Epdemiology and Treatment of Pseudarthrosis of Long Bones in the Servce D Orthopedics-Traumatology of the University Hospital of Donka

Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.

Surgical Treatment of a Subtrochanteric Pseudarthrosis in a 5 Year-Old Child at the University Hospital of Tingandogo in Burkina Faso

The subtrochanteric fractures are relatively rare in the child and they constitute a therapeutic problem. The pseudarthrosis of this fracture in the child is often the complication of a subtrochanteric fracture treated orthopedically. We report the case of a subtrochanteric pseudarthrosis in a 5 year-old child occurred following an orthopedic treatment. After surgical treatment by bloody reduction and pinning, the pseudarthrosis consolidated in 10 months with satisfactory functional results.

Relationship between postoperative complications and fibular integrity in congenital pseudarthrosis of the tibia in children

Background:This study aimed to investigate the relationship between postoperative complications and fibular integrity in congenital pseudarthrosis of the tibia (CPT) in children.Methods:A retrospective study was performed in 59 patients with Crawford type Ⅳ CPT who were treated with combined surgical technique from 2007 to 2011.The patients were divided into two groups,the CPT with fibular pseudarthrosis (group A) and CPT with intact fibula groups (group B),on the basis of fibula status after the union of CPT.The incidence rates of refracture,ankle vaigus,tibial valgus,and limb length discrepancy in the two groups were investigated.Results:In group A,14 (36.8%) cases had refracture,30 (78.9%) had ankle valgus;27 (71%) exhibited tibial valgus with an average tibial valgus of 7 (6-20),and 24 (63.2%) had limb length discrepancy with an average limb length of 1.26 cm (0.6-4.4 cm).In group B,2 (9.5%) cases had refracture,11 (52.4%) had ankle valgns,8 (42.9%) had tibial valgus with an average tibial valgus deformity of 2.9 (6-13),and 13 (61.9%) had limb length discrepancy with an average limb length of 1.48 cm (0.5-5 cm).Significant difference in refracture and ankle valgus was found between groups A and B (P<0.05).Conclusions:After the union of CPT,patients with fibular pseudarthrosis showed higher incidence of refracture and ankle valgus than those with intact fibula.Attention should be paid to the presence of fibular pseudarthrosis when managing CPT.

The Use of Autologous Tibia Strut Graft to Enhance Bone Healing of an Infected Long-Bone Nonunion

We treated five patients with an infected non-union of the femur and tibia with autologous tibia strut grafts. All patients had bone defects ranging from three to nine centimeters. Three patients suffered for more than seven years from chronic osteitis. Our objective was to describe this grafting technique and its results. We focussed on healing time, postoperative complications and functional recovery. We retrospectively studied five patients with an infected non-union of the lower limb who had undergone previous surgeries to overcome the bone healing problem. In this group of patients, we had four femur non-union and one tibia non-union. All of them had a previous infection episode, in which medical and surgical therapy was needed. Of the participants, three were men, and two were females with a mean age of 43.3 years (28 - 55).

Ilizarov bone transport combined with the Masquelet technique for bone defects of various etiologies (preliminary results)

BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.

Nonunion of the scaphoid treated by anterior vascularized bone graft： a review of 26 cases

[Abstract] Objective： To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid. Methods： This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot＇s classification and only one case showed a proximal pole necrosis （type IV）. The fixation was ensured by K-wire. The mean immobilization period was 9 weeks. Results： At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18°. Nineteen patients （73%） were free of pain, and the others had occasional pain Conclusions： It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.