OBJECTIVE: To review the results of a single-stage treatment protocol for presumptive aseptic diaphyseal nonunion with a well-healed wound and no infection history. DESIGN: Retrospective comparative study. SETTING: Tertiary referral center. PATIENTS AND METHODS: We retrospectively reviewed all presumptive aseptic diaphyseal nonunions treated by a single-stage protocol. There were 104 patients who met the inclusion criteria. Eighty-seven patients were available for follow-up through to complete healing (83.7% follow-up rate). INTERVENTION: The protocol entails withholding preoperative antibiotics, removing the implant, performing open debridement or canal reaming, taking 5 cultures of the nonunion site or canal reamings, followed by antibiotic administration, and revision open reduction and internal fixation or exchange nailing. If intraoperative cultures are positive, long-term antibiotics are begun specific to organism sensitivities. MAIN OUTCOME MEASUREMENTS: To analyze the rate of positive cultures and to compare the rate of secondary surgery to promote healing in positive and negative culture groups. RESULTS: Intraoperative cultures were positive in 28.7% (25/87) of patients with complete follow-up. The overall rate of secondary surgery for persistence of nonunion was 12.6% (11/87). In patients with positive intraoperative cultures, rate of secondary surgery was 28% (7/25) versus 6.4% (4/62) in the group without positive intraoperative cultures (P = 0.01). CONCLUSION: A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions was effective in obviating further revision surgery in 93.6% of truly aseptic cases and in 72% of positive culture cases and is still employed at our institution.
OBJECTIVE: To review the results of a single-stage treatment protocol for presumptive aseptic diaphyseal nonunion with a well-healed wound and no infection history. DESIGN: Retrospective comparative study. SETTING: Tertiary referral center. PATIENTS AND METHODS: We retrospectively reviewed all presumptive aseptic diaphyseal nonunions treated by a single-stage protocol. There were 104 patients who met the inclusion criteria. Eighty-seven patients were available for follow-up through to complete healing (83.7% follow-up rate). INTERVENTION: The protocol entails withholding preoperative antibiotics, removing the implant, performing open debridement or canal reaming, taking 5 cultures of the nonunion site or canal reamings, followed by antibiotic administration, and revision open reduction and internal fixation or exchange nailing. If intraoperative cultures are positive, long-term antibiotics are begun specific to organism sensitivities. MAIN OUTCOME MEASUREMENTS: To analyze the rate of positive cultures and to compare the rate of secondary surgery to promote healing in positive and negative culture groups. RESULTS: Intraoperative cultures were positive in 28.7% (25/87) of patients with complete follow-up. The overall rate of secondary surgery for persistence of nonunion was 12.6% (11/87). In patients with positive intraoperative cultures, rate of secondary surgery was 28% (7/25) versus 6.4% (4/62) in the group without positive intraoperative cultures (P = 0.01). CONCLUSION: A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions was effective in obviating further revision surgery in 93.6% of truly aseptic cases and in 72% of positive culture cases and is still employed at our institution.
Authors: Lucas Haase; Tyler Moon; Andrew Burcke; Jacob Speybroeck; Robert Wetzel; John Sontich; George Ochenjele; Joshua Napora Journal: Eur J Orthop Surg Traumatol Date: 2022-08-29
Authors: Louis F Amorosa; Leon D Buirs; Rens Bexkens; David S Wellman; Peter Kloen; Dean G Lorich; David L Helfet Journal: JBJS Essent Surg Tech Date: 2015-04-22
Authors: Christopher T Johnson; Mary Caitlin P Sok; Karen E Martin; Pranav P Kalelkar; Jeremy D Caplin; Edward A Botchwey; Andrés J García Journal: Sci Adv Date: 2019-05-17 Impact factor: 14.136
Authors: Theodoros H Tosounidis; Colin Holton; Vasileios P Giannoudis; Nikolaos K Kanakaris; Robert M West; Peter V Giannoudis Journal: J Clin Med Date: 2021-01-22 Impact factor: 4.241