Nonunion Of Humeral Fracture Research Articles

Results of Masquelet technique in the treatment of non-union of humeral fractures

Results of Masquelet technique in the treatment of non-union of humeral fractures

Etiological analysis of postoperative nonunion of humeral fractures and study of reoperation strategy

Objective To evaluate the risk factors of postoperative nonunion of humeral fractures and clinical efficacy of reoperation. Methods A retrospective analysis of 30 cases of postoperative humeral fractures treated in our department from May 2013 to June 2015 was conducted. There were 18 cases on the left side and 12 cases on the right side. All the patients suffered postoperative nonunion of humeral fractures and achieved fracture healing after reoperation. Results All the incisions achieved primary healing after reoperation. The postoperative follow-up time ranged from 12 to 24 months with an average of 18.5 months. They all achieved bony union without any malunion. Among them, 8 cases had partial dysfunction of elbow joint and 2 cases had myositis ossificans. No infection and fixator loosening or breaking occurred. According to Cassebaum elbow function evaluation criteria, the results were excellent in 20 cases, good in 6 cases and fair in 4 cases with the excellent and good rate being 86.7%. Conclusion Iatrogenic factors are still the main factors leading to fracture nonunion. Reasonable reoperation can cure most of the fracture nonunion. Key words: Humeral fractures; Fracture fixation,internal; Nonunion; Risk factors

Locking compression plates and autologous bone graft for the humeral shaft nonunion after surgical failure

Objective To evaluate the efficacy of secondary revision with locking compression plates (LCP) and autologous bone graft for nonunion of humeral shaft fracture after surgical failure. Methods Included in this study were 26 patients with nonunion of humeral shaft fracture after various surgical treatments who had received secondary revision with LCP and autologous iliac graft in our department between March 2006 and June 2008 and had been fully followed.They were 19 men and 7 women,with an average age of 46.7 years (range,19 to 63 years).There were 17 cases of hypertrophic nonunion,7 cases of atrophic nonunion and 2 cases of pseudarthrosis.The mean interval between the primary operative treatment and the secondary revision was 9.3 months (from 9.1 to 9.6 months). All nonunions were managed with removal of previous implants,open reduction and internal fixation with LCP,supplemented by cancellous bone graft.Functional recovery was evaluated by Mayo Elbow Performance Index and the modified scale of Constant and Murley. Results The average follow-up was 25.6 months (range,25 to 33 months).The secondary revision led to postoperative bone union in 25 patients after a mean time of 5.2 months (range,4 to 9 months).Only one patient suffered nonunion caused by wound infection before he eventually obtained bone union after anti-infective therapy for 5 months.Temporary palsy of the radial ncrve occurred in 2 cases.The mean functional scores for the shoulder (Constant) and the elbow (Mayo) were 79.1 ±0.1 and 85.7 ±0.8,respectively.Conclusions In revision of the nonunion of humeral shaft fracture after surgical failure,LCP and autologous bone graft can greatly increase the rate of union and reduce complications to ensure good functional recovery of the upper extremity.We believe the key to the procedure lies in complete resection of the nonunion ends and fibrous tissue,cortex-to-cortex apposition with stalwart compression across the entire site and wide use of autologous bone. Key words: Humeral fractures; Fractures, ununited; Fracture fixation, internal; Bone plates

Management of non-union of humeral fractures with the Stryker T2™ compression nail

Fractures of the humeral shaft are relatively common injuries and the majority achieve union uneventfully; however, non-union rates of up to 13% are reported when managed either conservatively or operatively. Despite the many surgical techniques described for the management of non-unions, including plate fixation, intramedullary nailing or external fixation, some cases remain resistant to treatment with ongoing problems achieving union. We describe a technique using the Stryker T2 humeral nail which incorporates a compression system allowing closure of the non-union fracture gap. Twelve patients underwent compression nailing for established humeral fracture non-union. All achieved radiological union at an average of 4.5 months (range 3-12 months). All patients reported a return to their normal pre-injury level of activities. We conclude that this technique of intramedullary nailing with a novel compression technique is effective in the treatment of humeral shaft fracture non-union.

Treatment of nonunions of humeral fractures with interlocking intramedullary nailing

To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing. Twelve patients with humeral nonunions were treated with interlocking intramedullary nailing. The time interval between trauma and surgery was 10.5 months on average. Open reduction with anterograde approach was performed. Axial compression was specially applied to the fracture site with humeral nail holder after insertion of distal locked screws. Iliac bone grafting was added. The average follow-up period was 21 months (ranging 9-51 months). All patients achieved osseous union 5.8 months after treatment on average. Eleven patients had good functions of the shoulder joints and the upper extremities. No patient experienced any permanent neurological deficit. Refracture of the original ununited region occurred in one patient after removal of the internal fixator one year later, but union was achieved after closed re-intramedullary nailing fixation. Humeral interlocking intramedullary nailing is an effective alternative treatment for humeral nonunion.

A comparison between interlocking intramedullary nailing and plating in treatment of nonunion of humeral fractures of middle and distal shafts

骨不连是肱骨中、下段骨折术后常见的并发症之一,发生率为15%～30%[1],治疗比较棘手.比较一致的治疗意见是切开复位、内固定并植骨,但究竟采用何种方式固定骨折存在争议.回顾2002年10月～2005年10月间分别采用钢板或髓内钉固定治疗的38例肱骨中、下段骨不连患者资料,分析如下。

Recalcitrant Nonunion of the Distal Humerus

We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Treatment of humeral diaphyseal fracture nonunion with AO unreamed humeral intramedullary locking nails

目的 探讨AO非扩髓(AO-UHN)肱骨交锁髓内钉加自体松质骨植骨在肱骨干骨折不愈合中的应用.方法20例患者手术取出原内固定,行正向或逆向插入AO-UHN肱骨交锁髓内钉,在不愈合部位行丰富的自体松质骨植骨.术后进行影像学观察和疗效评定.结果20例患者有15例得到随访,随访时间为9～23个月(平均13.8个月),愈合时间4～10个月(平均6.2个月).除1例在12个月时仍未愈合予再次植骨后6个月获得愈合外,其余均在一次手术后获得愈合,优良率为90%.结论AO-UHN肱骨交锁髓内钉加自体松质骨植骨是治疗肱骨干骨折不愈合的一种有效方法。

Humeral blade plate fixation of intercalary allografts and segmentally comminuted proximal humeral fractures: a preliminary report

The AO 90° humeral blade plate is a relatively new device, whose primary indication and previously described use is for proximal humeral fracture non-union. This study describes the use of the humeral blade plate for extended indications-fixation of segmentally comminuted proximal humeral fractures in two patients and fixation of humeral intercalary allografts after primary humeral neoplasm resection in three patients. A mean follow-up of 20 months revealed union in both fractures and five of the six allograft-host junctions. One patient required subsequent bone grafting for non-union at a proximal allograft-host junction. Functional results were excellent in three patients, good in one, and fair in one. Problems encountered intraoperatively were directly related to the limited array of implants. The long plates which were needed had blades which were too long and required intra-operative trimming in three cases. In four cases, additional plates were used to supplement the blade plate for distal fixation. In conclusion, the humeral blade plate is a useful device for fixation in these extended indications, but longer plates with 30.0 and 40.0-mm blade lengths should be made available.

Semiconstrained elbow replacement for distal humeral nonunion

The Journal of Bone and Joint Surgery. British volumeVol. 77-B, No. 4 ArticlesFree AccessSemiconstrained elbow replacement for distal humeral nonunionMD McKee, JB JupiterMD McKeeSearch for more papers by this author, JB JupiterSearch for more papers by this authorPublished Online:1 Jul 1995https://doi.org/10.1302/0301-620X.77B4.7615623AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByPedicled Vascularized Bone Graft of the Distal Radius for Recalcitrant Nonunion of the Distal HumerusJournal of Orthopaedic Trauma, Vol. 32, No. 10Distal humerus articular malunion after an open reduction–internal fixation of a capitellum-trochlea shear fracture: a case reportJournal of Shoulder and Elbow Surgery, Vol. 25, No. 3The Management of Delayed and Non-unions of the Distal HumerusTreatment of nonunions of humeral fractures with interlocking intramedullary nailingChinese Journal of Traumatology (English Edition), Vol. 11, No. 6The Management of Nonunion and Malunion of the Distal Humerus-A 30-Year ExperienceJournal of Orthopaedic Trauma, Vol. 22, No. 10Recalcitrant Nonunion of the Distal HumerusClinical Orthopaedics and Related Research, Vol. &NA;, No. 435 Vol. 77-B, No. 4 Metrics Downloaded 84 times History Published online 1 July 1995 Published in print 1 July 1995 InformationCopyright © 1995, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download