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Published in: Journal of Orthopaedic Surgery and Research 1/2010

Open Access 01-12-2010 | Case report

Ilizarov treatment of humeral shaft nonunion in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity

Authors: Vasileios S. Sioros, Marios G. Lykissas, Dimitrios Pafilas, Panayiotis Koulouvaris, Alexandros N. Mavrodontidis

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2010

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Abstract

Nonunion of the humeral shaft in patients with antiepileptic drug associated metabolic bone disorder constitute a challenging surgical problem difficult to treat due to seizure activity, osteoporosis, and poor stabilization options. We report a case of nonunion of the humeral shaft in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity successfully treated with Ilizarov external fixator and a follow-up of 4 years.
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Literature
1.
go back to reference Brinker MR, O'Connor DP: The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am. 2004, 86: 290-7.PubMed Brinker MR, O'Connor DP: The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am. 2004, 86: 290-7.PubMed
2.
go back to reference Borus TA, Yian EH, Karunakar MA: A case series and review of salvage surgery for refractory humeral shaft nonunion following two or more prior surgical procedures. Iowa Orthop J. 2005, 25: 194-9.PubMedCentralPubMed Borus TA, Yian EH, Karunakar MA: A case series and review of salvage surgery for refractory humeral shaft nonunion following two or more prior surgical procedures. Iowa Orthop J. 2005, 25: 194-9.PubMedCentralPubMed
3.
go back to reference Durbin R, Gottesman MJ, Saunders KC: Hackthal stacking nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res. 1983, 179: 168-74. 10.1097/00003086-198310000-00024.PubMed Durbin R, Gottesman MJ, Saunders KC: Hackthal stacking nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res. 1983, 179: 168-74. 10.1097/00003086-198310000-00024.PubMed
4.
go back to reference Healy WL, White GM, Mick CA, Brooker AF, Weiland AJ: Nonunion of the humeral shaft. Clin Orthop Rel Res. 1987, 219: 206-13. Healy WL, White GM, Mick CA, Brooker AF, Weiland AJ: Nonunion of the humeral shaft. Clin Orthop Rel Res. 1987, 219: 206-13.
5.
go back to reference Jupiter JB, von Deck M: Ununited humeral diaphyses. J Shoulder Elbow Surg. 1998, 7: 644-53. 10.1016/S1058-2746(98)90016-7.CrossRefPubMed Jupiter JB, von Deck M: Ununited humeral diaphyses. J Shoulder Elbow Surg. 1998, 7: 644-53. 10.1016/S1058-2746(98)90016-7.CrossRefPubMed
6.
go back to reference Marti RK, Verheyen CC, Besselaar PP: Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma. 2002, 16: 108-15. 10.1097/00005131-200202000-00007.CrossRefPubMed Marti RK, Verheyen CC, Besselaar PP: Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma. 2002, 16: 108-15. 10.1097/00005131-200202000-00007.CrossRefPubMed
7.
go back to reference Ring D, Kloen P, Kadzielski J, Helfet D, Jupiter JB: Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res. 2004, 425: 50-4. 10.1097/01.blo.0000131484.27501.4b.CrossRefPubMed Ring D, Kloen P, Kadzielski J, Helfet D, Jupiter JB: Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res. 2004, 425: 50-4. 10.1097/01.blo.0000131484.27501.4b.CrossRefPubMed
8.
go back to reference Khanna S, Pillai KK, Vohora D: Insights into liaison between antiepileptic drugs and bone. Drug Discov Today. 2009, 14: 428-35. 10.1016/j.drudis.2009.01.004.CrossRefPubMed Khanna S, Pillai KK, Vohora D: Insights into liaison between antiepileptic drugs and bone. Drug Discov Today. 2009, 14: 428-35. 10.1016/j.drudis.2009.01.004.CrossRefPubMed
9.
go back to reference Mattson RH, Gidal BE: Fractures, epilepsy, and antiepileptic drugs. Epilepsy Behav. 2004, 5 (Suppl 2): S36-40. 10.1016/j.yebeh.2003.11.030.CrossRefPubMed Mattson RH, Gidal BE: Fractures, epilepsy, and antiepileptic drugs. Epilepsy Behav. 2004, 5 (Suppl 2): S36-40. 10.1016/j.yebeh.2003.11.030.CrossRefPubMed
10.
go back to reference Desai KB, Ribbans WJ, Taylor GT: Incidence of five common fracture types in an institutional epileptic population. Injury. 1996, 27: 97-100. 10.1016/0020-1383(95)00189-1.CrossRefPubMed Desai KB, Ribbans WJ, Taylor GT: Incidence of five common fracture types in an institutional epileptic population. Injury. 1996, 27: 97-100. 10.1016/0020-1383(95)00189-1.CrossRefPubMed
11.
go back to reference Persson HBI, Alberts KA, Farahmand BY, Tomson T: Risk of extremity fractures in adult outpatients with epilepsy. Epilepsia. 2002, 43: 768-72. 10.1046/j.1528-1157.2002.15801.x.CrossRefPubMed Persson HBI, Alberts KA, Farahmand BY, Tomson T: Risk of extremity fractures in adult outpatients with epilepsy. Epilepsia. 2002, 43: 768-72. 10.1046/j.1528-1157.2002.15801.x.CrossRefPubMed
12.
go back to reference Vasconcelos D: Compression fractures of the vertebrae during major epileptic seizures. Epilepsia. 1973, 14: 323-8. 10.1111/j.1528-1157.1973.tb03967.x.CrossRefPubMed Vasconcelos D: Compression fractures of the vertebrae during major epileptic seizures. Epilepsia. 1973, 14: 323-8. 10.1111/j.1528-1157.1973.tb03967.x.CrossRefPubMed
13.
go back to reference Elsberger ST, Brody G: Bilateral posterior shoulder dislocations. Am J Emerg Med. 1995, 13: 331-2. 10.1016/0735-6757(95)90213-9.CrossRef Elsberger ST, Brody G: Bilateral posterior shoulder dislocations. Am J Emerg Med. 1995, 13: 331-2. 10.1016/0735-6757(95)90213-9.CrossRef
14.
go back to reference Khanna S, Pillai KK, Vohora D: Insights into liaison between antiepileptic drugs and bone. Drug Discov Today. 2009, 14: 428-35. 10.1016/j.drudis.2009.01.004.CrossRefPubMed Khanna S, Pillai KK, Vohora D: Insights into liaison between antiepileptic drugs and bone. Drug Discov Today. 2009, 14: 428-35. 10.1016/j.drudis.2009.01.004.CrossRefPubMed
15.
go back to reference Patsalos PN, Fröscher W, Pisani F, van Rijn CM: The importance of drug interactions in epilepsy therapy. Epilepsia. 2002, 43: 365-85. 10.1046/j.1528-1157.2002.13001.x.CrossRefPubMed Patsalos PN, Fröscher W, Pisani F, van Rijn CM: The importance of drug interactions in epilepsy therapy. Epilepsia. 2002, 43: 365-85. 10.1046/j.1528-1157.2002.13001.x.CrossRefPubMed
16.
go back to reference Collins N, Maher J, Cole M, Baker M, Callaghan N: A prospective study to evaluate the dose of vitamin D required to correct 25-hydroxyvitamin D levels, calcium and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J Med. 1991, 286: 113-22. Collins N, Maher J, Cole M, Baker M, Callaghan N: A prospective study to evaluate the dose of vitamin D required to correct 25-hydroxyvitamin D levels, calcium and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J Med. 1991, 286: 113-22.
17.
go back to reference Takasu H, Sugita A, Uchiyama Y, Katagiri N, Okazaki M, Ogata E, Ikeda K: c-Fos protein as a target of anti-osteoclastogenic action of vitamin D, and synthesis of new analogs. J Clin Invest. 2006, 116: 528-35. 10.1172/JCI24742.PubMedCentralCrossRefPubMed Takasu H, Sugita A, Uchiyama Y, Katagiri N, Okazaki M, Ogata E, Ikeda K: c-Fos protein as a target of anti-osteoclastogenic action of vitamin D, and synthesis of new analogs. J Clin Invest. 2006, 116: 528-35. 10.1172/JCI24742.PubMedCentralCrossRefPubMed
18.
go back to reference Foxa SW, Lovibond AC: Current insights into the role of transforming growth factor-b in bone resorption. Mol Cell Endocrinol. 2005, 243: 19-26. 10.1016/j.mce.2005.09.008.CrossRef Foxa SW, Lovibond AC: Current insights into the role of transforming growth factor-b in bone resorption. Mol Cell Endocrinol. 2005, 243: 19-26. 10.1016/j.mce.2005.09.008.CrossRef
19.
go back to reference Feldkamp J, Becker A, Witte OW, Scharff D, Scherbaum WA: Long-term anticonvulsant therapy leads to low bone mineral density-evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells. Exp Clin Endocrinol Diabetes. 2000, 108: 37-43.PubMed Feldkamp J, Becker A, Witte OW, Scharff D, Scherbaum WA: Long-term anticonvulsant therapy leads to low bone mineral density-evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells. Exp Clin Endocrinol Diabetes. 2000, 108: 37-43.PubMed
21.
go back to reference Tomić S, Bumbasirević M, Lesić A, Mitković M, Atkinson HD: Ilizarov frame fixation without bone graft for atrophic humeral shaft nonunion: 28 patients with a minimum 2-year follow-up. J Orthop Trauma. 2007, 21: 549-56. 10.1097/BOT.0b013e31814612c8.CrossRefPubMed Tomić S, Bumbasirević M, Lesić A, Mitković M, Atkinson HD: Ilizarov frame fixation without bone graft for atrophic humeral shaft nonunion: 28 patients with a minimum 2-year follow-up. J Orthop Trauma. 2007, 21: 549-56. 10.1097/BOT.0b013e31814612c8.CrossRefPubMed
22.
go back to reference Hsu TL, Chiu FY, Chen CM, Chen TH: Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft. J Chin Med Assoc. 2005, 68: 73-6. 10.1016/S1726-4901(09)70138-8.CrossRefPubMed Hsu TL, Chiu FY, Chen CM, Chen TH: Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft. J Chin Med Assoc. 2005, 68: 73-6. 10.1016/S1726-4901(09)70138-8.CrossRefPubMed
23.
go back to reference Hems TE, Bhullar TP: Interlocking nailing of humeral shaft fractures: the Oxfo experience 1991 to 1994. Injury. 1996, 27: 485-9. 10.1016/0020-1383(96)00056-3.CrossRefPubMed Hems TE, Bhullar TP: Interlocking nailing of humeral shaft fractures: the Oxfo experience 1991 to 1994. Injury. 1996, 27: 485-9. 10.1016/0020-1383(96)00056-3.CrossRefPubMed
24.
go back to reference Lin J, Hou SM: Antegrade locked nailing for humeral shaft fractures. Clin Orthop Relat Res. 1999, 365: 201-10. 10.1097/00003086-199908000-00025.CrossRefPubMed Lin J, Hou SM: Antegrade locked nailing for humeral shaft fractures. Clin Orthop Relat Res. 1999, 365: 201-10. 10.1097/00003086-199908000-00025.CrossRefPubMed
25.
go back to reference Lammens J, Bauduin G, Driesen R, Moens P, Stuyck J, De Smet L, Fabry G: Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop Relat Res. 1998, 353: 223-30. 10.1097/00003086-199808000-00026.CrossRefPubMed Lammens J, Bauduin G, Driesen R, Moens P, Stuyck J, De Smet L, Fabry G: Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop Relat Res. 1998, 353: 223-30. 10.1097/00003086-199808000-00026.CrossRefPubMed
26.
go back to reference Cierny G III, Mader JT: Approach to adult osteomyelitis. Orthop Rev. 1987, 16: 259-72.PubMed Cierny G III, Mader JT: Approach to adult osteomyelitis. Orthop Rev. 1987, 16: 259-72.PubMed
27.
go back to reference Patel VR, Menon DK, Pool RD, Simonis RB: Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br. 2000, 82: 977-83. 10.1302/0301-620X.82B7.10180.CrossRefPubMed Patel VR, Menon DK, Pool RD, Simonis RB: Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br. 2000, 82: 977-83. 10.1302/0301-620X.82B7.10180.CrossRefPubMed
28.
go back to reference Beris AE, Lykissas MG, Sioros V, Mavrodontidis AN, Korompilias AV: Femoral periprosthetic fracture in osteoporotic bone after a total knee replacement. Treatment with Ilizarov external fixation. J Arthroplasty. 2010, Beris AE, Lykissas MG, Sioros V, Mavrodontidis AN, Korompilias AV: Femoral periprosthetic fracture in osteoporotic bone after a total knee replacement. Treatment with Ilizarov external fixation. J Arthroplasty. 2010,
29.
Metadata
Title
Ilizarov treatment of humeral shaft nonunion in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity
Authors
Vasileios S. Sioros
Marios G. Lykissas
Dimitrios Pafilas
Panayiotis Koulouvaris
Alexandros N. Mavrodontidis
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2010
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-5-48

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