Dynamization of the plate in treating nonunion of the tibial fracture: Case report

Background: Plate osteosynthesis for the tibial fracture is one of the alternative treatments with satisfactory outcomes. Appropriate surgical techniques, including an open or minimally invasive approach, absolute or relative stability regarding fracture characteristics, and construct stiffness, could lead to proper fracture healing. However, in some circumstances the nonunion might be a problem. The treatment of the healing disturbance is challenging as more complex procedures, such as compression plating, bone grafting, or conversion to nailing, are considered. Dynamization, which aims to optimize the rigidity of the construct, was an alternative to stimulate bone healing. Case: We present two cases of tibial nonunion following open reduction internal fixation (ORIF) with plating. The dynamization concept by percutaneously removing screws close to the fracture site to reduce fixation stiffness for appropriate relative stability, promote callus formation, and facilitate fracture healing without additional bone grafting. This simple procedure could be an alternative option in selected healing problem cases. Conclusion: These cases highlight the importance of considering fixation construct rigidity in fracture management. Too rigid fixation with a simple fracture gap or in comminuted fracture led to delayed healing. Dynamization of plating should be considered when delayed healing is related to the fixation construct's stiffness. Screw removal, as demonstrated in this case report, can be done under local anesthesia as a simple procedure to stimulate fracture healing before more complex surgical options. However, individualized analysis of nonunion causes is essential for successful bone healing

Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study

Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) beads for chronic osteomyelitis treatment. A total of 62 patients were enrolled in this study. After radical surgical debridement, the bone defect was filled with three types of antibiotics (vancomycin or gentamicin or fosfomycin) impregnated HA beads. The follow-up period was 48 weeks. It was found that the success rate was approximately 98% with a re-infection in only one patient. Quality of life of all patients after treatment improved significantly over time. Systemic exposure to vancomycin and gentamicin after beads implantation was limited and high local antibiotics concentrations were found in wound drainage fluid at 24, 48 and 72 h. Blood biochemistry measurements did not show any nephrotoxic or hepatotoxic effects. 20 adverse events were reported, but 90% of the events were resolved without having to remove the beads and the patients recovered. Satisfactory outcomes were observed in terms of success rate, quality of life and adverse effect. nHA-ATB beads impregnated by vancomycin or gentamicin or fosfomycin could potentially be employed as an alternative product of choice for localized antibiotics delivery in chronic osteomyelitis treatment