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Wakefield SM, Giannoudis VP, Giannoudis PV. Clavicular bone defects managed with free vascularised fibular grafting: evidence to date. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3307-3318. [PMID: 37289244 PMCID: PMC10651534 DOI: 10.1007/s00590-023-03598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
Reconstructive surgery of the clavicle using free vascularised fibula grafting (FVFG) is sometimes required for the management of severe bone loss or non-union. As the procedure is relatively rare, there is no universal agreement on the management and outcome. This systematic review aimed to first, identify the conditions for which FVFG has been applied; second, to gain an understanding of the surgical techniques used; and third, to report outcomes related to bone union, infection eradication, function and complications. A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Fourteen studies based on 37 patients were identified with a mean follow-up time of 33.3 months. The most common reasons for the procedure were: fracture non-union; tumours requiring resection; post-radiation treatment osteonecrosis and osteomyelitis. The operation approaches were similar, involving graft retrieval, insertion and fixation and vessels chosen for reattachment. The mean clavicular bone defect size was 6.6 cm (± 1.5), prior to FVFG. Bone union occurred in 94.6% with good functional outcomes. Complete infection eradication occurred in those with preceding osteomyelitis. The main complications were broken metalwork, delayed union/non-union and fibular leg paraesthesia (n = 20). The mean re-operation number was 1.6 (range 0-5.0). The study demonstrates that FVFG is well tolerated and has a high success rate. However, patients should be advised about complication development and re-intervention requirement. Interestingly, overall data is sparse with no large cohort groups or randomised trials.
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Affiliation(s)
- Sophia M Wakefield
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Vasileios P Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK.
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.
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Sabir AB, Singh H, Manzar K, Julfiqar M, Chowdhry M. A prospective comparative study on management of midshaft clavicle fractures: Conservative versus surgical. JOURNAL OF BONE AND JOINT DISEASES 2023; 38:166-172. [DOI: 10.4103/jbjd.jbjd_18_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/08/2023] [Indexed: 05/26/2025]
Abstract
Abstract
Background:
With nonunion rates up to 15% and unsatisfactory patient-reported outcomes in around a third of patients treated conservatively, recent research on displaced midshaft clavicular fractures points to a considerable unmet medical need. These findings have prompted a recent increase in surgical fixation of displaced midshaft clavicular fractures.
Objective:
In addition to open reduction and plate fixation, intramedullary pins, wires, or nails may also be used to treat clavicle fractures. In this study, we compare the clinical, radiological, and functional results of midshaft clavicular fractures managed with open reduction and plate fixation versus conservative therapy, as well as their overall complication rates.
Materials and Methods:
All skeletally mature patients presenting to outpatient department/inpatient department with clavicle fracture less than 3 weeks old and displacement/loss of cortical contact between fractured ends of more than 2 cm were included in the study. Patients were randomly allocated to either conservative or surgical management. For conservative management, strapping of the involved side and application of figure-of-eight bandage was done. The minimum follow-up requirement of all patients was 1 year. The clinical assessment involved the assessment of complications, grading of results according to Constant and Murley score as well as the Disabilities of the Arm, Shoulder, and Hand score (DASH score). A radiological assessment for the union of the fracture was also done.
Results:
In the conservative management group (n = 52), the mean age of the group was 36 years (range, 19–58 years), and the mean follow-up was 1.6 years (range, 1–2.2 years). At 1 year follow-up, the mean DASH score was 7.9 ± 2.1, and the mean Constant score was 90.2 ± 15. The overall complication rate was found to be 21/52 (40.3%) in the operative management group. In the operative management group (n = 50), the mean age of the group was 42 years (range, 24–57 years) and the mean follow-up was 1.3 years (range, 1.1–1.8 years). At 1-year follow-up, the mean DASH score was 10.8 ± 1.1, and the mean Constant score was 93.1 ± 13. The overall complication rate was found to be 14/50 (28%) in the operative management group. In comparison, the overall rate of complications was significantly lower in the operative management group compared with the conservative management group (P = 0.001).
Conclusions:
Conservative management of midshaft clavicular fractures was associated with similar clinical and radiological outcomes compared to operative management. However, the overall complication rate was lower for operatively managed patients.
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Affiliation(s)
- Aamir Bin Sabir
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Harshit Singh
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Kashif Manzar
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Julfiqar
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Madhav Chowdhry
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Gao G, Zhang Y, Li H, Nong L, Zhou X, Jiang W, Han L. Comparison of the Effectiveness of Simple Plate Fixation and Plate Combined with Local Fixation of Broken Ends in the Treatment of Oblique Fracture of Midshaft Clavicle. Orthop Surg 2022; 14:1331-1339. [PMID: 35603559 PMCID: PMC9251270 DOI: 10.1111/os.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the clinical efficacy of performing simple plate fixation with that using a plate combined with fracture end fixation to investigate the necessity of fracture end fixation outside the plate in cases of oblique fracture of the middle clavicle. Methods This was a retrospective follow‐up study of patients with middle clavicle oblique fractures (Robinson types 2A1 and 2A2) between 2015 and 2020. Patients were divided into two groups according to their treatment options: the simple plate fixation (SPF) group (n = 79; 43 men and 36 women; average age, 46.37 ± 14.54 years) and the plate combined with fracture local fixation (PLFP) group (n = 81; 36 men and 45 women; average age, 48.42 ± 12.55 years). Intraoperative blood loss, operation time, postoperative fracture healing time, postoperative shoulder function score (Constant–Murley and disabilities of the arm, shoulder, and hand [DASH] scores), clinical complications, and postoperative subjective satisfaction were compared between the two groups. Results One hundred sixty patients with a sufficient follow‐up period were included in the final analysis: 79 in the SPF group (follow‐up time: 16.24 ± 3.94 months) and 81 in the PLFP group (follow‐up time: 16.15 ± 3.43 months). Age, sex, body mass index, follow‐up duration, fracture classification, and cause of injury were not significantly different between the two groups. There was no significant difference in blood loss, Constant–Murley and DASH scores, follow‐up period, and postoperative subjective satisfaction between the two groups (P > 0.05). The fracture healing time was shorter in the PLFP group than in the SPF group (4.41 ± 0.99 vs. 4.87 ± 1.60 months, P < 0.05), but the operation duration was longer in the PLFP group than in the SPF group (65.48 ± 16.48 min, P < 0.05). There were seven (complication rate, 8.86%) and five (complication rate, 6.17%) cases that had complications in the SPF and PLFP groups, respectively. There was no significant difference in the complication rates between the two groups (P > 0.05). Conclusion Although the healing time was shorter in the PLFP group than in the SPF group, the clinical efficiency of the two methods in the treatment of oblique fracture of the middle clavicle was similar.
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Affiliation(s)
- Gong‐ming Gao
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Yi Zhang
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Hai‐bo Li
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Lu‐ming Nong
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Xin‐die Zhou
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Wei Jiang
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
| | - Long Han
- Department of Orthopedics The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University Changzhou China
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Peters J, Singh G, Hakobyan H. Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite. Ther Clin Risk Manag 2022; 18:551-560. [PMID: 35586156 PMCID: PMC9109884 DOI: 10.2147/tcrm.s361006] [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: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT). Patients and Methods Patients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed. Results A total of 26 clavicles in 25 patients with a mean age of 50.7 (16–85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6–31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32–35) points and 0.6±1.6 (0–5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1–58.9) points, and no patient experienced any pain at the last follow-up. Conclusion Our initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.
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Affiliation(s)
- Jens Peters
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
- Correspondence: Jens Peters, Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Schmelingstrasse 47, Sulingen, Lower Saxony, 27232, Germany, Tel +49 4271 82 33210, Fax +49 4271 82 33212, Email
| | - Gurdeep Singh
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
| | - Hrayr Hakobyan
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
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Safe and Effective Treatment of Compromised Clavicle Fracture of the Medial and Lateral Third Using Focused Shockwaves. J Clin Med 2022; 11:jcm11071988. [PMID: 35407594 PMCID: PMC8999686 DOI: 10.3390/jcm11071988] [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: 03/10/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
A delay or failure to heal is the most common possible complication in clavicle fractures, especially in cases primarily treated conservatively. As the current standard therapy, surgical revision achieves good healing results, but is associated with potential surgery-related complications. Shockwave therapy as a non-invasive therapy shows similar reasonable consolidation rates in the non-union of different localizations, but avoids complications. Compromised clavicle fractures in the middle and lateral third treated with focused high-energy shockwave therapy were compared with those treated with surgical revision (ORIF). In addition, a three-dimensional computer simulation for evaluating the pressure distribution during shockwave application accompanied the clinical study. A comparable healing rate in bony consolidation was achieved in both groups. Significantly fewer complications, however, occurred in the shockwave group. The simulations showed safe application in this instance, particularly in avoiding lung tissue affection. When applied correctly, shockwaves represent a safe and promising therapy option for compromised clavicle fractures in the middle and lateral third.
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Rollo G, Vicenti G, Rotini R, Prkic A, Eygendaal D, Meccariello L. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2022; 16:144-151. [PMID: 35111253 PMCID: PMC8778730 DOI: 10.5005/jp-journals-10080-1533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. Materials and methods A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18–84 years) and mean total follow-up was 43 months (range, 24–62 months). Results All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. Conclusion The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. Clinical significance The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications. How to cite this article Rollo G, Vicenti G, Rotini R, et al. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144–151.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”–AOU Policlinico Consorziale, Bari, Italy; Orthopaedic and Trauma Unit, Bari, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, “Rizzoli” Orthopaedic Institute, Bologna, Italy
| | - Ante Prkic
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Ante Prkic, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands, Phone: +31648340436; e-mail:
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands; Department of Orthopedic Surgery, AUMC, Amsterdam, The Netherlands
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
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Ying H, Wang J, Sun Y, Dai K, Yu C, Yang F. Treatment of unstable distal clavicle fractures (Neer type IIb): a modified system using a miniature locking plate with a single button. J Int Med Res 2021; 49:3000605211022505. [PMID: 34154435 PMCID: PMC8236791 DOI: 10.1177/03000605211022505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Distal clavicle fractures are common in patients with shoulder injuries. We retrospectively evaluated the clinical outcomes of a novel fixation technique using a miniature locking plate with a single button in patients with distal clavicle fractures associated with coracoclavicular ligament disruption. The study involved seven patients with distal clavicle fractures with a follow-up period of 12 months. All patients were diagnosed with type IIb fractures according to the Neer classification. The distal clavicle fracture was fixed with a miniature locking plate, and the coracoclavicular ligaments were reconstructed using a single button. Functional outcomes were assessed at the final follow-up visit. At the 1-year follow-up, all patients had achieved radiographic union. There were no cases of nonunion or osteolysis. The mean Constant score at the final follow-up was 88 ± 5.13 (range, 78–93); the mean Disabilities of the Arm, Shoulder and Hand score was 19.17 ± 7.70 (range, 11.67–25); and the mean University of California Los Angeles score was 30 ± 2.52 (range, 25–33). In summary, internal fixation using a miniature locking plate and coracoclavicular reconstruction with a single button is a reliable surgical technique for restoring stability in patients with Neer type IIb distal clavicle fractures.
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Affiliation(s)
- Hua Ying
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jihuan Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yuehua Sun
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chao Yu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Fei Yang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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King PR, Lamberts RP. Management of clavicle shaft fractures with intramedullary devices: a narrative review. Expert Rev Med Devices 2020; 17:807-815. [PMID: 32635794 DOI: 10.1080/17434440.2020.1793668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Displaced and shortened clavicle fractures are frequently treated surgically. Although extramedullary fixation using a plate and screws is most commonly used, intramedullary nailing has become increasingly popular over the last decade. Traditional intramedullary nailing is usually associated with a high risk of hardware migration as well as hardware irritation at its entry point. Newer devices, however, seem to mitigate these problems. The aim of this narrative review is to provide an overview of clavicle shaft fractures and treatment with intramedullary nails, in particular the newer, locked devices. AREAS COVERED In general, this review covers current literature related to clavicle shaft fractures with a specific focus on the treatment of displaced and shortened fractures with intramedullary nails. EXPERT OPINION Clavicle shaft fractures can be effectively treated with an intramedullary nail. The risk of hardware migration when employing the newer, improved designs appears to be minimal. The advantages of using intramedullary fixation include smaller incision sizes as well as the avoidance of routine procedures generally associated with the removal of prominent subcutaneous hardware as per extramedullary fixation.
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Affiliation(s)
- Paul Reginald King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
| | - Robert Patrick Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
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Medial Femoral Condyle Vascularized Bone Graft for Treatment of Midshaft Clavicle Recalcitrant Nonunion With Use of the Transverse Cervical Artery as an Anastomosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00049. [PMID: 32656481 PMCID: PMC7322782 DOI: 10.5435/jaaosglobal-d-19-00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/24/2019] [Indexed: 12/01/2022]
Abstract
Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, the patient had returned to full duty and resumed competitive triathlons. Radiographs demonstrated complete healing of clavicle fracture.
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Ullah K, Khan S, Wang YQ, Zhao ZH, Cheng P, Sapkota B, Ren L, Khan S, Rehman MU, Xue Y. Bilaterally Threaded, Minimal Invasive, Elastic Locking Intramedullary Nailing (ELIN) for the Treatment of Clavicle Fractures. Orthop Surg 2020; 12:321-332. [PMID: 32077261 PMCID: PMC7031594 DOI: 10.1111/os.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate and present the effectiveness of this innovatively designed, elastic locking intramedullary nail (ELIN) in fixation of clavicle fractures. Methods The study included 38 patients from July 2014 to July 2017. All of them received intramedullary fixation treated with ELIN, 22 were males and 16 females. The mean age of the patients was 54 years. There were twenty right‐side and 18 left‐side clavicular fractures. Radiographs were taken to assess the fracture type: 21 were type A, 16 type B, and one type C. General anesthesia or cervical block was given to all patients. A small incision of 3–5 cm was given only to those who needed mini‐open reduction. The administration of ELIN and reduction of the fracture was made sure with a C arm machine. After a follow‐up of 8 to 33 months, the clinical outcomes were assessed and evaluated. The constant scores and disabilities of the arm, shoulder and hand questionnaire (DASH) were used to determine the outcomes and functional status of the patients. The study was done accordingly to the guidelines provided by the ethics committee. Results Mean operation time was 25.63 min. Mean follow‐up time was 16.5 months. The rate of closed reduction and open reduction was 84% and 16% respectively. There was no shortening of the clavicle. There was no breakage of the nail, though bending of the nail occurred in one patient. Superficial skin infection occurred in three patients at insertion points or the nail tip which was embedded subcutaneously. Skin erosion with nail exposure occurred in a patient with no significant infection. All the other patients had excellent shoulder function. A mini scar was observed in seven patients all the other patients had no scar. Asymmetry was observed in three patients. The mean Constant score was 98.47 and the mean DASH score was 1.55 at the last follow‐up. The implant was removed in all the patients. Conclusion Clavicular fractures treated with ELIN is minimally invasive, which presents a safe and novel surgical technique with less complications and a high success rate, excellent aesthetic and quick recovery after surgery. ELIN restores the micro‐dynamic stress at the fracture ends and promotes fracture healing, keeps intact the fracture hematoma and maintains the blood supply, accelerates healing and thus leads to faster osseous healing and better restoration of clavicle length.
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Affiliation(s)
- Kifayat Ullah
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Saima Khan
- Department of Infertility and Reproductive Endocrinology, Tianjin Medical University Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Yong-Qing Wang
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Zhi-Hui Zhao
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Peng Cheng
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | | | - Liang Ren
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mujeeb Ur Rehman
- Department of Cardiovascular and Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Rollo G, Prkic A, Bisaccia M, Eygendaal D, Pichierri P, Marsilio A, Giaracuni M, Meccariello L. Grafting and fixation after aseptic non-union of the humeral shaft: A case series. J Clin Orthop Trauma 2020; 11:S51-S55. [PMID: 31992917 PMCID: PMC6977174 DOI: 10.1016/j.jcot.2019.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/12/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Non-unions after humeral shaft fractures are seen frequently in clinical practice at about 2-10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. METHODS From 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. RESULTS In all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. CONCLUSION Given the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | | | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, “S. Maria della Misericordia” Hospital, Perugia, Italy
| | - Denise Eygendaal
- Amphia Hospital, Breda, the Netherlands,Department of Orthopedics AUMC, Amsterdam, the Netherlands
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Marsilio
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Marco Giaracuni
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy,Corresponding author. Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, Lecce, Italy.
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Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series. J Clin Orthop Trauma 2019; 10:S127-S132. [PMID: 31695271 PMCID: PMC6823753 DOI: 10.1016/j.jcot.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2-10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus. MATERIALS AND METHODS 26 consecutive cases were treated using a trans-triceps approach. The non-union was fixed with a 4.5 mm Locking Compression Plate combined with a strut bone allograft at the anterior part of the humerus and bone chips. All patients underwent the same rehabilitation protocol of 12 weeks. Clinical evaluation took place 12 months after surgery with the Mayo elbow score and Oxford elbow score. RESULTS Complete bone healing without complications was achieved in all 26 patients. The average period of radiographic union was 106 days. The average range of flexion-extension was 108° (94°-180°) and pro-supination was 159° (102°-180°). Twelve months after surgery, average Mayo elbow score was 86 (68-100) and the Oxford elbow score was 83 (52-100). CONCLUSION The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.
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Ripani U, Manzarbeitia-Arroba P, Guijarro-Leo S, Urrutia-Graña J, De Masi-De Luca A. Vitamin C May Help to Reduce the Knee's Arthritic Symptoms. Outcomes Assessment of Nutriceutical Therapy. Med Arch 2019; 73:173-177. [PMID: 31404121 PMCID: PMC6643354 DOI: 10.5455/medarh.2019.73.173-177] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/26/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, changes in the physico-chemical properties of the synovial fluid and macroscopical modifications of the joint. Patients with Classes I and II of Knee OA can be treated with pharmacologic therapy. Vitamin C is key for both preventing inflammatory arthritis and maintaining healthy joints with OA. AIM The aim of our paper is to verify the effectiveness of the addition of vitamin c in nutriceutical drugs for the therapy of the knee arthritis in the young adult. RESULTS Group B has a lower VAS score at 6 and 12 months with p<0.05. Not statistical difference we found in KSS during all follow up. A better quality of life was founded in Group B at 12 months in group B(p<0.05) and less use of pain killers/monthly(p<0.05). CONCLUSION There is no denying that vitamin C benefits everybody, whether they have arthritis or not. Therefore, it is a good idea to maintain a healthy balance of vitamin C. Without a doubt, vitamin C benefits most people with early OA.
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Affiliation(s)
- Umberto Ripani
- Pain Therapy Center, Division of Anesthesia, Analgesia and Intensive Care, Department of Emergency, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Paloma Manzarbeitia-Arroba
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Sandra Guijarro-Leo
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Javier Urrutia-Graña
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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Hu K, Jiang W, Sun H, Li Z, Rong G, Yin Z. Long noncoding RNA ZBED3‐AS1 induces the differentiation of mesenchymal stem cells and enhances bone regeneration by repressing IL‐1β via Wnt/β‐catenin signaling pathway. J Cell Physiol 2019; 234:17863-17875. [DOI: 10.1002/jcp.28416] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/01/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Kongzu Hu
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
| | - Wei Jiang
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
| | - Heyan Sun
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
| | - Zhenwei Li
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
| | - Genxiang Rong
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
| | - Zongsheng Yin
- Department of Orthopaedics The First Affiliated Hospital of Anhui Medical University Hefei Anhui P. R. China
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