Journal of Musculoskeletal Trauma

Original Articles

Treatment of Infected Nonunion of Long Bone Shaft: Comparison between Fixation by Antibiotic-cement Loaded Intramedullary Nailing and Fixation by Antibiotic-cement Loaded External Monofixator: Ki Ho Nah, Seong Jin Park, Suk Ku Han, Hyun Suk Song, Nam Yong Choi; J Korean Soc Fract 2003;16(4):511-518. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.511

Abstract PDF: PURPOSE
To evaluate the surgical results between fixations by antibiotic-cement loaded intramedullary nailing and antibiotic-cement loaded external monofixator in the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm.
MATERIALS AND METHODS
Among the 15 cases of infected nonunion of long bone shaft, 6 cases treated with fixation by antibiotic-cement coated intramedullary nailing and 3 cases treated with fixation by intramedullary nailing along with antibiotic-cement beads insertion were divided as group I (n=9), and other 6 cases treated with fixation by external monofixator along with antibiotic-cement beads insertion were divided as group II (n=6). There was no difference between the two groups in the degree of infection in the laboratory data and clinical feature and degree of bone loss and shortening. Male was in 7 and 5 patients, average age of the patients was 34.8 (26~53) and 37.2 (20~63) years old and average follow-up period was 15.9 (12~35) and 19.3 (15~41) months in group I and II respectively.
RESULTS
Among the nine cases of group I, 3 cases were newly convereted into fixation by antibiotic-cement coated intramedullary nailing at average 9.5 weeks. Radiologic union was gained at the average of 26 weeks from the time of initial nail fixation. Infection was responsive at 6.1 weeks by laboratoey data. Knee ROM of more than 100 degrees was gained in all case and average shortening was 9.2 mm in the last follow-up. And external rotation deformity of more than 5 degrees was noted in 1 case. Among the six cases of group II, radiologic union was gained at 14 weeks in 1 case without converting to internal fixation, and the other 5 cases were converted to antibiotic cement loaded intramedullary nailing at average 12.5 weeks because of delayed uinon or angulation deformity, and radiologic union was gained at average 44 weeks from the time of fixation by external fixator. Infection was responsive at 10.2 weeks by laboratoey data. Knee ROM of more than 100degrees was gained in 5 cases, and average shortening was 11.8 mm in the last follow-up.
CONCLUSION
In the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm, the fixation by intramedullary nailing with the use of antibiotic-cement prefers to the fixation by external monofixator with the use of antibiotic-cement in the velocity of union, control of infection, and in the clinical aspects such as alignment, early ambulation and joint stiffness.

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New Bone formation in Vascularized Periosteal Flap over the Bone Defect of the Shaft of the Radius in Rabbit. : Early Radiological, Histological and Immunohistochemical Study of Osteogenesis: Jae Kwang Yum, Young Bok Jung, Mi Kyung Kim, Ho Rim Choi, Tae Yeul Yoo, Jung Nam Han; J Korean Soc Fract 1999;12(4):1003-1011. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1003

Abstract PDF: Vascularized periosteal flap(VPF) it thought to enable formation of new bone and promote union in bone defect without risk of complications in donor site. Studiol about the VPF thus far have been centered on the long term result than early change after YPF. The purpose of this study was to elucidate the process of new bone formation in early stage after YPF by radiological, histological, electron microscopical and immunohistochemical studies. In experimental group, segmental resection of bone including the periosteum was performed in fifty-six radii of immature New Zealand white rabbits preserving the periosteal circulation from median artery which is the main source of blood supply to the periosteum. In order to simulate the transplantation of VPF, the vascular pedicle of median artery and veins was dissected from adjacent soft tissue and the periosteum was longitudinally incised to remove the bone tissue in the periosteum. Thereafter the vascularized periosteum was repaired. From the first to fourteenth day after the simulated VPF, the findings in the VPFs were observed by radiological, light microscopical, scanning electron microscopical methods and activity of osteocalcin was measured by immunohistochemical method. In control group, the bone tissue and periosteum were completely removed from the mid-shaft of seven radii, thereafter the radiological findings were observed at 1, 2, 3, 4, 8, 12, 16th week and light microscopical findings were observed at 8, 16th week after operation. From the results of this study, it is concluded that YPF is vigorously and uniformly osteogenic in its early stage. It it thought that this study could serve as a basic data for the future experimental studiol about VPF in animals and clinical application.

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