Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Sun, Liang; Zhong, Li; Ma, Teng; Xue, Hao; Wang, Qian; Lu, Daigang; Lu, Yao; Ren, Cheng; Li, Ming; Zhang, Kun

doi:10.1177/0300060518814607

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…Plating combined with bone grafting is the method most widely used to treat humeral shaft nonunion, as it achieves precise correction of the deformity and absolute stability, and enables the use of biologic augmentation [ 5 , 13 ]. One study reported a healing rate of 97% for anterior augmentation plating of aseptic humeral shaft nonunion [ 28 ], and a review of 36 studies found that plating with autologous bone grafting achieves a union rate of up to 98% in patients with humeral shaft nonunion [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although many studies have reported the successful treatment of primary humeral diaphysis nonunion, few studies have specifically evaluated revision procedures for the salvage of persistent nonunion following failed initial nonunion interventions [ 2 , 8 ]. As our previous study showed that double plate fixation combined with structural autologous iliac bone grafting results in reasonable treatment outcomes for limb nonunion [ 13 ], the aim of the present study was to evaluate the clinical outcomes of this treatment strategy for recalcitrant humeral shaft nonunion.…”

Section: Introductionmentioning

confidence: 99%

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Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Feng

Wang

Sun

et al. 2020

BMC Musculoskelet Disord

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Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Feng

Wang

Sun

et al. 2020

BMC Musculoskelet Disord

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“…Our previous studies had proved that LCP combined with autologous iliac structural bone grafting can effectively treat aseptic limb nonunions [5,13], and many researchers advocated this treatment strategy. Gessmann et al [28] reported a 97% healing rate of anterior augmentation plating for aseptic humeral shaft nonunions after antegrade or retrograde intramedullary nailing.…”

Section: Discussionmentioning

confidence: 99%

“…Although many authors have reported on successful treatment of primary humeral diaphysis nonunion, few papers speci cally address the revision procedures for salvage of persistent nonunions following failed initial nonunion interventions [2,8]. As our team's previous study had shown that double plates combined with structural auto-iliac bone graft resulted in reasonable outcomes for treatment of patients with limb nonunion, we would like to know if persistent humeral shaft nonunions response well for this treatment strategy [13]. The purpose of this study was to report the authors' experience in the use of double plates combined with autogenous iliac bone graft in the treatment of recalcitrant humeral shaft nonunions.…”

Section: Introductionmentioning

confidence: 99%

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Feng¹,

Wang²,

Sun³

et al. 2020

Preprint

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Background: Despite the majority of humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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“…During exposure, care was taken to identify and protect important structures, especially when the radial nerve was indicated, as the neurolysis would be necessary due to abundant scar tissue from multiple surgeries. The fracture nonunion site was opened and explored after original failed xation devices were removed (except in two patients who showed no gap between nonunion sites but remained a stable plating with at least layers of cortices xed at each side, where we left the previous plate in place and added a second plate), a thorough debridement was performed based on the Judet periosteal stripping technique [15], with the entire pseudocapsule, interposed brous tissue and sclerotic bone clearly excised until punctate bleeding was seen at the bony ends (Paprika sign) [5,16]. After opening the medullary canal using a drill bit, any angulation and rotation were corrected, and osteosynthesis was performed by using a 4.5-mm narrow LCP in compression mode to obtain cortex-to-cortex stability.…”

Section: Methodsmentioning

confidence: 99%

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

Feng¹,

Wang²,

Sun³

et al. 2020

Preprint

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Background: Despite the majority humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Cited by 14 publications

References 33 publications

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

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