Nonunions and their operative treatment

Reeh, Freya M; Sachse, Sebastian; Wedekind, Lisa; Hofmann, Gunther O.; Lenz, Mark

doi:10.3238/arztebl.m2022.0300

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…Fracture non-union incidences, drawn from comprehensive epidemiology studies-by Mills et al [69], Walter et al [40], and Reeh et al [25] 2022-reveal non-union rates of 1.88, 2.9, and 2.17 per 100,000 capita for foot injuries and 2.6, 2.8, and 3.33 per 100,000 capita for lower leg injuries [25,40,69]. Overall, the combined non-union incidence for the foot, ankle, and lower leg after fracture stands at 5.23 per 100,000 capita.…”

Section: Discussionmentioning

confidence: 99%

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Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw®)

Labmayr,

Huber,

Wenzel-Schwarz

et al. 2024

JPM

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Addressing non-unions involves stabilizing the affected area through osteosynthesis and improving bone biology using bone grafts. However, there is no consensus on the optimal treatment method. This study aims to compare outcomes of non-union surgery using conventional treatment methods (metal hardware ± graft) versus osteosynthesis with the human allogeneic cortical bone screw (Shark Screw®) alone or in combination with a metallic plate. Thirty-four patients underwent conventional treatment, while twenty-eight cases received one or more Shark Screws®. Patient demographics, bone healing, time to bone healing, and complications were assessed. Results revealed a healing rate of 96.4% for the Shark Screw® group, compared to 82.3% for the conventionally treated group. The Shark Screw® group exhibited a tendency for faster bone healing (9.4 ± 3.2 vs. 12.9 ± 8.5 weeks, p = 0.05061). Hardware irritations led to six metal removals in the conventional group versus two in the Shark Screw® group. The Shark Screw® emerges as a promising option for personalized non-union treatment in the foot, ankle, and select lower leg cases, facilitating effective osteosynthesis and grafting within a single construct and promoting high union rates, low complications, and a rapid healing process.

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Section: Discussionmentioning

confidence: 99%

“…However, evidence exists showing that allograft use results in similar bone healing as when using autografts [20][21][22][23][24]. In practice, a spectrum of surgical principles, including various combinations and variations, are applied [7,[25][26][27][28][29]. There is no consensus over the optimal treatment method [4].…”

Section: Introductionmentioning

confidence: 99%

Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw®)

Labmayr,

Huber,

Wenzel-Schwarz

et al. 2024

JPM

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“…Nonunion caused by fluid-filled, membrane-covered cavities formed between fracture fragments is known as synovial pseudarthrosis [ 11 ]. Debridement, bone grafting, and internal fixation are the most common surgical treatment options for nonunion [ 12 ]. Our success in obtaining bony fusion of a tibial ACL avulsion fracture nonunion can be attributed to adequate debridement, reduction, and internal fixation.…”

Section: Discussionmentioning

confidence: 99%

Osteosynthesis with Arthroscopy of a Nonunited Tibial Anterior Cruciate Ligament Avulsion Fracture 30 Years after Injury

Tanaka,

Ohno,

Ishikawa

et al. 2023

Case Reports in Orthopedics

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There are a few reports on the treatment of nonunited tibial anterior cruciate ligament (ACL) avulsion fractures. To our knowledge, this is the first report of a case of nonunited tibial ACL avulsion fracture 30 years after injury. A 36-year-old woman injured her knee during a road traffic accident 30 years ago. Since then, she had persistent knee instability that was left untreated. She presented to our clinic because of knee pain she had been experiencing for a week. Radiography and computed tomography revealed tibial ACL avulsion fracture nonunions. Screw fixation with arthroscopy was performed, and bone fusion was obtained. The knee injury and osteoarthritis outcome score improved from 24 points preoperatively to 83 points postoperatively. The nonunion of intercondylar eminence fractures of the tibia, even up to 30 years after the initial injury, can be treated by osteosynthesis with arthroscopy.

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“…Although there is still no uniform definition of nonunion, the current definition of the European Society of Tissue Regeneration in Orthopaedics and Traumatology (ESTROT), which defines a nonunion as a fracture that will not heal without further intervention regardless of the duration of treatment, has gained acceptance [ 2 ]. The risk of developing a nonunion per fracture is reported to be approximately 2% for the scaphoid, the tibia and the femur [ 3 , 4 ]. Depending on the localisation of the fracture and the individual risk profile, nonunion rates of up to 30% have been reported [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The risk of developing a nonunion per fracture is reported to be approximately 2% for the scaphoid, the tibia and the femur [ 3 , 4 ]. Depending on the localisation of the fracture and the individual risk profile, nonunion rates of up to 30% have been reported [ 4 , 5 ]. Due to patient-related risk factors such as sex, age, smoking status, diabetes and vascular status and general risk factors such as fracture localisation, high-energy trauma, open or multifragmentary fractures, deep infections, osteomyelitis and nontraumatic tumour resections, long bone fractures may even result in critical-size bone defects [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Matched-Pair Analysis: Large-Sized Defects in Surgery of Lower Limb Nonunions

Findeisen,

Schwilk,

Haubruck

et al. 2023

JCM

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Background: The treatment of large-sized bone defects remains a major challenge in trauma and orthopaedic surgery. Although there are many treatment options, there is still no clear guidance on surgical management, and the influence of defect size on radiological and clinical outcome remains unclear due to the small number of affected patients. The aim of the present study was to determine the influence of defect size on the outcome of atrophic and infected nonunions of the tibia or the femur based on the diamond concept in order to provide recommendations for treatment guidance. Patients and Methods: All medical records, surgical reports, laboratory data and radiological images of patients treated surgically for atrophic or infected nonunions of the lower limbs (femur or tibia) between 1 January 2010 and 31 December 2020 were examined. Patients with proximal, diaphyseal or distal nonunions of the femur or tibia who were surgically treated at our institution according to the “diamond concept” and attended our standardised follow-up program were included in a database. Surgical treatment was performed as a one- or two-step procedure, depending on the type of nonunion. Patients with a segmental bone defect ≥5 cm were matched with patients suffering a bone defect <5 cm based on five established criteria. According to our inclusion and exclusion criteria, 70 patients with a bone defect ≥5 cm were suitable for analysis. Two groups were formed by matching: the study group (bone defect ≥5 cm; n = 39) and control group (bone defect <5 cm; n = 39). The study was approved by the local ethics committee (S-262/2017). Results: The mean defect size was 7.13 cm in the study and 2.09 cm in the control group. The chi-square test showed equal consolidation rates between the groups (SG: 53.8%; CG: 66.7%). However, the Kaplan–Meier curve and log-rank test showed a significant difference regarding the mean duration until consolidation was achieved, with an average of 15.95 months in the study and 9.24 months in the control group (α = 0.05, p = 0.001). Linear regression showed a significant increase in consolidation duration with increasing defect size (R2 = 0.121, p = 0.021). Logistic regression modelling showed a significant negative correlation between consolidation rate and revision performance, as well as an increasing number of revisions, prior surgeries and total number of surgeries performed on the limb. Clinical outcomes showed equal full weight bearing of the lower extremity after 5.54 months in the study vs. 4.86 months in the control group (p = 0.267). Conclusion: Surprisingly, defect size does not seem to have a significant effect on the consolidation rate and should not be seen as a risk factor. However, for the treatment of large-sized nonunions, the follow-up period should be prolonged up to 24 months, due to the extended time until consolidation will be achieved. This period should also pass before a premature revision with new bone augmentation is performed. In addition, it should be kept in mind that as the number of previous surgeries and revisions increases, the prospects for consolidation decrease and a change in therapeutic approach may be required.

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Nonunions and their operative treatment

Cited by 5 publications

References 33 publications

Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw®)

Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw®)

Osteosynthesis with Arthroscopy of a Nonunited Tibial Anterior Cruciate Ligament Avulsion Fracture 30 Years after Injury

Matched-Pair Analysis: Large-Sized Defects in Surgery of Lower Limb Nonunions

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