Fibular Non-Vascularized Graft Might be a Practical Solution for Treatment of Osteopenic Humeral Shaft Non-union in Elderly Obese Patients

Kilic, Ayhan; Arslan, Armagan; Mutlu, Harun; Çetinkaya, Engin; May, Cuneyt; Parmaksizoglu, Atilla Sancar

doi:10.5152/jarem.2011.05

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Intramedullary fibular strut act as an internal splint giving stability at fracture site and also increases screw purchase as described by Wright et al 7 Several authors have shown successful results with the non-vascularized fibular graft (Table 2). 7,15,[34][35][36][37][38][39] However, the grafts longer than 6 cm have been shown to have decreased capacity for incorporation and healing. [28,40] The drawbacks to this technique are possibility of disruption of both endosteal and periosteal blood supply, iatrogenic fracture during insertion of graft and possible nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

Role of autologous non-vascularised intramedullary fibular strut graft in humeral shaft nonunions following failed plating

Kashayi-Chowdojirao

Vallurupalli

Chilakamarri

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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Seventy eight cases of nonunion humeral shaft fractures were managed in our institute between 2008 and 2015. Of these, 57 cases were failed plate osteosynthesis, in which 15 cases were infected and 42 cases were noninfected. Out of the 78 cases, bone grafting was done in 55 cases. Fibular strut graft was used in 22 patients, of which 4 cases were of primary nonunion with osteoporotic bone. Applying the exclusion criteria of infection and inclusion criteria of failed plate osteosynthesis managed with revision plating using either LCP or DCP and ANVFG, 17 cases were studied. The mean age of the patients was 40.11 yrs (range: 26-57 yrs). The mean duration of non-union was 4.43 yrs (range: 0.5-14 yrs). The mean follow-up period was 33.41 months (range: 12-94 months). The average length of fibula was 10.7 cm (range: 6-15 cm). Main outcome measurements included bony union by radiographic assessment and pre- and postoperative functional evaluation using the DASH (Disabilities of the Arm, Shoulder and Hand) score. Results: Sixteen out of 17 fractures united following revision plating and fibular strut grafting. Average time taken for union was 3.5 months (range: 3-5 months). Complications included one each of implant failure with bending, transient radial nerve palsy and transient ulnar nerve palsy. No case had infection, graft site morbidity or peroneal nerve palsy. Functional assessment by DASH score improved from 59.14 (range: 43.6-73.21) preoperatively to 23.39 (range: 8.03-34.2) postoperatively (p = 0.0003). Conclusion: The results of our study indicate that revision plating along with ANVFG is a reliable option in humeral diaphyseal non-unions with failed plate-screw osteosynthesis providing adequate screw purchase, mechanical stability and high chances of union with good functional outcome.

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