JBJS essential surgical techniques · 2015
Single-Stage Treatment Protocol for Presumed Aseptic Diaphyseal Nonunion.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Amorosa Louis F, Buirs Leon D, Bexkens Rens, Wellman David S, Kloen Peter, Lorich Dean G, Helfet David L
Аннотация
INTRODUCTION: This article describes the general surgical technique for treating presumed diaphyseal nonunion with a one-stage procedure involving intraoperative removal of specimens for culture, revision open reduction and internal fixation (ORIF) with a plate or nail, and bone-grafting.
STEP 1 PREOPERATIVE EVALUATION: Take a careful history, evaluate the extremity and wound, and note comorbidities and medications.
STEP 2 PREOPERATIVE PLANNING: Preoperative planning is essential before revision nonunion surgery.
STEP 3 DEBRIDEMENT IMPLANT REMOVAL AND CULTURES: Debride the nonunion site, remove all failed and loose implants, and take specimens for culture; withhold antibiotics until all culture specimens have been obtained.
STEP 4 OPEN REDUCTION AND INTERNAL FIXATION: Reduce the fracture and use interfragmentary fixation and/or compression, or a bridging plate.
STEP 5 POSTOPERATIVE CARE: If any of the five cultures are positive, consult an infectious disease specialist with experience in treating musculoskeletal infections.
RESULTS: We have used this protocol at our institution for patients with prior fracture surgery who subsequently developed a nonunion, with or without implant failure, that had no obvious infectious etiology.IndicationsContraindicationsPitfalls & Challenges.
STEP 1 PREOPERATIVE EVALUATION: Take a careful history, evaluate the extremity and wound, and note comorbidities and medications.
STEP 2 PREOPERATIVE PLANNING: Preoperative planning is essential before revision nonunion surgery.
STEP 3 DEBRIDEMENT IMPLANT REMOVAL AND CULTURES: Debride the nonunion site, remove all failed and loose implants, and take specimens for culture; withhold antibiotics until all culture specimens have been obtained.
STEP 4 OPEN REDUCTION AND INTERNAL FIXATION: Reduce the fracture and use interfragmentary fixation and/or compression, or a bridging plate.
STEP 5 POSTOPERATIVE CARE: If any of the five cultures are positive, consult an infectious disease specialist with experience in treating musculoskeletal infections.
RESULTS: We have used this protocol at our institution for patients with prior fracture surgery who subsequently developed a nonunion, with or without implant failure, that had no obvious infectious etiology.IndicationsContraindicationsPitfalls & Challenges.