The role of autologous bone graft in surgical treatment of hypertrophic nonunion of midshaft clavicle fractures

Huang, Hui‐Kuang; Chiang, Cheng‐Chin; Hung, Shih-Hsin; Su, Yu‐Ping; Chiu, Fang-Yao; Liu, Chien-Lin; Chen, Tain-Hsiung

doi:10.1016/j.jcma.2012.04.003

Cited by 11 publications

(6 citation statements)

References 36 publications

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“…In the subanalysis of single-plate (n = 853) 6,11-42 vs. intramedullary (n = 93) 40,43-47 fixation, 39 studies were included (Table V). Of the 14 studies not included, 5 studies reported aggregate outcomes from single and double plating, 5 from multiple fixations methods, 3 from external fixators, and 1 from tension band wiring.…”

Section: Resultsmentioning

confidence: 99%

“…In the subanalysis of the use of bone graft (n = 687) 6,12,13,15,16,19,22-25,30,32-42,44-52 vs. no bone graft (n = 224) 11,17,23,26,27,29,43,53-55 , 41 studies were included (Table VI). The bone graft subjects had significantly longer follow-up than the nonbone graft group (3 vs. 2 years, p < 0.0001), but there was no difference in age (42 vs. 43 years).…”

Section: Resultsmentioning

confidence: 99%

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Complications and Outcomes After Surgical Intervention in Clavicular Nonunion

Yetter¹,

Harper²,

Weatherby

et al. 2023

JBJS Reviews

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Background: Surgical repair of clavicle fractures is being employed more frequently, although most fractures are still treated conservatively. Both can result in nonunion. Current treatments for clavicle nonunion include open reduction with internal fixation (ORIF) plating without bone graft, ORIF plating with bone graft, and intramedullary pin fixation.Methods: We performed a systematic review and meta-analysis of studies reporting outcome, complication, and reoperation rates following surgical treatment for clavicle nonunion. Subgroup analysis was undertaken for outcome and complication rates between single plating and intramedullary pin fixation, bone graft use, and nonunion time length definition.Results: Fifty-three studies met inclusion criteria (1,258 clavicle nonunions). Mean clinical follow-up was 2.6 years. Seventy-two percent of nonunions were of the middle third, 1% were proximal third, 12% were distal third, and 15% were not reported. Forty-eight percent of nonunions were atrophic or oligotrophic and 17% were hypertrophic (35% not reported). Mean time to union was 13.6 weeks. Ninety-five percent of patients achieved union after the primary nonunion surgery. Overall complication rate was 17%. Singleplating fixation had significantly faster union time (15.2 vs. 19.8 weeks), lower reoperation rate (23% vs. 37%), and hardware removal rate (20% vs. 34%) than intramedullary pin fixation. Bone graft had significantly lower rates of delayed union (0.6% vs. 3.6%) but higher complication (15% vs. 8%) and reoperation rates (29% vs. 14%) than the other groups. Studies that defined nonunion after 3 months had significantly faster union times than the 6-month studies (13 vs. 16 weeks). The 3-month group had a significantly lower overall complication rate (12% vs. 25%) and hardware/fixation failure rate (3% vs. 5.5%) than the 6-month group.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Complications and Outcomes After Surgical Intervention in Clavicular Nonunion

Yetter¹,

Harper²,

Weatherby

et al. 2023

JBJS Reviews

View full text Add to dashboard Cite

show abstract

“…In 2011, Singh et al [ 36 ] compared the use of ICBG in 20 patients to demineralized bone matrix (DBM) in 10 patients as supplementation to ORIF in the treatment of mid-shaft clavicle nonunions; both groups achieved 90% union, and they concluded that DBM obviates the need for BG. In 2012, Huang et al published two retrospective studies [ 23 , 24 ]. The first study described the treatment of 51 patients with hypertrophic nonunion treated with ORIF and BG from local callus, while the second study compared treatment of 60 patients with atrophic nonunion with ORIF alone vs. ORIF with ICBG.…”

Section: Discussionmentioning

confidence: 99%

“…In both studies, all patients achieved union. Huang et al [ 23 , 24 ] concluded that the use of autologous ICBG was not required to achieve union. The union rate achieved (95.2%) in the current study is well within the range of union rates found in previous studies of 90–100%.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperatively, patients were examined at 2, 8, 20, and 50 weeks and then annually as needed, and radiographic evaluation with standardized anteroposterior and clavicle view was performed on every follow-up visit. Union was defined as a completely bridging bone in two radiographs (i.e., two healed cortices), with obliteration of the fracture gap; this method was described in previous studies [ 22 , 23 , 24 ]. All radiographs were evaluated independently by two senior authors (D.B.…”

Section: Methodsmentioning

confidence: 99%

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Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series

Benshabat

Factor

Maman

et al. 2021

JCM

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Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.

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Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study

Zhang

Duan

et al. 2022

International Orthopaedics (SICOT)

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The role of autologous bone graft in surgical treatment of hypertrophic nonunion of midshaft clavicle fractures

Abstract: LC-DCP fixation is an effective method for treating hypertrophic nonunion of mid-shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.

Cited by 11 publications

References 36 publications

Complications and Outcomes After Surgical Intervention in Clavicular Nonunion

Complications and Outcomes After Surgical Intervention in Clavicular Nonunion

Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series

Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study

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