Open interlocked nailing without a targeting device or X-ray guidance for non-union of the femur: a case series

From October 2005 to August 2007, we operated on six patients who had femoral non-unions and performed interlocked intramedullary nailing without X-ray guidance or a targeting device. There were three fractures of the distal femur, two fractures of the mid-shaft and one of the proximal femur. Fatigue failure of a non-interlocked Kuntscher nail and one nail migration were the presenting features in two patients. The presence of sclerosis of the bone ends in four cases and a need for cancellous bone grafts at the site of non-union in all patients made wide dissection and open reduction unavoidable. There was a limb length discrepancy in all patients before surgical intervention. Partial weight bearing was commenced at 6 weeks post-operation. There was no case of wound infection. There was no misplaced screw. Minimum range of knee flexion was 105° at 2 months post-operation. These early results call for a closer look at this cheap, safe and effective means of handling femoral non-union in third world societies where there is paucity of instrumentation and implants for interlocked nailing

Adaptation of the rubber bandage for safe use as tourniquet

The safety of the pneumatic tourniquet lies in the fact that the pressure generated beneath it can be determined and is reproducible unlike the rubber bandage tourniquet with subjective and irreproducible tissue pressure. Application of the rubber bandage over the cuff of an aneroid sphygmomanometer enabled direct determination of tourniquet pressure in sixty-four patients with associated low rate of tourniquet related complications. Seventy-eight limbs, in sixty-four patients, were operated using this composite tourniquet and evaluation after surgery as well as out-patients' clinic follow-up for tourniquet complications revealed complications in six out of eight patients in whom the tourniquet time exceeded 120minutes. In conclusion, the inclusion of an aneroid sphygmomanometer to record tourniquet pressure enhanced the safety of the rubber bandage tourniquet in our study and offers an alternative to the pneumatic type in the attainment of bloodless field where the latter is unavailable

Congenital pseudoarthrosis of the tibia: treatment by intramedullary nailing without bone graft

Established Congenital Tibial Pseudarthrosis of the tibia (CTP) has been treated surgically by primary bone graft and a variety of fixation methods the aim being to achieve osseous union. We report five cases of established CTP treated by a modification of the Patterson technique but without primary bone grafting (PBG). Of the 5 patients 4 of the scierotic type treated by this modified technique achieved union in an average of six months and limb length shortening was less than 2.5cm. In our opinion, the encouraging result obtained may justify proposing this procedure as a first choice option for the treatment of the scierotic form and so avoid the complexzity of autologous bone grafting in children. Nigerian Journal of Surgical Sciences Vol. 15(2) 2005: 57-6

Adaptation of the rubber bandage for safe use as tourniquet

The safety of the pneumatic tourniquet lies in the fact that the pressure generated beneath it can be determined and is reproducible unlike the rubber bandage tourniquet with subjective and irreproducible tissue pressure. Application of the rubber bandage over the cuff of an aneroid sphygmomanometer enabled direct determination of tourniquet pressure in sixty-four patients with associated low rate of tourniquet related complications. Seventy-eight limbs, in sixty-four patients, were operated using this composite tourniquet and evaluation after surgery as well as out-patients' clinic follow-up for tourniquet complications revealed complications in six out of eight patients in whom the tourniquet time exceeded 120minutes. In conclusion, the inclusion of an aneroid sphygmomanometer to record tourniquet pressure enhanced the safety of the rubber bandage tourniquet in our study and offers an alternative to the pneumatic type in the attainment of bloodless field where the latter is unavailable