Intramedullary fibular graft and quadricortical plate fixation in atrophic non-union of the osteoporotic humerus

Farouk, Osama; El-Sherif, Essam; Mostafa, Khaled; Khalil, Aly

doi:10.1016/j.injury.2007.10.006

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…The elements related to the patient's condition are accepted by the majority of the authors and confirmed by the various studies [2,5,9,12]. These include obesity, smoking, alcoholism and osteoporosis [1,2,10,15,39]; which our study did not find because only obesity is found in 2 patients. Non-union of the humerus complicates above all a fracture with a single transverse or oblique line located at the middle third or distal third [8,9,10,12,15,24,32,33] because of their small contact surface, and hence a lower osteogenic potential [2,9,10].…”

Section: Favoring Factorssupporting

confidence: 73%

“…These include obesity, smoking, alcoholism and osteoporosis [1,2,10,15,39]; which our study did not find because only obesity is found in 2 patients. Non-union of the humerus complicates above all a fracture with a single transverse or oblique line located at the middle third or distal third [8,9,10,12,15,24,32,33] because of their small contact surface, and hence a lower osteogenic potential [2,9,10]. According to Caroll's anatomical study [7], the main alimentary artery of the humerus is located at its medial edge at the middle third.…”

Section: Favoring Factorsmentioning

confidence: 63%

“…Non-union is the most common progressive and late complication of fractures of the humeral shaft. It complicates 10% of these fractures whatever the technique used and comes in 4 th position after that of the leg, femur and forearm [4,15,18]. Despite this low incidence, it remains a particularly difficult complication whose treatment is difficult and varied with sometimes aleatory results.…”

Section: Introductionmentioning

confidence: 99%

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Aseptic Humeral Shaft Non-union Predisposing Factor and Evaluation Treatment

Dembelé¹,

Nf²,

Sarr³

et al. 2017

SM J Orthop

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Patients and Methods PatientsIt was a prospective and continuous study from January 2008 to July 2015. All patients with non-union of the humerus were included.Criteria for non-inclusion concerned septic non-union, patients lost to follow-up and incomplete records. The data were collected on the history of the patients (which included the patient's civil status, history and habit, initial treatment), clinical examination, radiography status, treatment and progression after treatment.Thus 22 cases of non-union of the humeral diaphysis were collected in 22 patients. They were 14 men and 8 women with an average age of 52.7 years (23-85 years).The reason for the consultation was the deformation of the arm during the execution of the gestures and the absolute functional impotence of the limb. All patients were right-handed and the dominant side was reached 7 times. Pain was present in 7 of them.Patients were in various occupations (6 housewives, 2 drivers, 5 without profession, 2 retired patients, 1 plumber, 1 pompist, 2 merchants, 1 fisherman, 1 receptionist and 1 transporter).According to the radiological aspect we have found several anatopathological forms. The classification of Weber and Cech [6] allowed us to find 15 eutrophic, 5 atrophic and 2 hypertrophic forms.

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Section: Favoring Factorssupporting

confidence: 73%

Section: Favoring Factorsmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Aseptic Humeral Shaft Non-union Predisposing Factor and Evaluation Treatment

Dembelé¹,

Nf²,

Sarr³

et al. 2017

SM J Orthop

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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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“…Multiple surgical options have been described in the literature including open reduction and internal fixation with dynamic compression plate (DCP), locking compression plate (LCP) interlocking nail (ILN), and external fixator [1]. Autologous nonvascularized fibular graft (ANVFG) has been used in combination with plating [2][3][4]. This construct improves biomechanical strength and provides enhanced biology for gap and atrophic nonunions in long bones.…”

Section: Introductionmentioning

confidence: 99%

Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion

Shetty¹,

Cheppalli²,

Kaki³

2022

Cureus

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IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for "complex" diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

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Intramedullary fibular graft and quadricortical plate fixation in atrophic non-union of the osteoporotic humerus

Cited by 6 publications

References 10 publications

Aseptic Humeral Shaft Non-union Predisposing Factor and Evaluation Treatment

Aseptic Humeral Shaft Non-union Predisposing Factor and Evaluation Treatment

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

Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion

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