Judet osteoperiosteal decortication for treatment of non-union: The Cornwall experience

Guyver, P.M.; Wakeling, Christopher; Naik, K. Sunil; Norton, M.R.

doi:10.1016/j.injury.2012.03.035

Cited by 25 publications

(10 citation statements)

References 13 publications

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“…e disparity in results among the three groups underlines the need of categorizing nonunions based on their severity or complexity before prognosticating the case and estimating the likelihood of union. Guyver et al [11] observed a 92% union rate in their study, while Raju et al [28] showed a 100% union rate in their case series of 20 patients with tibial fracture nonunion. In both these studies, the classification of nonunion according to their severity or complexity has not been taken into consideration.…”

Section: Discussionmentioning

confidence: 85%

“…In both these studies, the classification of nonunion according to their severity or complexity has not been taken into consideration. Guyver observed three patients with superficial infections and two patients with deep infections [11]. In our study, we had an infection rate of 20.5% (7/34), out of which the infection rate in group A was 7% (1/14), 10% (1/10) in group B, and 50% (5/10) in group C. e infection rate was significantly higher in group C compared with groups A and B. is increased infection rate could be attributed to the factors we considered in NUSS scoring.…”

Section: Discussionmentioning

confidence: 99%

“…ese bone chips with their blood supply (through the muscles attached) constitute the osteoperiosteal flap. Subsequently, in 2012 Guyver et al, in their publication, demonstrated similar results with 92.3% union rates [11]. Despite promising results, this technique has not gained much popularity.…”

Section: Background Of the Workmentioning

confidence: 92%

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Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

Kumar

Waliullah

Avasthi

et al. 2021

Advances in Orthopedics

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Introduction. The treatment of long bone shaft nonunions is challenging. The technique of osteoperiosteal decortications flap for approaching the nonunion site coupled with fixation modalities was first described by Judet in 1963. Despite promising clinical and radiological union, this technique is not popular among orthopaedic surgeons. Our study aimed to evaluate the radiological union and functional results of shaft tibia nonunions treated by the osteoperiosteal decortication approach. Methods. This retrospective study included all the cases with established tibial shaft nonunion following stringent inclusion and exclusion criteria and operated upon by following the principle of osteoperiosteal flap technique from April 2015 to July 2019. Further subgroups were made based on nonunions complexity based on nonunion scoring system (NUSS) score. The outcome measures included radiological union scale in tibial fractures (RUST) and lower extremity functional scale (LEFS). The preoperative scores for union and function were recorded, and the subsequent scores were obtained at three, six, and nine months and one year. Appropriate statistical analysis of the data was done. Results. Thirty-four cases were shortlisted for analysis, fulfilling our inclusion and exclusion criteria. There were 22 males (64.7%) and 12 females (35.3%) with a mean age of 34.17 ± 10.3 years. Subgroup analysis based on the complexity of nonunion (NUSS score) revealed 14 cases in group A, 10 cases in group B, 10 cases in group C, and 0 cases in group D. The average time from fracture to surgery in these cases was 14.6 months. The average time to achieve union was 9.6 months, with patients in groups A, B, and C, having a mean duration of 9, 10.5, and 12 months, respectively. Statistically, significant improvement was seen in both RUST scores and LEFS score. Complications included infection in seven cases, wound dehiscence in two cases, and four cases of persistent nonunion. Conclusion. Osteoperiosteal decortication remains a highly effective surgical technique in the management of nonunion of long bones. NUSS scoring is an essential tool for prognosticating nonunion cases. This score is inversely related to the radiological union (RUST score) of the bone and functional recovery (LEFS score) of the patient.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

Kumar

Waliullah

Avasthi

et al. 2021

Advances in Orthopedics

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“…Ramoutar et al [3] combined Judet's technique with compression plating to treat long bone non-union(both upper and lower limb long bone fractures) and concluded that routine use of bone grafts is not necessary when there is minimal or no bone loss for treatment of non-union. Guyver et al [4] observed that Judet's technique with plate and screw fixation was highly effective in treating failed fracture union and was best suited for hypertrophic non-union in short oblique and transverse diaphyseal fractures which failed to unite following intramedullary nailing.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of modified Judet's technique in non union tibia, with inter locking nail as fixation device

Raju¹,

Ahmed²,

Hosamani³

et al. 2020

Int. J. Orthop. Sci.

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Background-Non Union Tibia can be managed by many techniques, Judet's osteoperosteal flap is one of them. In traditional Judet's Technique compression plate was used as fixation device. We use interlocking nail as fixation device and studied the efficacy of its usage. Objective: To evaluate efficacy of modified Judet's technique. Methodology: A total 20 Patients of Victoria Hospital and Bowring & Lady Curzon hospital Bangalore during the period from 2017 to 2019 with aseptic non-union tibial fractures are taken for study. All cases were treated with opening of fracture site, freshening of fracture edges and raising of osteoperosteal flap followed by internal fixation with interlocking nail. The cases were followed for post operatively at 4 weeks, 12 weeks and 24 weeks. Result: Excellent results were obtained in 80% of cases. Good results were obtained in 15%, fair results in 5%. Complications include 10% delayed wound healing, 10% restriction of ankle and knee movements. Conclusion:Our study suggests that Judet's osteoperiosteal decortication (Shingling) with interlocking nail as internal fixation device is an effective technique in the surgical management of aseptic non-union tibia. It is also cost effective and alternative to other bone healing augmentation procedures. The procedure is simple and easily reproducible in most hospital settings, even in peripheral centres.

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“…Aseptic tibial diaphyseal nonunions with a nail in situ have been commonly managed efficiently with augmentation plating along with bone grafting. Robert Judet in 1963 proposed osteoperiosteal decortication as a possible treatment option for tibial nonunions [36]. He hypothesized that elevation of cortical chips attached to the periosteum at the nonunion site in combination with mechanical support led to union over a period of eight months in 99% of the cases.…”

Section: Alternative Treatment Modalities For Tibial Nonunion With a mentioning

confidence: 99%

Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence

Bhan

Tyagi

Kainth

et al. 2020

Cureus

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One of the most dreaded complications of fracture management is a nonunion. Nonunions are usually difficult to manage and can be a source of significant mental, physical, and financial distress to the patient. The incidence of nonunion is dependent on multiple factors including degree of comminution, open versus closed, concomitant infection, and vascular status, and therefore the management of such nonunions continues to be an often debated topic. Currently, there is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions. While reamed exchange nailing for aseptic tibial shaft nonunions has shown promising results, with very high union rates, many surgeons prefer newer novel techniques such as plating along with osteoperiosteal decortication or the use of more conventional compressive plating with bone grafts. The aim of this article is to critically review and understand the available evidence base on reamed exchange nailing in nonunion of tibial shaft fractures and to explore the other options available and their indications.

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Judet osteoperiosteal decortication for treatment of non-union: The Cornwall experience

Cited by 25 publications

References 13 publications

Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

Efficacy of modified Judet's technique in non union tibia, with inter locking nail as fixation device

Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence

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