Unstable Osteosynthesis of a Humeral Diaphyseal Fracture as a Cause of a Pseudoarthrosis and an Extensive Bone Defect (A Case Report)
Abstract: Relevance. The causes of the formation of a humeral diaphyseal pseudarthrosis can be various risk factors and their combination, including iatrogenic, associated with osteosynthesis technique non-compliance. This leads to instability of the metal constructions with the destructive consequences for the bone tissue and the injured limb function in general. Case presentation. A 60-year-old woman received a right humeral diaphyseal fracture with displacement (АО/АSIF 12-A3) and underwent locking intramedullary ost… Show more
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Cited by 3 publications
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Flistory and prospects of development of methods of osteosynthesis and osteosynthesis of the humerus diaphysis
Relevance. About 800 thousand people die every year as a result of injuries and their consequences, in the Russian Federation the frequency of injuries is 12 %. Fractures of the humerus diaphysis account for 1-5 % of the total number of traumatic injuries of the skeleton, at the same time, there is no tendency to reduce injuries in modern society, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Among the reasons for the unsatisfactory results of osteosynthesis, iatrogenic ones are distinguished: inconsistency from a biomechanical point of view, the choice of an unsuitable metal structure, insufficiently correct comparison of the ends of bone fragments and neglect of contraindications to the use of submerged structures with increased contamination of the wound with open fractures. Non-infectious complications of primary osteosynthesis include false joints, improperly fused fractures, untenable osteosynthesis, as well as fractures and migrations of implanted metal structures. The described complications are the basis for repeated (revision) surgery, or rheosteosynthesis. The purpose of this study is to analyze the historical aspects of the development of osteosynthesis and rheosteosynthesis methods, as well as to determine the prospects for their further development.Materials and methods. In the process of writing the article, the analysis of data from literary sources published in the period from 2016 to 2023 was carried out.Results. Speaking about the choice of osteosynthesis technique, it should be noted that no recommended and maximally described techniques will be able to fully cover the variety of situations that arise during osteosynthesis operations, therefore, first of all, a positive outcome depends on the experience of the surgeon and his ability to make situational decisions. Each of the methods used has both advantages and disadvantages, and which treatment tactics the surgeon would not prefer - there is always a risk of complications and, as a result, an unsatisfactory result. In such cases, patients undergo revision operations of osteosynthesis (rheosteosynthesis), minimizing or completely eliminating bone defects. The complexity of correcting the consequences of injuries of the humerus diaphysis is due to the variety of conditions leading to the development of various kinds of bone defects or false joints, as well as in a limited number of techniques that can fully repair the damage in a short time. Taking into account the rather long periods of consolidation of fragments, rehabilitation of patients with this type of pathology implies the use of devices capable of providing stable fixation and the possibility of early restoration of upper limb functions for fastening bone fragments. As a rule, revision surgical interventions include excision of scars from the interfragmental area or corticotomy, removal of deformation (if present), rimming of the medullary cavity and intramedullary osteosynthesis, to which, in rare cases, fixation with a short plate may additionally be applied. The range of revision surgical interventions may include rheosteosynthesis in combination with: segment elongation and corrective osteotomies, bone alio- and autoplasty, with bone elongation on a nail in an external fixation device.Conclusion. The development of modern technologies of osteosynthesis and osteosynthesis of the diaphyses of long tubular bones in general, and the humerus in particular, has passed a serious evolutionary path. In recent decades, methods and technologies of osteosynthesis have been actively developing and improving. With the development of knowledge in the field of the mechanism of bone fusion, implant designs and installation technologies are changing, new modifications of operative accesses are being developed. When choosing the method of fixation of bone fragments, minimally invasive osteosynthesis techniques are becoming increasingly popular. Currently, combinations of different rheosteosynthesis methods are being actively introduced, which significantly expands their capabilities, in comparison with their application separately.
Flistory and prospects of development of methods of osteosynthesis and osteosynthesis of the humerus diaphysis
Relevance. About 800 thousand people die every year as a result of injuries and their consequences, in the Russian Federation the frequency of injuries is 12 %. Fractures of the humerus diaphysis account for 1-5 % of the total number of traumatic injuries of the skeleton, at the same time, there is no tendency to reduce injuries in modern society, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Among the reasons for the unsatisfactory results of osteosynthesis, iatrogenic ones are distinguished: inconsistency from a biomechanical point of view, the choice of an unsuitable metal structure, insufficiently correct comparison of the ends of bone fragments and neglect of contraindications to the use of submerged structures with increased contamination of the wound with open fractures. Non-infectious complications of primary osteosynthesis include false joints, improperly fused fractures, untenable osteosynthesis, as well as fractures and migrations of implanted metal structures. The described complications are the basis for repeated (revision) surgery, or rheosteosynthesis. The purpose of this study is to analyze the historical aspects of the development of osteosynthesis and rheosteosynthesis methods, as well as to determine the prospects for their further development.Materials and methods. In the process of writing the article, the analysis of data from literary sources published in the period from 2016 to 2023 was carried out.Results. Speaking about the choice of osteosynthesis technique, it should be noted that no recommended and maximally described techniques will be able to fully cover the variety of situations that arise during osteosynthesis operations, therefore, first of all, a positive outcome depends on the experience of the surgeon and his ability to make situational decisions. Each of the methods used has both advantages and disadvantages, and which treatment tactics the surgeon would not prefer - there is always a risk of complications and, as a result, an unsatisfactory result. In such cases, patients undergo revision operations of osteosynthesis (rheosteosynthesis), minimizing or completely eliminating bone defects. The complexity of correcting the consequences of injuries of the humerus diaphysis is due to the variety of conditions leading to the development of various kinds of bone defects or false joints, as well as in a limited number of techniques that can fully repair the damage in a short time. Taking into account the rather long periods of consolidation of fragments, rehabilitation of patients with this type of pathology implies the use of devices capable of providing stable fixation and the possibility of early restoration of upper limb functions for fastening bone fragments. As a rule, revision surgical interventions include excision of scars from the interfragmental area or corticotomy, removal of deformation (if present), rimming of the medullary cavity and intramedullary osteosynthesis, to which, in rare cases, fixation with a short plate may additionally be applied. The range of revision surgical interventions may include rheosteosynthesis in combination with: segment elongation and corrective osteotomies, bone alio- and autoplasty, with bone elongation on a nail in an external fixation device.Conclusion. The development of modern technologies of osteosynthesis and osteosynthesis of the diaphyses of long tubular bones in general, and the humerus in particular, has passed a serious evolutionary path. In recent decades, methods and technologies of osteosynthesis have been actively developing and improving. With the development of knowledge in the field of the mechanism of bone fusion, implant designs and installation technologies are changing, new modifications of operative accesses are being developed. When choosing the method of fixation of bone fragments, minimally invasive osteosynthesis techniques are becoming increasingly popular. Currently, combinations of different rheosteosynthesis methods are being actively introduced, which significantly expands their capabilities, in comparison with their application separately.
The use of bone autoplasty for false joints of the humerus diaphysis
Relevance. Fractures of the diaphysis of the humerus account for 1–5% of the total number of traumatic skeletal injuries and 20% of the number of humerus injuries. At the same time, in modern society there is no tendency to reduce traumatism, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Over the decades, approaches to tactics and choice of drugs for correction of defects for fusion and restoration of motor function of the limb have been changing. Physicians from different countries have tried to use both auto- and allografts, with the results they achieved significantly increasing the chances of survival of the transplanted material. The multitude of studies conducted in different countries only confirms their high relevance, which makes the task of pseudarthrosis treatment one of the most important, but at the same time one of the most difficult in traumatology and orthopedics injuries.Objective. To study the application of bone autotransplantation for the treatment of false joints of the diaphysis of the humerus diaphysis.Materials and methods. A review of the literature sources published in the last 5 years on the problem of application of bone autografting methods for false joints of the humerus diaphysis was carried out.Results. Disruption of the process of humerus fusion and formation of a false joint make surgical intervention inevitable, and the results of treatment directly depend on the determination of the correct indications for a certain type of surgical intervention and competent implementation of the treatment plan. The chosen treatment tactics allow successful restoration of the anatomy and function of the damaged segment. There are many different methods of surgical treatment of false joints. The main purpose of bone-plastic materials application in traumatology and orthopedics is optimization of reparative osteogenesis.Conclusion. Over the last decades, clinical practice has changed many approaches to the tactics and choice of therapeutic means to restore bone integrity, as well as to restore the supporting and motor functions of the traumatized limb. Analysis of the data obtained from the literature has shown that the best results in the treatment of false joints of the humerus diaphysis were demonstrated by the techniques combining the use of bone autoplasty and additional metal structures.
A clinical case of diaphyseal fracture and nonunion of the humerus
A 33-year-old female patient was admitted following a car accident, presenting with a diaphyseal fracture of the humerus (wedge-shaped, intact, classified as type B2 according to the AO classification). Osteosynthesis using a plate was initially performed; however, an incorrect choice of plate thickness led to migration of the metal structure three days post-operation. The causes of this error, diagnostic approaches, and corrective surgical treatment are discussed. To prevent such complications, careful selection of the osteosynthesis method and implant type is essential, along with close attention to the donor site during bone autografting.
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