Case Histories

• Patient with brittle bones (Neurofibromatosis - Von Recklinghausens Disease)
• Patient with severe break of the left elbow (humerus fracture)
• Patient with a fracture of the left wrist (carpal navicular bone)

Patient with Brittle Bones (Neurofibromatosis - Von Recklinghausens Disease)

This patient is a 22 year-old male with Neurofibromatosis (Von Recklinghausens Disease). He suffered an associated fracture of the shine bone (tibia) as a small child and had multiple surgical procedures, including autologous bone graft's, in an attempt to heal the bone. The tibia ultimately united but with a profound deformity and 2.2 cm of shortening. In July he was treated with a double osteotomy, (bone graft) and an intramedullary rod was installed. By early January there was no evidence of union of the osteotomies so a second graft was performed. By June the upper osteotomy had healed but the lower one had not. The intramedullary rod was removed and the lower osteotomy was plated.

The following December the patient was reviewed at orthopaedic problem rounds at which time it was evident the lower osteotomy was going on to an established non-union. The consensus was that the patient would require amputation. The patient accepted this course of action, but agreed to try the Matrix II.

The Matrix II was applied and the patient was re-casted and instructed not to weight bear. After eight months electrical stimulation there was evidence radiologically of callus formation. The orthopaedic surgeon elected to continue stimulation for a further two months. By the years end the patient was weight bearing and has gone on to complete recovery.

DISCUSSION: It is reported that 80% of tibia non-union in patients with Neurofibromatosis will go on to amputation. This case presents convincing evidence of the efficacy of the Matrix II.

Myron K. MacDonald, M.D.

Patient with severe break of the left elbow (humerus fracture)

This 32 year-old female sustained a severe fracture of the left humerus. Although solid bony union was achieved with conservative treatment, there was a slight degree of overlap and angular deformity, which resulted in considerable distortion of the elbow joint. Because of ongoing pain and disability, a debridement anthroplasty and asteotomy was performed. Five months post-surgery it was clinically and radiologically apparent that the osteotomy was not healing.

At this point a hinged elbow prosthesis with a large humeral intramedullary component was inserted.

One year later it was apparent that the osteotomy remained un-united and the intramedullary portion of the prosthesis was progressively loosening.

A Matrix II was applied over the osteotomy non-union. After nine months of electrical stimulation therapy there was sufficient radiological and clinical evidence of callus formation to terminate this treatment.

The patient has gone on to bony union and has excellent functional results.

Myron K. MacDonald, M.D.

Patient with a fracture of the left wrist (carpal navicular bone)

The patient is a 49 year-old female with a fracture of the left wrist (carpal navicular bone). She was placed in a standard short arm cast with the thumb immobilized. Radiograms taken monthly showed no evidence of callus formation over a period of five months, so it was decided to try a course of electrical stimulation.

After four months of stimulation using the Matrix II, there was radiological evidence of callus formation and treatment was discontinued.

The fracture has gone on to complete union.

Myron K MacDonald, M.D.