Outcomes of Distal Femur Nonunions Treated With a Combined Nail/Plate Construct and Autogenous Bone Grafting

Attum, Basem; Douleh, Diana G.; Whiting, Paul S.; White-Dzuro, Gabrielle A.; Dodd, Ashley C.; Shen, Michelle; Mir, Hassan R.; Obremskey, William T.; Sethi, Manish K.

doi:10.1097/bot.0000000000000926

Cited by 42 publications

(25 citation statements)

References 23 publications

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“…Variations of the above technique have been used successfully in the femur and tibia [14,15]; however, we are unaware of previously published reports of its use in the forearm. We are hopeful that this technique can be used by others in the future when select circumstances are present.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

Jacobs¹,

Schmitz²,

Swiontkowski³

2022

Cureus

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A 35-year-old female patient with cerebellar ataxia presented with a right periprosthetic both-bone forearm fracture after a ground-level fall. Her surgical history was significant for multiple both-bone forearm fractures treated by open reduction and internal fixation. Subsequent treatment with a combination of intramedullary nailing and plate fixation for each bone provided successful fracture union while allowing immediate return to weight-bearing and range of motion. This case report demonstrates that intramedullary nailing and plate fixation of both-bone forearm fractures provides complete protection of the radius and ulna in recurrent, peri-implant both-bone forearm fractures. This technique is a valuable treatment option in the setting of a patient at risk for recurrent injury of the forearm.

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Section: Discussionmentioning

confidence: 99%

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

Jacobs¹,

Schmitz²,

Swiontkowski³

2022

Cureus

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“…Also the study by Attum et al was dedicated to the treatment of distal femoral nonunions, but these authors used a combined nail/plate construct as fixation method in association to autologous bone grafting. 36 This clinical series included 10 patients with an average age of 56 years (range, 26 to 88). The RIA System was used in all patients and was associated to adjunctive augmentation (allograft, BMP sponge, synthetic bone) in 60% of the cases.…”

Section: Discussionmentioning

confidence: 99%

The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review.

Landrino¹,

Alberio

Clemente³

et al. 2022

Orthopedic Reviews

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Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures. Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union. The Reamer-Irrigator-Aspirator (RIA) System® was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature. In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed. Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.

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“…Intramedullary nail and plate construct is another augmented fixation approach that can be used to manage distal femoral fractures. The combination of nail and plating creates a load sharing device with good distal bone fixation and has been used as a technique to manage non-unions 14. Nail plating for non-union has been shown to result in quicker union times and a return to work compared with other techniques 15.…”

Section: Discussionmentioning

confidence: 99%

Failure of dual plating in a complex open distal femur fracture as the result of major trauma

2021

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A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.

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Outcomes of Distal Femur Nonunions Treated With a Combined Nail/Plate Construct and Autogenous Bone Grafting

Cited by 42 publications

References 23 publications

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review.

Failure of dual plating in a complex open distal femur fracture as the result of major trauma

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