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Cognetti DJ, Ghali A, Gutierrez-Naranjo BJM, Handcox J, Karia R, Dutta AK. Technical Considerations and Early Results of Magnetic Compressive Intramedullary Nailing for Humeral Shaft Delayed Unions and Nonunions. JSES Int 2022; 6:385-390. [PMID: 35572440 PMCID: PMC9091776 DOI: 10.1016/j.jseint.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Expandable magnetic rods and intramedullary nails are being used in a number of innovative ways, including limb length discrepancy and scoliosis correction. However, recently, the full complement of these devices has been further explored, with the utilization of their compressive capacity to improve fracture healing. The purpose of the present study was to report on early results of compressive magnetic intramedullary nailing for humeral shaft delayed unions and nonunions. Methods This retrospective case series was completed at a level 1 trauma center, with adult patients who underwent compressive intramedullary nailing from 2017 to 2021 for humeral shaft nonunion or delayed union. The primary indication for this procedure was nonunion in the setting of previous conventional fixation, but a subset of patients with atrophic nonunions and risk factors for recalcitrant nonunion were also included. Results Fourteen patients, with a mean age of 51 ± 17 years, underwent compressive magnetic intramedullary nailing. Nine patients had previously underwent surgery, 6 of which had undergone multiple prior procedures. Five others were initially treated nonoperatively and underwent surgery 4.1 ± 2.9 months out from injury. Ten patients went on to union at a mean of 2.9 ± 2.4 months. One patient experienced hardware failure with nail cut-out at 2 weeks, and one required revision surgery for a wound infection. Three other patients were lost to follow-up, one of which was deceased for reasons unrelated to surgery. Conclusion Compressive magnetic intramedullary nails are a viable solution for complex humeral shaft nonunions, particularly in the setting of previously well-fixed fractures and those at risk of recalcitrant nonunion. However, comparative and prospective studies looking at union rates and secondary procedures are needed to more clearly define their role in treatment and assure their safety, given recent concerns regarding osteolysis at the nail modular junction.
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Polat O, Toy S, Kibar B. InSafeLOCK® humeral nailing for humeral nonunions: Clinical and radiological results. Jt Dis Relat Surg 2021; 32:446-453. [PMID: 34145823 PMCID: PMC8343851 DOI: 10.52312/jdrs.2021.81535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives
This study aims to evaluate the clinical and functional results of patients treated with InSafeLOCK® humeral nail and iliac crest autograft for humeral nonunion. Patients and methods
A total of 15 patients (11 males, 4 females; mean age: 52.1±15.3 years; range, 31 to 78 years) who were followed conservatively for humeral fractures and operated with the InSafeLOCK® humeral nail and iliac bone graft in our center between June 2018 and January 2020 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, operative data, and pre- and postoperative Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Constant-Murley Scores (CMS) were recorded. Results
The mean time from injury to nonunion treatment was 10.9±1.6 months. Five patients had atrophic, eight patients had oligotrophic, and two patients had hypertrophic nonunion. Preoperatively, the mean DASH was 37.7±9.1, the mean CMS was 69.7±6.3, and the mean VAS was 3.8±0.7. In all patients, union was achieved. The mean operation time was 59.0±16.2 min. The mean postoperative DASH score was 16.1±8.7, CMS 87.4±3.4, and VAS score 0.8±0.7. Regarding the shoulder joint, the mean abduction was 164.7±11.3 degrees, the mean internal rotation was 82.0±6.8 degrees, the mean external rotation was 81.3±8.3 degrees, and the mean flexion was 162.0±12.1 degrees. During follow-up, complications such as vascular-nerve injury, reflex sympathetic dystrophy, screw migration or loosening, implant failure, and loss of reduction did not occur in any of our patients. Conclusion
Considering the satisfactory functional and radiological results, the InSafeLOCK® humeral nail can be used safely in humeral nonunions.
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Affiliation(s)
- Oktay Polat
- Ağrı Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 04200 Ağrı, Türkiye.
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The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions. Jt Dis Relat Surg 2021; 32:67-74. [PMID: 33463420 PMCID: PMC8073438 DOI: 10.5606/ehc.2021.74488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives
This study aims to evaluate the early- and mid-term shoulder and elbow functions and compare the union rates after the application of single plate and double plate for the treatment of humerus shaft nonunions. Patients and methods
This retrospective study included 56 patients (36 males, 20 females; mean age 53.8±9.5; range, 28 to 68 years) treated with double plate (n=25) and single plate (n=31) osteosynthesis between October 2012 and January 2016. Surgical treatment of the nonunion was applied in the fourth month after the fracture at the earliest. Autograft taken from the iliac bone was applied during the surgery in all patients. Evaluation was performed using The University of California at Los Angeles (UCLA) Shoulder Score, Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), Constant Shoulder Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Results
The mean postoperative follow-up time was 40.7±9.6 (range, 25 to 58) months. No statistically significant difference was determined in respect of time to union, follow-up time, DASH questionnaire score, UCLA Shoulder Score, VAS, MEPS and Constant Shoulder Score after union in the comparison of the two groups (p>0.05). In the examination of postoperative early (three months) recovery phase of shoulder and elbow functions, statistically significant superior scores were obtained in the double plate group for MEPS (double plate median=85 [min 75-max 90], single plate median=75 [min 70-max 85]) and Constant Shoulder Score (double plate median=89 [min 85-max 92], single plate median=81 [min 75-max 90]) (p<0.001). Conclusion
There was no statistically significant difference in terms of time to union and union rates between single plate and double plate fixations for surgical treatment of humeral shaft nonunions. However, superior clinical results were obtained in the early recovery phase of shoulder and elbow functions with double plate fixation.
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Gaillard J, Masquelet AC, Boutroux P, Cambon-Binder A. Induced-membrane treatment of refractory humeral non-union with or without bone defect. Orthop Traumatol Surg Res 2020; 106:803-811. [PMID: 32446812 DOI: 10.1016/j.otsr.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 12/16/2019] [Accepted: 02/06/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of humeral non-union with or without bone defect is complex, with non-negligible rates of complication and failure. Few reports focused on management of treatment failure. OBJECTIVE The study hypothesis was that the induced-membrane technique associated in a 2-stage strategy to internal fixation provides systematic bone healing in refractory humeral non-union. MATERIAL AND METHODS The study included 15 patients, with a median age of 46.6 years, with humeral non-union of a mean 24 months' progression and mean history of 3 attempted revision surgeries. Seven patients showed bone defect, exceeding 5cm in 2 cases. Six had history of radial palsy. RESULTS Consolidation was achieved in all cases, at a mean 4.6 months. Ten patients underwent radial nerve transposition, 6 of whom had shown radial motor nerve palsy; all recovered within 2 to 5 months. There was 1 case of superficial infection, and 1 of seroma. DISCUSSION The induced-membrane technique ensures bone healing due to the biological properties of the membrane; the main drawback is the need for 2-stage surgery. When bone defect exceeds 5cm, a multi-perforated fibula segment can be placed inside the membrane to increase primary stability and enhance bone integration. CONCLUSION The induced-membrane technique is suited to humeral non-union, with or without bone defect. The 2-stage strategy is mandatory in case of suspected latent infection. In the 2-stage procedure, anteromedial radial nerve transposition facilitates the bone-graft stage. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Julien Gaillard
- Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Orthopedic surgery department, American Hospital of Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France.
| | - Alain-Charles Masquelet
- Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Pierre Boutroux
- Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Adeline Cambon-Binder
- Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
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Peters RM, Claessen FMAP, Doornberg JN, Kolovich GP, Diercks RL, van den Bekerom MPJ. Union rate after operative treatment of humeral shaft nonunion--A systematic review. Injury 2015; 46:2314-24. [PMID: 26499226 DOI: 10.1016/j.injury.2015.09.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/29/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Humeral shaft nonunions can lead to morbidity from subsequent operations, complications and impaired function. Currently there is no evidenced-based consensus for treatment of humeral shaft nonunions. AIM We aimed to summarize and analyze union rates and complications after operative treatment for humeral shaft nonunion. METHODS Studies investigating operative treatment strategies for humeral shaft nonunion were identified by searching: EMBASE, MEDLINE, Ovid SP, Web of Science, Cochrane Central, PubMed and Google Scolar up to October 24, 2014. Studies were eligible if: (1) outcome of operative treatment for humeral shaft nonunion was reported; (2) at least ten adult patients with humeral shaft nonunion included; (3) full text article available; (4) written in English, German or Dutch; and (5) nonunion was defined as no bone-bridging between the fracture ends after 6 months. RESULTS Thirty-six studies were included. A union rate of 98% was found in patients (n=672) who underwent plate fixation with autologous bone grafting (ABG), 95% in plate fixation without ABG (n=19), 88% in intramedullary nailing with ABG (n=164), 66% in intramedullary nailing without ABG (n=78), 92% in bone strut fixation (n=91) and 98% in external fixation (n=152). A total complication rate of 12% was found in patients treated with plate fixation combined with ABG, 15% in intramedullary nail with ABG and 8% intramedullary nailing without ABG, 20% in bone strut fixation and 22% in external fixation. CONCLUSION Plate fixation with ABG was recommended for humeral shaft nonunion, since the union rate is highest and the complication rate is relatively low. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Rinne M Peters
- University of Groningen, Department of Orthopaedic Surgery, University Medical Center Groningen Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Femke M A P Claessen
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Job N Doornberg
- University of Amsterdam, Orthopaedic Residency Program (PGY 5), Orthotrauma Research Center, Amsterdam, The Netherlands
| | - Gregory P Kolovich
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Ron L Diercks
- University of Groningen, Department of Orthopaedic Surgery, University Medical Center Groningen Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Chen HW, Liu GD, Ou S, Jiang XY, Fei J, Wu LJ. Comparison of three fixations for tibial plateau fractures by biomechanical study and radiographic observation. Int J Surg 2015; 13:292-296. [DOI: 10.1016/j.ijsu.2014.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Longo UG, Trovato U, Loppini M, Rizzello G, Khan WS, Maffulli N, Denaro V. Tissue engineered strategies for pseudoarthrosis. Open Orthop J 2012; 6:564-70. [PMID: 23248729 PMCID: PMC3522502 DOI: 10.2174/1874325001206010564] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/14/2012] [Accepted: 09/22/2012] [Indexed: 11/22/2022] Open
Abstract
Numerous classification systems of non-union have been proposed based on: presence or absence of infection, radiographic features, clinical findings, biologic activity, location and shape. The management of pseudarthrosis is strongly related to the type of non-union (infected versus uninfected, atrophic versus hypertrophic). Surgical management of pseudarthrosis is generally effective with a success rate ranging from 75 to 100%. Nevertheless, in a relatively high number of instances several combined treatments are required for the fracture healing. The current gold standard to stimulate the bone regeneration is represented by the revision surgery with the application of autologous bone grafts. However, several approaches have been described to promote and enhance the bone tissue regeneration, including extracorporeal shock wave therapy (ESWT), ultrasound, electromagnetic, bone morphogenic proteins (BMPs) and platelet-rich-plasma (PRP).The aim of the present study was to perform a systematic review of the literature evaluating the current therapies to promote and enhance the bone tissue healing. The systematic review was performed according to PRISMA guidelines with a PRISMA checklist and algorithm.Limitations of the present systematic review are mainly related to the scanty quality of the studies available in the literature. Although the therapies previously described for the management of patients with non-unions seems to be effective, the limitations of the included studies, especially the extensive clinical heterogeneity, make not possible to provide clear recommendations regarding the application of these approaches. The problems remain the need to better understand the most effective treatment options, subject to surgical stabilization as a first step.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery. Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy ; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Chen SB, Zhang CQ, Jin DX, Cheng XG, Sheng JG, Zeng BF. Treatment of aseptic nonunion after intramedullary nailing fixation with locking plate. Orthop Surg 2012; 1:258-63. [PMID: 22009872 DOI: 10.1111/j.1757-7861.2009.00040.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. METHODS Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9-70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. RESULTS All patients were followed up for 6-20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4-8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow-up. CONCLUSION Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.
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Affiliation(s)
- Sheng-bao Chen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
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Apard T, Ducellier F, Hubert L, Talha A, Cronier P, Bizot P. Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: A preliminary report of seven cases. Injury 2010; 41:1262-5. [PMID: 20621293 DOI: 10.1016/j.injury.2010.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/19/2010] [Accepted: 05/24/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Plating with bone grafting is considered the gold standard treatment for nonunion of humeral shaft fractures. However, this complex procedure involves multiple risks. The aim of this study is to evaluate an alternative treatment using isolated axial interfragmentary compression for the dynamisation of humeral shaft nonunion after retrograde locked nailing. MATERIALS AND METHODS Between January 2000 and May 2009, 124 humeral shaft fractures were treated in our trauma department with retrograde locked nailing using the unreamed humeral nail (UHN(®), Synthes, Paoli, PA, USA). Nonunion occurred in seven patients (5.6%) - five females and two males, mean age 44 years (range: 17-73 years). The nonunion was treated by applying isolated secondary interfragmentary compression. Mean follow-up was 43 months (range: 8-74 months). The Rommens score and the disabilities of the arm, shoulder and hand (DASH) score were used to evaluate the global functioning of the upper limb. RESULTS The compression procedure was successful in all seven cases. In each case, the union occurred without any complications in 3-5 months. The mean DASH score was 25/100 (range: 8.3-60.8/100). The Rommens score was judged excellent for five of the seven patients but two were rated moderate. One of these suffered from complex regional pain syndrome type II since the fracture, and another developed a stiff shoulder 6 months after trauma. CONCLUSION Isolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion.
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Affiliation(s)
- T Apard
- Bone Surgery Department, University Hospital of Angers, Angers, 4 rue Larrey, 49033 Angers Cedex 01, France.
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Abstract
Successful operative treatment of a humeral shaft non-union may be a challenge for the surgeon. Several treatment options have been reported over the years. A systematic review of the literature was performed. Twenty-three retrieved articles (level of evidence IV) fulfilled our inclusion criteria and dealt with aseptic diaphyseal humeral non-union managed by plating, intramedullary nailing and external fixation based on Ilizarov's principles. Despite an obvious superiority of plating in the treatment of humeral shaft non-unions, there is no doubt that intramedullary nailing as well as external fixation devices have a role. An algorithm of management of the humeral shaft non-unions following a rational approach is suggested.
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Affiliation(s)
- George M Kontakis
- Department of Orthopaedics - Traumatolosy, University of Crete, Greece.
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Subasi M. Failure of reamed nailing in humeral non-union: an analysis of 26 patients. Injury 2006; 37:87-8; author reply 88. [PMID: 16253252 DOI: 10.1016/j.injury.2005.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 03/24/2005] [Accepted: 07/15/2005] [Indexed: 02/02/2023]
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