Plate Augmentation Research Articles

Locking plate augmentation of polymethylmethacrylate-filled distal femoral defects: A biomechanical study.

Benign, locally aggressive tumors of the distal femur are typically treated with intralesional curettage and polymethylmethacrylate (PMMA) cementation. However, it is not known whether plate fixation should be added to biomechanically augment these PMMA-filled defects. The purpose of this study was to evaluate the performance of two competing techniques for reconstruction of a distal femoral defect. For this biomechanical study, we used 12 composite femurs with properties comparable to bone. In nine femurs, identical contained medial distal femoral defects were created using a robotic arm. Group A contained three intact femurs, Group B three femurs with an unfilled defect, Group C three femurs reconstructed with PMMA alone, and Group D three femurs reconstructed with PMMA plus a medial locking plate. Locations of greatest stress concentration were determined by PhotoStress analysis, then three strain gauges were applied to each specimen at these high-stress locations. Specimens were loaded within a physiologic range followed by loading to failure. Outcome measures included construct stiffness, strain along the distal femur, and load at failure. Results showed that stiffness and strain were not significantly different between reconstructive techniques; however, both techniques reduced tensile strain along the popliteal surface by approximately 40% compared to non-reconstructed specimens. All specimens failed at the femoral neck before failing at the distal femur. These findings suggest that plate augmentation of PMMA-filled distal femoral defects like the one in this study offers insignificant biomechanical benefit within physiologic loads and therefore may be unnecessary.

Management of infected bone defects of the femoral shaft by Masquelet technique: sequential internal fixation and nail with plate augmentation

BackgroundTo evaluate the effectiveness of a sequential internal fixation strategy and intramedullary nailing with plate augmentation (IMN/PA) for bone reconstruction in the management of infected femoral shaft defects using the Masquelet technique.MethodsWe performed a retrospective descriptive cohort study of 21 patients (mean age, 36.4 years) with infected bone defects of the femoral shaft treated by the Masquelet technique with a minimum follow-up of 18 months after second stage. After aggressive debridement, temporary stabilisation (T1) was achieved by an antibiotic-loaded bone cement spacer and internal fixation with a bone cement–coated locking plate. At second stage (T2), the spacer and the locking plate were removed following re-debridement, and IMN/PA was used as definitive fixation together with bone grafting. We evaluated the following clinical outcomes: infection recurrence, bone union time, complications, and the affected limb’s knee joint function.ResultsThe median and quartiles of bone defect length was 7 (4.75–9.5) cm. Four patients required iterative debridement for infection recurrence after T1. The median of interval between T1 and T2 was 10 (9–19) weeks. At a median follow-up of 22 (20–27.5) months, none of the patients experienced recurrence of infection. Bone union was achieved at 7 (6–8.5) months in all patients, with one patient experiencing delayed union at the distal end of bone defect due to screws loosening. At the last follow-up, the median of flexion ROM of the knee joint was 120 (105–120.0)°.ConclusionsFor infected femoral shaft bone defects treated by the Masquelet technique, sequential internal fixation and IMN/PA for the reconstruction can provide excellent mechanical stability, which is beneficial for early functional exercise and bone union, and does not increase the rate of infection recurrence.

Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis

PurposeTo methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity. MethodsPubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3. ResultsThis meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 − 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): −1.08, 95 % CI: -1.79 − -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95 % CI: -0.93 − -0.19, p = 0.003), less bleeding (SMD: -1.5, 95 % CI: -2.81 − -0.18), p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95 % CI: -0.27 − -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95 % CI: -3.28 − -0.61, p < 0.001; isthmal SMD: -1.08, 95 % CI: -1.64 − -0.52, p = 0.002). ConclusionIn the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.

Plate augmentation and hybrid bone grafting are effective treatments for atrophic nonunion of the femur with the original intramedullary nail retained in situ

The purpose of this study is to evaluate the efficacy of plate augmentation and hybrid bone grafting for treating atrophic nonunion of the femur with original intramedullary nail retained in situ.In this study, 36 patients with atrophic nonunion of the femur who underwent surgery using the technique of plate augmentation and a hybrid bone grafting while retaining the original intramedullary nail in situ in Xi’an Honghui Hospital from January 2019 to December 2021 were enrolled. 28 patients who met the inclusion and exclusion criteria were ultimately included in the study. These 28 patients, consisting of 20 males and 8 females with a mean age of 38 years, were evaluated based on factors such as operation time, intraoperative blood loss, the average hospitalization days. Additionally, the results and function of these patients were evaluated by union time, Wu’s scores of limb function and incidence of serious complications.All 28 patients achieved bone union at the 12 month follow-up, with an average follow-up time of 14.6 ± 4.2 months.The average operation time was 68.3 ± 11.2 min, and the average intraoperative blood loss was 140 ± 22.6 ml. Patients were hospitalized for an average of 5.8 ± 1.1 days. Full clinical and radiological bone union was achieved on average at 5.1 ± 1.9 months. The mean value of Wu's scores at the 12 month follow-up was significantly higher than before the operation. Limb function was excellent in 27 patients and good in one patient at the 12 month follow-up. However, five patients experienced the lower limb vein thrombosis, including one deep vein thrombosis and four lower limb intermuscular vein thromboses. One patient had a superficial infections of the surgical incision site, while three patients reported pain and numbness where their iliac bone graft was extracted at the 12 month follow-up. The technique of plate augmentation and hybrid bone grafting, combined with retaining the original intramedullary nail in situ has been shown to be a safe, effective, simply and standardizable practice for treating atrophic femoral nonunion with an intact original IMN fixation.

Triceps Tendon Reattachment Using Mini Plates and Screws After Failure of Olecranon Avulsion Fracture Fixation in Osteoporotic Bone: A Case Report.

This is a case report of an 85-year-old woman with osteopenia who underwent olecranon avulsion fracture repair with supplemental triceps tendon repair following a fall on an outstretched arm. The initial procedure failed due to osteoporotic bone quality and an atraumatic disruption of the olecranon fracture fixation. The patient subsequently underwent further surgical intervention with an olecranon avulsion fracture excision and a novel triceps tendon repair technique using plate augmentation and fiber tape. Surgeons may consider this novel approach as an initial treatment for elderly patients with osteopenia or osteoporosis undergoing olecranon avulsion fracture fixation, to prevent the failure and consequent revision surgery.

Effect of Denosumab Injection in Early Union and Consolidation o f Callus in Aseptic Tibial Shaft Non-union

Fractures of the tibial shaft is one of the most common fractures than any other long bone fractures in the human body. Surgical treatment offers better functional outcome than a conservative management. Reamed intramedullary interlocking (IMIL) nailing is the treatment of choice for most of the closed tibial shaft fractures. Despite after a good surgical fixation non-union still persists after reamed IMIL nailing. Plate augmentation and bone grafting with nail in situ was found to have superior results and union rates than any other methods, but the average union time was almost 3 to 5 months. To enhance faster union and recovery here we have used Injection Denosumab 60 mg Sc post operatively during follow up. So, the aim of the study is to find the efficacy of injection Denosumab in enhancing early union and consolidation of callus. It is a comparative prospective study involving 43 patients treated for aseptic non-union of tibial shaft fractures following reamed intramedullary interlocking nailing between 2020 and 2023. All the patients treated by reamed intramedullary interlocking nailing who met the inclusion and exclusion criteria were included in the study. Group A was managed with plate augmentation and bone grafting following non-union IMIL nailing and Group B was managed with Plate augmentation bone grafting with Injection Denosumab Sc post operatively. Both the groups were followed up post operatively for period of one year. Total of 43 patients were included in the study. The average duration of union in GROUP A -14.82 weeks and in GROUP B- 9.45 weeks. Excellent results were obtained in both the groups. There was no complication such as malunion, non-union, implant loosening, nerve palsy, infection and plate/IMIL nail breakage. Augmentation plating, decortication and autogenous iliac crest bone grating is a better treatment option compared to exchange nailing in case of tibial shaft aseptic non-union following IMIL nailing. Using injection denosumab 60mg Sc postoperatively after plate augmentation and bone grafting offers early union and early consolidation of callus. Keywords Tibial Shaft Fractures, Intramedullary Interlocking Nailing, Plate Augmentation, Bone Grafting

Nonunions after intertrochanteric and subtrochanteric femoral fractures

The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite arelatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results. Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed. Atotal of 66patients were analyzed. The mean age was 58years (range 25-88years). The overall healing rate was 88% with amean consolidation time of 8months (range 2-29months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of adynamic hip screw (n = 1). The analysis of our treatment data as well as the current literature, revealed atrend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain apredictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in atargeted manner by acombination of mechanical and biological methods with areamed nail change to alarger caliber implant.

Anterior cervical discectomy and fusion with and without plate augmentation for degenerative diseases: A prospective comparative study

Anterior cervical discectomy and fusion with and without plate augmentation for degenerative diseases: A prospective comparative study

Mechanical evaluation of revision surgery for femoral shaft nonunion initially treated with intramedullary nailing: Exchange nailing versus augmentation plating

IntroductionExchange nailing (EN) or augmentation plating (AP) has been employed to treat nonunions after intramedullary nailing for femoral shaft fractures. Although instability is a factor in hypertrophic nonunion, mechanical evaluations have been limited because the contribution of the callus to fracture site stability varies with healing. Our previous study illustrated the potential for evaluation using a finite element analysis (FEA) that incorporates callus material properties. This study aimed to mechanically evaluate revision surgery for nonunions using FEA. Materials and methodsA quantitative computed tomography-based FEA was performed on virtual revision models of a patient with suspected nonunion after intramedullary nailing. In addition to the initial nailing model (IN) with an 11-mm diameter (D) and 360-mm length (L), four EN models with D12mm (EN1), D13mm (EN2), D12mm-L400mm (EN3), and D13mm-L400mm (EN4) nails and three AP models with 5- (AP1), 6- (AP2), and 7-hole (AP3) plates were created. As with bone, callus was assigned inhomogeneous material properties derived from density based on an empirical formula. The hip joint reaction force and muscle forces at maximum load during the gait cycle were applied. The volume ratio of the callus at the fracture site with a tensile failure risk of ≥1 (tensile failure ratio) and bone fragment movement were evaluated. ResultsThe tensile failure ratio was 11.6 % (IN), 10.1 % (EN1), 6.3 % (EN2), 10.9 % (EN3), 6.2 % (EN4), 6.4 % (AP1), 7.2 % (AP2), and 7.7 % (AP3), respectively. The bone fragment movement showed an opening on the lateral side with the initial intramedullary nailing. However, both revision surgeries reduced the opening, leading to compression except in the EN1 model. The proximal bone fragments were internally rotated relative to the distal fragments, and the rotational instability was more suppressed in models with lower tensile failure ratio. ConclusionsFor EN, the increase in diameter, not length, is important to suppress instability. AP reduces instability, comparable to a 2 mm increase in nail diameter, and screw fixation closer to the fracture site reduces instability. This study suggest that AP is mechanically equivalent to EN and could be an option for revision surgery for femoral shaft nonunions.

Augmentation plate without bone graft in the management of distal tibial diaphyseal non-union

PurposeThe objective of this study was to assess the efficacy of augmentation plating with retaining of previous implant in situ in cases of non-united oligotrophic or atrophic aseptic distal tibial diaphyseal and metaphyseal fractures without bone grafting depending on the unified bone healing and non-union theory. MethodsThrough the period between December 2019 and December 2022, twelve patients with distal third tibial non-unions who were fixed at time of fracture either by intramedullary interlocking nails (seven cases) or by minimally invasive plate osteosynthesis (five cases) were included. Non-union was diagnosed on basis of absence of any healing progression in three months period or absence of fracture healing after six months from index surgery. All patients had oligotrophic or atrophic non-union. Augmentation plating through an anterolateral approach was done on average of 7.25 months after initial surgery (6–9 months). Circumferential exposure of the fracture site and debridement of fibrous tissue were not necessary. No bone grafting was done as no cases had major bone defect. ResultsAll patients achieved complete radiological union with a mean time of 21.8 weeks (range 18–30 weeks) that mean full callus formation in all cortices. All patients were walking independently after three months (13weeks) from surgery and returned to work even in cases of absent complete radiological union. No cases had been complicated with wound healing problems (infection or dehiscence). One patient had incomplete ankle dorsiflexion (10°) due to tight calf muscles and one patient had paresthesia on the dorsum of the foot that was not improved at last follow up (one year after surgery). ConclusionAugmentation plating is a safe and effective option for management of distal tibial diaphyseal nonunion even in cases of oligotrophic or atrophic non-union.

To Study the Functional and Radiological Results of Intramedullary Nail with Augmentation Plating in Distal Femur Fractures

This prospective study was conducted on all the patients with extra articular distal femur fractures coming to casualty of Sawai Man Singh Medical College and Hospital Jaipu

Medial augmentation plating of aseptic distal femoral nonunions

BackgroundDistal femur nonunions are well-recognized contributors to persistent functional disability, with limited data regarding their treatment options. In the current study, we asked whether additional medial augmentation plating is a feasible treatment option for patients with aseptic distal femoral nonunion and intact lateral implants.MethodsWe conducted a single-center, retrospective study including 20 patients treated for aseptic distal femoral nonunion between 2002 and 2017. The treatment procedure included a medial approach to the distal femur, debridement of the nonunion site, bone grafting and medial augmentation plating utilizing a large-fragment titanium plate. Outcome measures were bone-related and functional results, measured by the Hospital for Special Surgery Knee Rating Scale (HSS) and the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D).ResultsEighteen of 20 nonunions showed osseous healing at 8.16 ± 5.23 (range: 3–21) months after augmentation plating. Regarding functional results, the mean HSS score was 74.17 ± 11.12 (range: 57–87). The mean SMFA-D functional index was 47.38 ± 16.78 (range 25.74–71.32) at the last follow-up. Index procedure-associated complications included two cases of persistent nonunion and one case of infection.ConclusionsAccording to the assessed outcome measures, augmentation plating is a feasible treatment option, with a high proportion of patients achieving bony union and good functional outcomes and a few patients experiencing complications.

Hindfoot fusion with various auxiliary techniques in Charcot’s management

Abstract Introduction: Management of Charcot’s arthropathy of the hindfoot (Sanders/Frykberg Type IV) is a challenging situation to address. Complex deformities linked with ankle/hindfoot Charcot’s disease are frequently multiplanar. Due to the collapse of the distal tibia and the two bones of the hindfoot, the talus, and calcaneus, the limb frequently shortens when the skeletal architecture is damaged. A varus ankle or heel results in increased lateral column plantar pressure of the foot due to changed foot pressure loading, predisposing the patient to develop lateral foot ulceration. Collapse and secondary avascular necrosis of the talus; additional stress on the injured bone exacerbates these deformities and contributes to ulcers in the foot, instability during walking, and limb-length discrepancy. Management: The primary indication for surgical ankle stabilization is a foot that cannot be braced and is unstable during walking. Other surgical indications include imminent ulceration, nonhealing ulcers, recurring ulcers, osteomyelitis, and/or severe pain. Achieving ankle and/or hindfoot arthrodesis and correcting these complex multiplanar deformities in this location stabilizes the hindfoot. Various auxiliary techniques that can be combined with Tibio-talo-calcaneal (TTC) are tricortical iliac crest graft and femoral head allograft to build hindfoot, plate augmentation, distally mobilized fibula as biological augmentation and multiple 6.5-mm screws. The choice between internal or exterior fixation is mostly determined by the presence or absence of an active infection and the quality of the bone. Conclusion: Surgical stabilization with TTC nail for Charcot’s arthropathy of the ankle and hindfoot is associated with good clinical outcomes. Despite the high likelihood of complications, limb salvage rates are between 80% and 90%. A meticulous selection of cases, a diligent multimodal strategy, and an experienced team are required to attain this result. Assessment of vascular status, glycemic control, optimum foot care, use of protective footwear during the acute inflammatory phase to prevent inadvertent trivial foot injuries, correction of calcium and vitamin D deficiencies, and cessation of tobacco and alcohol use are preoperative factors that can improve outcomes. Various auxiliary techniques can be combined with TTC nailing for optimum results.

Augmentative Plating versus Exchange Intramedullary Nailing for the Treatment of Aseptic Non-Unions of the Femoral Shaft-A Biomechanical Study in a SawboneTM Model.

Non-unions after intramedullary nailing of femoral shaft fractures are a significant problem. Treatment options such as augmenting with plates or exchange nailing have been proposed. The ideal treatment remains controversial. Augmentative plating using a 4.5 mm LCP or a 3.2 mm LCP leaving the nail in situ was tested biomechanically and compared to exchange intramedullary nailing in a SawboneTM model of a femoral shaft non-union. The difference of fracture gap motion in axial testing was small. In rotational testing, the exchange nail allowed for the largest amount of motion. The 4.5 mm augmentative plate was the most stable construct in all loading conditions. Augmentative plating using a 4.5 mm LCP plate while leaving the nail in situ is biomechanically superior to exchange intramedullary nailing. A small fragment 3.2 mm LCP is undersized and does not reduce fracture motion sufficiently in a femoral shaft non-union.

A comparison of exchange nailing and plate augmentation over a retained intramedullary nail in aseptic oligotrophic and atrophic femoral shaft pseudoarthrosis.

This study aims to evaluate the success of plate augmentation over a retained intramedullary nail (IMN) against exchange nailing performed with autologous bone grafting in oligotrophic and atrophic pseudoarthrosis of the femoral shaft. Between May 2005 and October 2020, a total of 42 of 56 patients (28 males, 14 females; mean age: 47.3±17.2 years; range, 19 to 84 years) with aseptic atrophic or oligotrophic femoral nonunion were retrospectively analyzed. The patients, 20 were operated with plate over a retained IMN, and the rest (n=22) by exchange nailing. Data including demographic and clinical characteristics of the patients, treatment success, duration of surgery, blood loss during surgery, infection rates, length of hospital stay, time to bridging of the nonunion site, and time to obliteration of the fracture line (solid union) were recorded. The mean follow-up was 23.8±20.4 (range, 12 to 96) months in the plate over an IMN group and 34.7±27.4 (range, 12 to 90) months in the exchange nailing group. At the final follow-up, solid union occurred in all of the patients in the plate augmentation over a retained IMN group, and 21 of 22 (95.45%) patients in the exchange nailing group. Blood loss during surgery was significantly less in the plate augmentation over IMN group (p=0.027). There was no statistically significant difference in the other variables between the two groups (p>0.05). Our study results demonstrate that plate over a retained IMN is effective as exchange nailing in the surgical treatment of oligotrophic and atrophic pseudoarthrosis of the femoral shaft. However, it can be speculated that plate application over IMN is more advantageous in terms of blood loss during surgery.

The role of an augmentative plating in the management of femoral subtrochanteric nonunion.

Owing to its distinct biomechanical properties, nonunion is common (7-20%) after intramedullary (IM) nailing of subtrochanteric femoral fractures. Unlike diaphyseal nonunion, it is difficult to provide sufficient stability by exchanging nailing alone in subtrochanteric nonunion. This study investigated the clinical outcomes of femoral subtrochanteric nonunion initially treated with an IM nail and subsequently managed with minimally invasive augmentative plate fixation. Nineteen patients were enrolled retrospectively. The mechanisms of initial injury were traffic accidents in 8, falls from a height in seven, and slipping in two patients. Two patients with atypical subtrochanteric femoral fractures without a specific trauma history were further included. All patients underwent IM nailing as the index operation. Nonunion surgery was performed an average of 45.2weeks after the initial surgery. In cases of hardware damage and/or atrophic nonunion, exchange nailing and bone grafting were performed in addition to augmentative plating, as necessary. Conversely, augmentative plating alone was performed in cases of hypertrophic nonunion without any failure of the preexisting IM nail or malalignment. A narrow locking compression plate was fixed after contouring according to the shape of the proximal femur. The mean follow-up period was 36.1months. Bony union was achieved in 18/19 patients (94.7%), at an average of 19.8weeks after nonunion surgery. In the case that did not heal even after exchange nailing, additional plating and bone grafting, further autogenous bone grafting was required after 11months, which healed uneventfully. There were 2 cases of soft tissue irritation over the plate, but no major complications were observed. Additional plate augmentation over a retained IM nail yields satisfactory outcomes in terms of the bony union in subtrochanteric nonunion. Given its expected biomechanical superiority and relatively easy surgical technique, it may be a reasonable option for the management of femoral subtrochanteric nonunion.

Augmentation plates and bone grafting for treatment of nonunited long bones fractures fixed by intramedullary nails

Abstract Background A delayed union was defined as when the fracture fails to unite within the expected time. Delayed union becomes nonunion when the fracture healing stops (at least 6 months). Intramedullary nailing has proven to be a good treatment option in the management of long bones fracture. The aim of this study is to obtain union in nonunited long bones fractures fixed previously by intramedullary nails by using of augmentation plating and bone grafting to obtain the best outcome. Patients and methods The study included 18 patients of nonunited long bones fractures fixed previously by intramedullary nails treated with augmentation plating and bone grafting with maintaining the nail in situ. Full history, clinical and radiological examination were performed. All subjects gave their informed consent prior to their inclusion in the study. Eight cases with femoral fracture nonunion were performed through the lateral approach of the femur. Seven cases of tibial fracture nonunion were performed through the anterior approach of the tibia, Three cases of humeral nonunion was performed using the posterior approach of the humerus. In the postoperatively follow-up, function was assessed using Dash score and Lower extremity functional score. Results There was an excellent improvement for bone union occurred to 94.4% of studied patients. Furthermore lower extremities function percent ranged between 92.5-100 with mean±SD 98.1 ± 2.56, and humerus Dash score ranged between 4.16-6.66 with mean±SD 5.41 ± 1.77. There was statistically insignificant difference between the period of nonunion bone per months and fracture bone criteria of studied patients P&gt;0.05. Also, there is statistically insignificant difference between lower extremities function score percent after implant procedure and fracture bone criteria of studied patients P &gt; 0.05. Conclusion Augmentation plating is an excellent solution for the management of nonunited nailed long bones fractures with maintaining the nail in situ, especially with instability at nonunion site and comminution or gap nonunion.

Plate over nail and bone graft for management of tibial non union after intramedullary fixation

Abstract Non union after intramedullary nail fixation is difficult to treat. Many options are available for its management including nail exchange, bone graft while keeping the nail, nail removal and plating. Each method has its advantages and disadvantages. The aim of this study is to evaluate the results of management of tibial non union after intramedullary fixation using plate augmentation. Between January 2012 and December 2019, thirty four patients with nonunited fracture tibia previously treated with locked intramedullary nails were included in this study. The ages of patients ranged from 20 to 62 years ( an average age: 43 years). All patients were diagnosed to have aseptic nonunion. All patients achived bony union except 2. Bone union was achieved in a time ranged from 3 to 9 months (an average time 5 months). The average limb length discrepancy was 1 cm ( range 0 to 1.5 cm ). The reported complications were superficial wound infection in 2 cases, joint stiffness in 3 patients and nonunion in 2 cases. There were no intraoperative complications. All patients reported no pain at the fracture site during weight bearing at the final follow-up. We concluded that augmentation plate fixation is a good option for treatment of tibial nonunion after intramedullary nail.

Oblique lumbar interbody fusion combined with stress end plate augmentation and anterolateral screw fixation for degenerative lumbar spinal stenosis with osteoporosis: a matched-pair case-controlled study

BACKGROUND CONTEXTOblique lumbar interbody fusion (OLIF) has been proven to be effective in treating degenerative lumbar spinal stenosis (DLSS). Whether OLIF is suitable for treating patients with DLSS with osteoporosis (OP) is still controversial. Bone cement augmentation is widely used to enhance the internal fixation strength of osteoporotic spines. However, the effectiveness of OLIF combined with bone cement stress end plate augmentation (SEA) and anterolateral screw fixation (AF) for DLSS with OP have not confirmed yet. PURPOSETo evaluate the clinical, radiological, and functional outcomes of OLIF-AF versus OLIF-AF-SEA in the treatment of DLSS with OP. STUDY DESIGNRetrospective case-control study. PATIENT SAMPLEA total of 60 patients with OP managed for DLSS at L4–L5. OUTCOME MEASURESVisual analog scale (VAS) score of the lower back and leg, Oswestry Disability Index (ODI), disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence and fusion rate. METHODSThe study was performed as a retrospective matched-pair case‒controlled study. Patients with OP managed for DLSS at L4–L5 between October 2017 and June 2020 and completed at least 2 years of follow-up were included, which were 30 patients treated by OLIF-AF and 30 patients undergoing OLIF-AF-SEA. The demographics and radiographic data, fusion status and functional outcomes were therefore compared to evaluate the efficacy of the two approaches. RESULTSPain and disability improved similarly in both groups at the 24-month follow-up. However, the SEA group had lower pain and functional disability at 3 months postoperatively (p<.05). The mean postoperative disc height decrease (△DH) was significantly lower in the SEA group than in the control group (1.17±0.81 mm vs 2.89±2.03 mm; p<.001). There was no significant difference in lumbar lordosis (LL) or segmental lordosis (SL) between the groups preoperatively and 1 day postoperatively. However, a statistically significant difference was observed in SL and LL between the groups at 24 months postoperatively (p<.05). CS was observed in 4 cases (13.33%) in the SEA group and 17 cases (56.67%) in the control group (p<.001). A nonsignificant difference was observed in the fusion rate between the SEA and control groups (p=.347) at 24 months postoperatively. CONCLUSIONSThis study revealed that OLIF-AF-SEA was safe and effective in the treatment of DLSS with OP. Compared with OLIF-AF, OLIF-AF-SEA results in a minor postoperative disc height decrease, a lower rate of CS, better sagittal balance, and no adverse effect on interbody fusion.

Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review.

Background: Femoral shaft fractures (FSFs) are a frequent injury in traumatology for which intramedullary nailing (IMN) is considered the gold standard treatment. Nonunion (NU) is one of the most frequent complications in FSF treated with IMN, with a percentage from 1.1% to 14%. Plate augmentation (PA), the addition of a compression plate and screws, with or without bone graft has been described as an effective option for the treatment of NU, improving the biomechanical conditions at the fracture site. The aim of this review was to analyze the literature relating to the use of PA in NU after IMN in FSFs to assess the efficacy of the technique. Methods: An electronic search on PubMed, Google Scholar, and Web of Science was conducted to search for all studies concerning PA of femoral shaft NUs after IMN. Results: Twenty-four studies were included in the review comprising a total of 502 patients with a mean age of 39.5 years. Of these, 200 hundred patients had atrophic pseudoarthrosis and 123 had hypertrophic pseudoarthrosis, while in 179, the type of pseudoarthrosis was not reported. The most frequently used plate for PA was the dynamic compression plate (DCP); in 87.1% of the cases, the authors added a bone graft to the plate fixation. In 98.0% of the patients, a complete bone union was achieved in a mean time of 5.8 ± 2.12 months. Conclusion: The patients treated with PA included in this review showed a good rate of consolidation in the femoral shaft NUs, with good functional recovery and a low incidence of complications.