid IM nail that had a specially designed slot on its exterior surface for the application of cement impregnated with antibiotics. In conclusion, an easy, affordable, and successful treatment for infected non-union of the tibia is antibiotic cement-impregnated nailing. It has strong patient compliance and removes the problems associated with external fixators, which makes it superior to them. A few benefits of this approach are early weight-bearing, stabilisation of the fracture, local antibiotic treatment, and the potential for accelerated rehabilitation. Additionally, lowering the requirement for continuous antibiotic medication may lessen the chance that antibiotic resistance may arise.

Radiological Evaluation of Lumbar Endplate Dimensions in the Indian Population and Their Correlation With Cage Placement/Length in Diverse Lumbar Fusion Techniques.

Background Lumbar fusion techniques are vital for treating various spinal conditions by promoting vertebral fusion to alleviate pain and restore stability. Given the anatomical uniqueness of the Indian skeletal structure, this study evaluates the radiological dimensions of lumbar endplates in the Indian population and their correlation with the placement and length of interbody cages used in various lumbar fusion techniques such as oblique lateral lumbar interbody fusion (OLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF). This study aimed to conduct radiological measurements of lumbar endplates in the Indian population and correlate them with cage placement and length in lumbar fusion techniques. Methods This prospective study was conducted at the orthopaedic ward of a tertiary care center in Western Maharashtra, India. Healthy individuals (aged >18 years, either gender) selected with a 95% confidence level using Philip Core Integrity software (Amsterdam, Netherlands) were included in the study. We excluded those with a history of low back pain, previous lumbar spine surgeries, fractures, tuberculosis, tumors, deformities, degenerative diseases, or lesions affecting the lumbar spine. Quantitative measurements such as oblique and sagittal diameters, apophyseal ring widths, and interbody cage lengths were calculated using multiplanar reformatting with specific imaging parameters. Results A total of 150 individuals with an average age of 39.83 ± 14.17 years, ranging from 20 to 65 years. Among the study population, 68 were males and 82 were females. Among the male study population, oblique parameters such as Angle AOB and Mid-OD (oblique diameter) show considerable variability, with Angle AOB ranging from 51.43 ± 2.40 mm (L2 inferior) to 31.59 ± 4.25 mm (L5 inferior) and Mid-OD ranging from 41.59 ± 2.59 mm (L3 superior) to 34.38 ± 2.26 mm (S1 superior). Side-sagittal dimensions vary from 32.11 ± 2.50 mm (S1 superior) to 36.48 ±3.26 mm (L3 superior), emphasizing the need for tailored surgical planning. In contrast, females in the study population exhibit distinct anatomical profiles, with Angle AOB ranging from 52.15 ± 2.43 mm (L2 inferior) to 20.45 ± 5.45 mm (S1 superior) and Mid-OD from 33.48 ± 2.15 mm (L3 inferior) to 42.45 ± 2.59 mm (L3 superior). These findings underscore gender-specific anatomical differences crucial for individualized clinical evaluation and treatment strategies. Conclusion This study comprehensively analyzes oblique, side-sagittal, transverse, and midsagittal anatomic parameters across various vertebral levels in men and women, highlighting significant anatomical variations crucial for clinical assessments and surgical interventions.

Bilateral Humerus Midshaft Fracture Associated With Birth Trauma: A Case Report.

Bilateral humerus fractures as a result of birth trauma are a rare occurrence in neonatal care, necessitating special consideration due to their potential long-term implications. Birth-related injuries involving neonatal skeletal structures, especially fractures of the humerus, require special attention and a comprehensive approach to diagnosis and management. Here, we present the case of a newborn female child who experienced bilateral humerus fractures due to birth trauma. The subsequent management involved the application of splints to immobilize the affected arms, a standard practice in the treatment of fractures.