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Yang Z, Ouyang B, Yang J, Liu D, Kang X. Anterior medial minimally invasive plate osteosynthesis for humeral shaft fractures shows superior early shoulder and elbow function compared to locking compression plate: A retrospective study. Injury 2024; 55:111692. [PMID: 38945080 DOI: 10.1016/j.injury.2024.111692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Humeral shaft fractures are a common injury of the upper limb, with the primary surgical treatment modality being the locking compression plate (LCP) technique. The advent of Anterior medial minimally invasive plate osteosynthesis (MIPO) technology has led to its gradual implementation in clinical practice. However, the efficacy and long-term outcomes of MIPO require further investigation. The objective of this study is to compare the therapeutic effects of LCP and MIPO in the management of humeral shaft fractures. METHODS The present study conducted a retrospective review of patients diagnosed with humeral shaft fractures between June 2016 and December 2019. The patients were divided into MIPO and LCP groups based on the different surgical methods. The study analyzed the length of hospital stay, radiation exposure, operative time, and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores using statistical methods. RESULTS A total of 53 patients who met the inclusion criteria were included in the study. The MIPO group demonstrated a statistically significant reduction in length of hospital stay compared to the LCP group (length of hospital stay: 5.39 ± 2.23 days vs 12.00 ± 7.19 days, P < 0.001). All patients achieved callus formation after surgery. However, the MIPO group had significantly more radiation exposures than the LCP group (45.96 ± 19.49 vs 5.33 ± 2.20, P < 0.001). Additionally, there was no statistically significant difference observed in the time from admission to surgery, operative time,and healing time between the two groups (the time from admission to surgery: P = 0.593; operative time: P = 0.407; Healing time: P = 0.664). During the postoperative follow-up, the MIPO group exhibited significantly lower 6-week and 3-month DASH scores compared to the LCP group (6-week: 34.17 ± 12.16 vs 45.65 ± 22.94, P = 0.028; 3-month: 17.43 ± 11.70 vs 30.12 ± 9.80, P < 0.001). However, there was no statistically significant difference in the 6-month and 12-month DASH scores between the two groups (6-month: P = 0.787; 12-month: P = 0.058). CONCLUSION The MIPO technique provides better short-term functional recovery of the shoulder and elbow compared to the LCP technique in the treatment of humeral shaft fractures, while ensuring equivalent surgical healing.
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Affiliation(s)
- Zhenxing Yang
- Department of Emergency Medicine, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou 510999, China; Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Botian Ouyang
- Department of Emergency Medicine, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou 510999, China
| | - Jing Yang
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
| | - Dapeng Liu
- Department of Orthopedics, People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi, Xinjiang 830001, China.
| | - Xin Kang
- Department of Emergency Medicine, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou 510999, China.
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Devendra A, Patra SK, Velmurugesan P, Zackariya M, Ramesh P, Arun Kamal C, Dheenadhayalan J, Rajasekaran S. Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients. Injury 2024; 55:111412. [PMID: 38341997 DOI: 10.1016/j.injury.2024.111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups. MATERIALS AND METHODS We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT. RESULTS Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01). CONCLUSION Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India.
| | - Sudipta Kumar Patra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Velmurugesan
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Mohd Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Ramesh
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Chandramohan Arun Kamal
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
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Maseda M, Egol KA. Lag Screw Exchange for Impinging Lateral Hardware Following Intramedullary Nailing of Intertrochanteric Hip Fractures - A Case Series Demonstrating Efficacy. THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:167-171. [PMID: 38919366 PMCID: PMC11195895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background This study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an intertrochanteric hip fracture. Methods Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively. Results Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange. Conclusion Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.
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Affiliation(s)
- Megan Maseda
- Orthopaedics and Sports Medicine, USF Health, South Florida, Florida, USA
| | - Kenneth A. Egol
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Bianco Prevot L, Nannini A, Mangiavini L, Bobba A, Buzzi S, Sinigaglia F, Peretti G. What Is the Best Treatment of the Femoral Shaft Nonunion after Intramedullary Nailing? A Systematic Review. Life (Basel) 2023; 13:1508. [PMID: 37511883 PMCID: PMC10381168 DOI: 10.3390/life13071508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Nonunion (NU) is one of the most feared complications of femoral shaft fracture treatment. Femoral shaft fracture treatment is often linked with poor bone stock and reduced bone metabolism. In this paper, the goal is to carefully analyze the best treatment options for patients who developed nonunion after the intramedullary nailing of a femoral shaft fracture. A systematic review of the literature available in the PubMed, EMBASE and Cochran library databases was carried out, and 16 studies were included. Exclusion criteria included case reports and case series that do not have data about clinical outcomes or functional outcomes and included fewer than 10 patients. The reviewed data provide evidence for very good results about the treatment of this pathology with exchanging intramedullary nails or the implantation of a plate and screws (general healing rate of 96.3%). Moreover, the data support the utilization of autologous bone graft in order to stimulate the healing process. In conclusion, the choice between these two types of treatment must be guided by the type of pseudarthrosis that the patient presents. Additionally, bone grafting or growth factors promote bone regenerative processes, especially in patients with oligo-atrophic pseudoarthrosis.
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Affiliation(s)
- Luca Bianco Prevot
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Alessandra Nannini
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Laura Mangiavini
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Andrea Bobba
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Sara Buzzi
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Federico Sinigaglia
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Giuseppe Peretti
- IRCCS Galeazzi-S. Ambrogio Institute, EUORR University Equip of Regenerative and Reconstructive Orthopedics, Via Cristina Belgioioso 173, 20157 Milan, Italy
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Management of Traumatic Femur Fractures: A Focus on the Time to Intramedullary Nailing and Clinical Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13061147. [PMID: 36980455 PMCID: PMC10047428 DOI: 10.3390/diagnostics13061147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center. Methods: This was a retrospective observational study of all the admitted trauma patients who sustained femoral fractures between January 2016 and September 2020. Data were analyzed and compared based on time to Intramedullary Nailing (IMN) (<12 h, 12–24 h and >24 h) and outcomes of FSF (union, delayed union and nonunion). Results: A total of 668 eligible patients were included in the study, of which the majority were males (90.9%) with a mean age of 34.5 ± 15.8, and 54% of the injuries were due to MVCs. The chest (35.8%) was the most commonly associated injured body region, followed by the pelvis (25.9%) and spine (25.4%). Most of femur fractures (93.3%) were unilateral, and 84.4% were closed fractures. The complete union of fractures was observed in 76.8% of cases, whereas only 4.2% and 3.3% cases had delayed union and nonunion, respectively, on the clinical follow-up. Patients in the delayed IMN (>24 h) were severely injured, had bilateral femur fracture (p = 0.001) and had higher rate of external fixation, blood transfusion, pulmonary complications and prolonged hospitalization. Non-union proportion was greater in those who had IMN <24 h, whereas a delayed union was greater in IMN done after 24 h (p = 0.5). Those with a nonunion femur fracture were more likely to have bilateral fracture (p = 0.003), frequently had retrograde nailing (p = 0.01), and high-grade femur fracture (AO type C; p = 0.04). Conclusion: This study showed that femur fracture is not uncommon (8.9%), which is manifested with the variety of clinical characteristics, depending on the mechanism, management and outcome in our center. Bilateral fracture, retrograde nailing and AO classification type C were the significant risk factors of non-union in patients with diaphyseal fractures. The timing of IMN has an impact on the fracture union; however, it is not a statistically significant difference. Therefore, the treating physicians should consider the potential risk factors for a better outcome by careful selection of treatment in sub-groups of patients.
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Oesman I, Kurniawan D, Canintika AF. Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series. Int J Surg Case Rep 2023; 103:107908. [PMID: 36753821 PMCID: PMC9937947 DOI: 10.1016/j.ijscr.2023.107908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The management of implant failure in femoral shaft fractures remains a challenging problem for orthopaedic surgeons. This series aim to evaluate the effectiveness of intramedullary (IM) nailing for treating femoral shaft nonunions after implant failure. CASE PRESENTATION Three patients presented with pain after walking on crutch and limping with history of fixation using plate for femoral shaft fracture. Implant removal was then performed with subsequent refixation using intramedullary nailing with A2FN. The Lower Extremity Functional Score and Visual Analogue Score evaluation showed excellent result in these patients. CLINICAL DISCUSSION IM nailing is the mainstay of treatment for patients with femoral shaft fractures. This intervention provides support to fractures and aid in union of fractures. Several advantages have been reported in IM nailing, including shorter length of stay, rapid union, and early functional capacity of the limb. Insertion of IM nailing may preserve anatomical structure in the patients, which leads to better improvement of functional capacity. Nailing also limits soft tissue damage. Thus, in patients presented with previous plate failure similar to our patients, IM nailing with reaming is recommended. CONCLUSION Nonunion after femoral shaft plating are common. Nailing conversion is one of available treatment options to achieve maximum recover in this type of case.
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Affiliation(s)
- Ihsan Oesman
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dody Kurniawan
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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The role of an augmentative plating in the management of femoral subtrochanteric nonunion. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04767-4. [PMID: 36624207 DOI: 10.1007/s00402-023-04767-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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 45.2 weeks 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 36.1 months. RESULTS Bony union was achieved in 18/19 patients (94.7%), at an average of 19.8 weeks 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 11 months, which healed uneventfully. There were 2 cases of soft tissue irritation over the plate, but no major complications were observed. CONCLUSIONS 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.
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Wu T, Zhang W, Chang Z, Zhu Z, Sun L, Tang P, Chen H. Augmented Stability in Leaving Original Internal Fixation with Multidimensional Cross Locking Plate through Mini-Open Femoral Anterior Approach for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study. Orthop Surg 2022; 15:169-178. [PMID: 36411511 PMCID: PMC9837237 DOI: 10.1111/os.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Aseptic femoral shaft nonunion constitutes approximately 1%-10% of all femoral shaft fractures treated with intramedullary nail (IMN) fixation, possibly attributable to the lack of anti-rotational stability. Although a lateral locking plate (LP) with retainment of original IMN has shown the most success, lateral LP inflicts significant surgical trauma on patients. Therefore, the Multidimensional Cross Locking Plate (MDC-LP) was designed based on a mini-open femoral anterior approach. We aim to report and compare the technical aspects and clinical outcomes of using anterior MDC-LP or lateral LP with retention of original IMN for the treatment of aseptic femoral shaft nonunion. METHODS In this single center retrospective cohort study, records of 49 patients who had undergone revision of femoral shaft aseptic nonunion with anterior MDC-LP or lateral LP while retaining the original IMN from January 2015 to October 2019 were retrospectively reviewed. Information on patients' demographics, clinical data, and surgical outcomes were gathered and analyzed. X-ray and CT scans were used for bone union evaluation and the lower extremity functional scale (LEFS) was used for follow-up functional evaluation. For quantitative data, the Student's t-test was used if the data were normally distributed. The Mann-Whitney U-test was used for non-normally distributed data. For qualitative data, the Chi-square test was used for comparisons. RESULTS Twenty-seven patients were treated with anterior MDC-LP, and 22 patients were treated with lateral LP. There are no significant differences in age, sex, BMI, time since initial femoral shaft fracture, initial fracture type (close/open), nonunion type, or nonunion location between patients' group. Among patients treated with anterior MDC-LP, an average of 2-months advantage in time to union was observed (4.09 months vs. 6.8 months in the lateral LP group: P = 0.000), smaller incision was required for MDC-LP installment (7.7 cm vs 17.1 cm in lateral LP group: P = 0.000). CONCLUSIONS For the treatment of aseptic femoral shaft nonunion with retainment of original IMN, anterior MDC-LP via mini-open femoral anterior approach described in this study is a better option than lateral LP for achieving faster bone union and satisfactory functional outcome with less surgical trauma.
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Affiliation(s)
- Taoguang Wu
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
| | - Wei Zhang
- School of Sports EngineeringBeijing Sport UniversityBeijingChina
| | - Zuhao Chang
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
| | - Zhengguo Zhu
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
| | - Lijun Sun
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
| | - Peifu Tang
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
| | - Hua Chen
- Department of Orthopedic Surgerythe fourth medical center, Chinese PLA General hospitalBeijingChina
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Lai L, Li Y, Shen M, Wang X, Zhong C, Xu S. Treatment of postoperative non-union with internal fixation loosening of Garden IV femoral neck fracture with teriparatide in a young adult: A case report. Front Surg 2022; 9:938595. [PMID: 36406375 PMCID: PMC9669336 DOI: 10.3389/fsurg.2022.938595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/12/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Postoperative non-union of femoral neck fracture often needs secondary operation. We report a case of a postoperative non-union of femoral neck fracture treated with teriparatide. CASE PRESENTATION A young male patient with Garden IV femoral neck fracture who showed no obvious signs of healing 3 months after percutaneous hollow nail fixation in which the fracture line was enlarged and the hollow nail was withdrawn. Bone non-union healed after 6 months of continuous subcutaneous injection of teriparatide at a dosage of 20 mg/day after the patient refused a secondary surgery. As far as we know, there have been no relevant reports on this type of fracture yet. CONCLUSIONS Teriparatide is expected to be beneficial in treating young patients with a displaced femoral neck fracture who have difficulty in healing from non-union and who are keen on avoiding secondary surgery.
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Khalifa AA, Fadle AA, Elsherif ME, Said HG, Elsherif E, Said G, Refai O. Concomitant intramedullary nailing and plate augmentation as a single-stage procedure in treating complicated nonunited femoral shaft fractures. TRAUMA-ENGLAND 2022; 24:286-293. [DOI: 10.1177/14604086211007037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background and Purpose: Complicated femur fracture represents a major challenge for the orthopedic surgeon, with failed internal fixation, nonunion with broken intramedullary nail (IMN), and infected nonunion among the complications. Mechanical instability, as well as the poor biological environment, is considered as a concern when treating these cases. The purpose of this study was to evaluate concomitant IMN and plate augmentation as a single-stage procedure for the management of multiply operated nonunited femoral shaft fractures. Materials and Methods: Between January 2015 and May 2018, nine patients (eight men) with an average age of 40.8 years (range 25–70) diagnosed as nonunion femoral fractures after an average of four previous surgeries (range 2–6). All patients were available for follow-up with an average of 22 months (range 12–36). Results: The average time for fracture union was 6.7 months (range 3–12); five patients needed bone grafting to compensate for the bone defect encountered during the initial procedure, and two patients required secondary bone grafting after 6 months follow-up. Two patients presented with surgical site infection which was treated by antibiotics and daily dressing. The average leg length discrepancy at last follow-up was 1 cm (range 0.5–1.5). No patient had a metalwork failure or needed removal of the implants. Conclusion: In treating complicated multiply operated nonunited femoral shaft fractures, we believe that this technique can provide a robust mechanical foundation as well as an improved biological environment for such nonunited fractures to heal.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Amr A Fadle
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Hatem G Said
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Essam Elsherif
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Galal Said
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Omar Refai
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
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Wang C, Sun L, Wang Q, Ma T, Zhang K, Li Z. The technique of "autologous bone grafting through channels" combined with double-plate fixation is effective treatment of femoral nonunion. INTERNATIONAL ORTHOPAEDICS 2022; 46:2385-2391. [PMID: 35849163 DOI: 10.1007/s00264-022-05519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aims of this retrospective study were to evaluate the effective treatment of femoral nonunion using the technique of "autologous bone grafting through channels" combined with double-plate fixation. METHODS In this study, 186 patients with nonunion fracture of femur who underwent surgery using the technique of "autologous bone grafting through channels" combined with double-plate fixation in Hong Hui Hospital from May 2010 to July 2020 were enrolled. Totally, 122 males and 64 females with mean age of 44 years were evaluated. These patients were evaluated for the full clinical and radiological union time, duration of follow-up, levels of post-operative limb shortening, and range of motion of adjacent joints, and incidence of serious complications. RESULTS The mean follow-up time was 22 ± 6.2 months (range 12-44 months). Mean union time from surgery using our technique to full clinical and radiological union was 7.6 ± 1.2 months (range 4-9 months). All patients have achieved the union after one operation or two operations using the technique. The one-operation union rate is 98.4%. Post-operative severe complications were seen in seven patients which included deep vein thrombosis; the surgical site infection and the fracture nonunion. The range of motion in the adjacent joint of 17.7% (33/186) in all patients have an effect to the limb function. Six patients have the limb shortening more than 10 mm after surgery. CONCLUSION The technique of "autologous bone grafting through channels" combined with double-plate fixation is showed to be safe, effective, and easy to master and operate surgical option for treating the femoral nonunion.
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Affiliation(s)
- Chaofeng Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
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Landrino M, Alberio RL, Clemente A, Grassi FA. The Reamer-Irrigator-Aspirator (RIA) System for the treatment of aseptic femoral nonunions: Report of two cases and literature review. Orthop Rev (Pavia) 2022; 14:37889. [PMID: 36213618 PMCID: PMC9534743 DOI: 10.52965/001c.37889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Femoral shaft nonunions are disabling complications of fractures, with relevant socioeconomic and psychological impact. The incidence of femoral shaft nonunions is not negligible, ranging between 1% and 10% after intramedullary nailing, but can exceed 20% in case of subtrochanteric fractures. Treatment options are influenced by pathomechanical, anatomical, and clinical factors. Hypertrophic nonunions are usually treated by enhancing stability of fixation, while atrophic nonunions require additional biological stimulation to achieve bone union. The Reamer-Irrigator-Aspirator (RIA) System® was developed to reduce intramedullary pressure and heat generation during intramedullary reaming, thus preventing thermal necrosis and decreasing the risk of fat embolism. The RIA System allows to provide large volumes of high-quality morselized autologous bone, that has shown high osteogenetic and osteoinductive properties. Therefore, its use has been expanded as a valuable source of autologous bone graft for the treatment of large bone defects of different nature. In this article, we present two cases of complex femoral nonunions treated with the use of the RIA System. A review of the published literature on the treatment of femoral nonunions with RIA was also performed. Core tip: In case of atrophic nonunions, the RIA System can be used to obtain biologically active tissue to enhance bone healing. Despite the absence of high-quality studies focused on femoral nonunions, the efficacy of RIA is well-known and orthopaedic surgeons should be aware of this powerful tool.
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Affiliation(s)
- Marco Landrino
- Department of Health Sciences, University of East Piedmont, Novara (Italy)
| | | | - Alice Clemente
- Department of Health Sciences, University of East Piedmont, Novara (Italy)
| | - Federico Alberto Grassi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia (Italy); IRCCS Hospital San Matteo, Pavia (Italy)
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Risk Factors for Development of a Recalcitrant Femoral Nonunion: A Single Surgeon Experience in 122 Patients. J Orthop Trauma 2021; 35:619-625. [PMID: 34596060 DOI: 10.1097/bot.0000000000002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The goals of the study were (1) to document the healing rates of femoral nonunions stratified by those that healed as intended, healed after a subsequent intervention, and those that did not heal; (2) to report the prevalence of recalcitrant femoral nonunions and (3) to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion. DESIGN Longitudinal observational cohort study. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred twenty-two femoral nonunions treated with either a plate or intramedullary nail by a single surgeon between 1991 and 2018. INTERVENTION Bivariate and multivariate regression analysis were performed to identify specific demographic, injury, and treatment factors in patients who developed a recalcitrant nonunion. RESULTS Although 83.6% of the femoral nonunions eventually healed, only 66% "healed as intended" with 17.2% requiring 1 or more additional procedures to consolidate and 16.4% of nonunions failing to unite. There were no statistically significant differences in the recalcitrance rate when we compared treatment with conventional versus locked plates or primary versus exchange nailing. Risk factors for developing a recalcitrant nonunion were deep infection, current smokers, metabolic bone disease, and patients who had undergone 3 or more prior surgical procedures. CONCLUSIONS The use of both intramedullary nails and modern plates were associated with a high rate of recalcitrance. Infection, current smokers, metabolic bone disease, and 3 or more prior surgical procedures were predictors for the development of a recalcitrant nonunion. LEVEL OF EVIDENCE Therapeutic Leve IV. See Instructions for Authors for a complete description of levels of evidence.
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Wildemann B, Ignatius A, Leung F, Taitsman LA, Smith RM, Pesántez R, Stoddart MJ, Richards RG, Jupiter JB. Non-union bone fractures. Nat Rev Dis Primers 2021; 7:57. [PMID: 34354083 DOI: 10.1038/s41572-021-00289-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
The human skeleton has remarkable regenerative properties, being one of the few structures in the body that can heal by recreating its normal cellular composition, orientation and mechanical strength. When the healing process of a fractured bone fails owing to inadequate immobilization, failed surgical intervention, insufficient biological response or infection, the outcome after a prolonged period of no healing is defined as non-union. Non-union represents a chronic medical condition not only affecting function but also potentially impacting the individual's psychosocial and economic well-being. This Primer provides the reader with an in-depth understanding of our contemporary knowledge regarding the important features to be considered when faced with non-union. The normal mechanisms involved in bone healing and the factors that disrupt the normal signalling mechanisms are addressed. Epidemiological considerations and advances in the diagnosis and surgical therapy of non-union are highlighted and the need for greater efforts in basic, translational and clinical research are identified.
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Affiliation(s)
- Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany. .,Julius Wolff Institute and BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University, Ulm, Baden Württemberg, Germany
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Hong Kong, Hong Kong
| | - Lisa A Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - R Malcolm Smith
- Orthopedic trauma service, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rodrigo Pesántez
- Departamento de Ortopedia Y Traumatología Fundación Santa Fé de Bogotá - Universidad de los Andes, Bogotá, Colombia
| | | | | | - Jesse B Jupiter
- Department of Orthopaedic surgery, Massachussets General Hospital, Boston, MA, USA.
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Zhao K, Lian X, Tian S, Wang Z, Zhang J, Li J, Chen W, Hou Z, Zhang Y. Traction methods in the retrograde intramedullary nailing of femur shaft fractures: the double reverse traction repositor or manual traction. INTERNATIONAL ORTHOPAEDICS 2021; 45:2711-2718. [PMID: 33532898 DOI: 10.1007/s00264-021-04961-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this prospective study was to compare the double reverse traction repositor (DRTR) and manual traction in retrograde intramedullary nailing (RE-IMN) for femoral shaft fractures. PATIENTS AND METHODS Seventy-seven patients with femur shaft fractures were randomized to undergo surgery with either DRTR or manual traction (MT) to facilitate RE-IMN between January 2018 and January 2019. Demographics, fracture characteristics, surgical data, post-operative complications, and functional outcomes were assessed. Data from 72 patients completing the final follow-up (12 months) were analysed in this study. RESULTS The average number of intra-operative perspectives in the DRTR group was 27.7, which was significantly reduced compared with that in the MT group (31.3, p < 0.001). Fewer assistants were required in the DRTR group compared with the MT group (1.1 vs 1.9, p < 0.001). Fewer patients with open reduction were discovered in the DRTR group compared with the MT group (2.8 vs 19.4, p=0.024). Demographics, fracture characteristics, other surgical data, and prognostic parameters were comparative between the two groups. CONCLUSIONS The DRTR can be effectively and safely used to treat femur shaft fractures with RE-IMN. The DRTR achieves similar results as MT and is also superior to MT in terms of intra-operative perspectives, the number of assistants, and the open reduction rate.
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Affiliation(s)
- Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaodong Lian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Siyu Tian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
- Chinese Academy of Engineering, Beijing, 10088, People's Republic of China.
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Joseph CM, Jepegnanam TS, Ramasamy B, Cherian VM, Nithyananth M, Sudarsanam TD, Premkumar PS. Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting. J Orthop Surg (Hong Kong) 2020; 28:2309499020907558. [PMID: 32186234 DOI: 10.1177/2309499020907558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting. METHODS A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury). OUTCOME The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients' quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months. RESULTS The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82-14.95) and infections (OR: 6.05, 95% CI: 2.85-12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h (p < 0.0001). SF-36 and SMFA scores were superior in the early group (p < 0.0001). CONCLUSION The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION German Clinical Trials Register DRKS00015186.
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Affiliation(s)
- Christina Marie Joseph
- Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Thilak Samuel Jepegnanam
- Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Boopalan Ramasamy
- Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Vinoo Mathew Cherian
- Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Manasseh Nithyananth
- Department of Orthopaedics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Thambu David Sudarsanam
- Department of Medicine Unit 2, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Prasanna Samuel Premkumar
- Department of Biostatistics and Wellcome Trust Research Laboratory, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
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Zhang R, Yin Y, Li S, Hou Z, Jin L, Zhang Y. Intramedullary nailing versus a locking compression plate for humeral shaft fracture (AO/OTA 12-A and B): A retrospective study. Orthop Traumatol Surg Res 2020; 106:1391-1397. [PMID: 32089473 DOI: 10.1016/j.otsr.2019.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 08/28/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There has been great progress in surgical techniques for treating humeral shaft fractures over the past few decades. The purpose of this study was to compare the therapeutic effects of intramedullary nailing (IMN) and locking compression plate (LCP) for humeral shaft fractures (AO/OTA 12-A and B). HYPOTHESIS Compared with LCP, better therapeutic effects could be obtained with less invasive IMN. MATERIALS AND METHODS Patients with a humeral shaft fracture who received anterograde IMN or LCP fixation in our institution from December 2011 to June 2016 were reviewed in this study. They were divided into two groups according to the different fixation methods: Group A (IMN) and Group B (LCP). The surgical time, intraoperative blood loss, and complications of the patients were reviewed. Fracture healing was evaluated by radiographs performed at each follow-up. The functional outcome was assessed by the DASH (Disabilities of the Arm, Shoulder and Hand) scoring system at the final follow-up. RESULTS Thirty-four patients in Group A and forty-six patients in Group B were included in this study. Mean incision length and blood loss in Group B were greater than those in Group A (p<0.001). The average surgical times were 118.53minutes in Group A and 128.91minutes in Group B (p=0.114). The mean DASH scores were 23.76±16.78 in Group A and 22.37±15.18 in Group B (p=0.609). The complication rates were 8/34 in Group A and 7/46 in Group B, respectively (p=0.887). DISCUSSION The study hypothesis was partially confirmed. Although IMN was a less invasive technique, similar therapeutic results were obtained for humeral shaft fractures (AO/OTA 12-A and B) fixed with two surgical methods. LEVELS OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China.
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18
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Zhao K, Zhang J, Li J, Meng H, Zhang R, Yin Y, Zhu Y, Hou Z, Zhang Y. Treatment of Unstable Intertrochanteric Fractures with Proximal Femoral Nailing Antirotation: Traction Table or Double Reverse Traction Repositor. J INVEST SURG 2020; 34:1178-1184. [PMID: 32619121 DOI: 10.1080/08941939.2020.1786610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The objective of this retrospective study was to compare the efficacy of the double reverse traction repositor (DRTR) and traction table with proximal femoral nailing antirotation (PFNA) in the treatment of unstable intertrochanteric fractures. Patients and Methods: Data from 66 patients (36 patients treated with the traction table and 30 patients treated with DRTR) with unstable intertrochanteric fractures were reviewed from January 2017 to June 2017. The demographics, fracture characteristics, surgical data, and prognostic parameters were collected to compare the differences between the two groups. Results: The collodiaphyseal angle (CDA) was significantly lower in the DRTR group than in the traction table group (129.37° ± 7.47 and 135.67° ± 6.95, respectively, p < 0.001). The open reduction rate was significantly lower in the DRTR group than in the traction table group (3.3% and 13.9%, respectively, p < 0.001). No significant differences were found in the demographics, fracture characteristics, other surgical data, or prognostic parameters between the two groups. Conclusions: DRTR can facilitate safe, effective, and minimally invasive treatment of unstable intertrochanteric fractures with PFNA.
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Affiliation(s)
- Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Perez JR, Jose J, Mohile NV, Boden AL, Greif DN, Barrera CM, Conway S, Subhawong T, Ugarte A, Pretell-Mazzini J. Limb salvage reconstruction: Radiologic features of common reconstructive techniques and their complications. J Orthop 2020; 21:183-191. [PMID: 32256002 DOI: 10.1016/j.jor.2020.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 01/26/2023] Open
Abstract
Limb salvage surgery refers to orthopaedic procedures designed to resect tumors and reconstruct limbs. Improvements in managing malignant bone lesions have led to a dramatic shift in limb salvage procedures. Orthopaedic surgeons now employ four main reconstructive procedures: endoprosthesis, autograft, bulk allograft, and allograft prosthetic composite. While each approach has its advantages, each technique is associated with complications. Furthermore, knowledge of procedure specific imaging findings can lead to earlier complication diagnosis and improved clinical outcomes. The aim of this article is to review leading reconstructive options available for limb salvage surgery and present a case series illustrating the associated complications.
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Affiliation(s)
- Jose R Perez
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Jean Jose
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Neil V Mohile
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Allison L Boden
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Dylan N Greif
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Carlos M Barrera
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Sheila Conway
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Ane Ugarte
- Hospital Universitario Donostia, Department of Radiology, Begiristain Doktorea Pasealekua #109, Gipuzkoa, 20014, Spain
| | - Juan Pretell-Mazzini
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
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20
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Zhang W, Zhang Z, Chen H. [Research progress of augmentation plate for femoral shaft nonunion after intramedullary nail fixation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1467-1473. [PMID: 31823542 PMCID: PMC8355795 DOI: 10.7507/1002-1892.201903073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/23/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. METHODS The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. RESULTS The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. CONCLUSION Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
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Affiliation(s)
- Wei Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Zhuo Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Hua Chen
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,
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Tsai MH, Hu CC. Teriparatide as nonoperative treatment for femoral shaft atrophic nonunion: A case report. World J Clin Cases 2019; 7:2838-2842. [PMID: 31616700 PMCID: PMC6789400 DOI: 10.12998/wjcc.v7.i18.2838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Femoral shaft fractures are a common type of fracture among adults and have high union rates. However, clinical decisions are difficult to make because of the different types of nonunions. Atrophic nonunion usually requires revision surgery combined with bone grafting. Furthermore, no study of teriparatide administration for femoral atrophic nonunion have been previously reported.
CASE SUMMARY A 60-year-old woman had a right femoral shaft fracture due to a traffic accident, and she immediately underwent closed reduction and internal fixation surgery with an intramedullary nailing. However, after 6 mo of rehabilitation, the fracture site showed no signs of healing, and her condition was diagnosed as atrophic nonunion. Subsequently, teriparatide was administered for 6 mo. Complete union was observed at the fracture site 6 mo after teriparatide discontinued.
CONCLUSION The use of teriparatide can be a promising treatment to improve the healing of nonunion fractures.
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Affiliation(s)
- Meng-Huan Tsai
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Department of Joint Reconstruction, Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taoyuan 33305, Taiwan
| | - Chih-Chien Hu
- Department of Joint Reconstruction, Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taoyuan 33305, Taiwan
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Mardani-Kivi M, Karimi Mobarakeh M, Keyhani S, Azari Z. Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique. Musculoskelet Surg 2019; 104:215-226. [PMID: 31243698 DOI: 10.1007/s12306-019-00615-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/20/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur. METHODS In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35 years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations. RESULTS Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37 months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients. CONCLUSION Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Ghaem Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Sohrab Keyhani
- Orthopedic Department, Akhtar Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Zoleikha Azari
- Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.
- Orthopedic Department, Poursina Hospital, Guilan University of Medical Sciences, Parastar Ave., Rasht, 4137816375, Iran.
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Lai PJ, Hsu YH, Chou YC, Yeh WL, Ueng SWN, Yu YH. Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study. BMC Musculoskelet Disord 2019; 20:127. [PMID: 30909909 PMCID: PMC6434807 DOI: 10.1186/s12891-019-2514-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background Atrophic nonunion of femoral shaft fracture after intramedullary (IM) nailing is uncommon. The treatment for femoral shaft aseptic atrophic non-union remained controversial. The aim of this study was to compare the surgical results between exchanging reamed nailing (ERN) and augmentative antirotational plating (AAP) for femoral shaft aseptic atrophic nonunion. Methods We retrospectively reviewed the patients with femoral shaft nonunion between the year of 2014 and 2015. The patients with nonunion after plate osteosynthesis, septic nonunion, hypertrophic nonunion, additional surgery during revision surgery were excluded. All the patients were followed up at least 12 months. Results Overall, the union rate after revision surgery was 70.8%. The union rate was significantly higher in the AAP group than in the ERN group. Operating time was also significantly shorter in the AAP group. Regarding the location of nonunion, the union rate was comparable between groups for isthmic nonunions. However, for non-isthmic nonunions, the union rate was significantly higher and operating time was significantly shorter in the AAP group. Conclusion AAP showed an overall higher union rate for management of femoral shaft aseptic atrophic nonunion compared with ERN. Especially for non-isthmic femoral shaft atrophic nonunions, AAP provided a significantly higher union rate and significantly shorter operating time.
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Affiliation(s)
- Po-Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan
| | - Wen-Ling Yeh
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan
| | - Steve W N Ueng
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan.
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsing St. Kwei Shan, Tao-Yuan, 33302, Taiwan.
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Fragomen AT, Wellman D, Rozbruch SR. The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report. Arch Orthop Trauma Surg 2019; 139:1551-1560. [PMID: 31218436 PMCID: PMC6797666 DOI: 10.1007/s00402-019-03225-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when adequate compression has been attained? Which types of nonunions are good candidates for this treatment? MATERIALS AND METHODS Fourteen patients with nonunions of the tibia (5) or femur (9) were treated with the PRECICE IM compression nail. The average age was 49 years number of previous surgeries was 1.9, 7 were atrophic and 7 normotrophic, 3 were metaphyseal and 11 diaphyseal. All PRECICE IM nails were pre-distracted prior to implantation. Compression was applied post-operatively until the locking bolts were seen on X-ray to be bending or the nail was no longer shortening despite applying the external magnet. RESULTS Union was achieved in 13/14 cases. The time to union was 24.5 weeks (range 11-60). The two proximal tibia metaphyseal nonunions, both deformed into varus (4°) and flexion (10°) after compression was applied with one failing to unite. The distal tibia metaphyseal and diaphyseal nonunions did not deform upon compression. Three patients had positive cultures and were treated with IV antibiotics for 6 weeks followed by 3 months of oral suppression without subsequent infection. No mechanical nail failures were seen. CONCLUSIONS The IM compression nail was successful at applying compression, preventing deformity, and obtaining union in all diaphyseal and in distal tibia metaphyseal nonunions. Signs of active compression are bending of the locking bolts and failure of the nail to shorten. Proximal tibia metaphyseal nonunion may not be suited for this treatment.
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Affiliation(s)
- Austin T. Fragomen
- grid.5386.8000000041936877XWeill Medical College of Cornell University, New York, USA ,grid.239915.50000 0001 2285 8823Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, USA
| | - David Wellman
- grid.5386.8000000041936877XWeill Medical College of Cornell University, New York, USA ,grid.239915.50000 0001 2285 8823Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - S. Robert Rozbruch
- grid.5386.8000000041936877XWeill Medical College of Cornell University, New York, USA ,grid.239915.50000 0001 2285 8823Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, USA
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Zhang W, Zhang Z, Li J, Zhang L, Chen H, Tang P. Clinical outcomes of femoral shaft non-union: dual plating versus exchange nailing with augmentation plating. J Orthop Surg Res 2018; 13:295. [PMID: 30458810 PMCID: PMC6247613 DOI: 10.1186/s13018-018-1002-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background By comparing clinical outcomes between dual plating (DP) and exchange nailing with augmentation plating (EN/AP), we aimed to provide better treatment strategies for femoral shaft non-union. Methods We retrospectively reviewed 30 patients with aseptic femoral shaft non-union at our level 1 trauma center between January 2014 and January 2017. All patients underwent a one-stage, definitive revision procedure, including DP for 16 patients and EN/AP for 14 patients. Perioperative surgical trauma, fracture healing, complications, and the time to return to work were evaluated. Results Twenty-nine patients achieved fracture healing. In the EN/AP group, the fracture healing rate was 100%, the healing time was 5.7 ± 1.7 months, and the time of return to work was 8.2 ± 2.9 months. In the DP group, the fracture healing rate was 94%, the healing time was 8.4 ± 4.1 months, and the time of return to work was 18.4 ± 10.3 months. In terms of fracture healing and return to work, the patients in the EN/AP group required less time than those in the DP group, and the differences were statistically significant (p = 0.024 and p < 0.01 respectively). Except for the length of the incision, the two groups showed no statistically significant differences in operative time, postoperative deformity, and complications. Conclusions Both EN/AP and DP are important surgical options for femoral shaft non-union. Compared to DP, EN/AP resulted in a shorter incision, faster fracture healing, and a shorter time to return to work. Trial registration ChiCTR-ORC-17014062
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Affiliation(s)
- Wei Zhang
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Zhuo Zhang
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Jiantao Li
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Licheng Zhang
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Hua Chen
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China
| | - Peifu Tang
- Department of Orthopedic Surgery, General Hospital of Chinese People's Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
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Vicenti G, Carrozzo M, Caiaffa V, Abate A, Solarino G, Bizzoca D, Maddalena R, Colasuonno G, Nappi V, Rifino F, Moretti B. The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study. INTERNATIONAL ORTHOPAEDICS 2018; 43:193-200. [PMID: 30488127 DOI: 10.1007/s00264-018-4214-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Femoral shaft fractures with third fragments have a high non-union rate, which may reach 14%. This study aims to assess the impact of the radiological features of the third fragment, evaluated on post-operative X-rays, on the outcome of femoral shaft fractures type 32-B managed with intramedullary nailing, in order to obtain an algorithm which could predict the fracture healing time. MATERIALS AND METHODS We have retrospectively evaluated a series of 52 patients. On post-operative X-rays, four radiological parameters were evaluated: the third fragment angle, the fracture gap, the third fragment size, and the mean third fragment displacement. All the patients underwent a radiologic follow-up at one, two, three, six, nine and 12 months post-operatively, to assess the bone healing. The patients were then divided into three groups, according to the fracture healing time: within six months (group A), between six and 12 months (group B), or fracture non-union after 12 months (group C). RESULTS In 28 patients, out of 52 (53.85%), the fracture healing was observed at 6-month follow-up; in 18 patients, out of 52 (34.62%), the fracture healed within 12 months after trauma; and in six patients, out of 52 (11.54%), no fracture healing was observed at 12-month follow-up. The mean third fragment size was significantly different in each group (p < 0.05), while the mean third fragment displacement was significantly higher in group C, compared with group A (p = 0.0006) and group B (p = 0.0027). In group B, a positive correlation was found between the fracture healing time and the mean third fragment size (R = 0.594, p = 0.036); in group C, the fracture union time was positively related to the third fragment size (R = 0.689, p = 0.013) and the mean third fragment displacement (R = 0.7107, p = 0.006). Regression analysis showed that the third fragment size and the mean third fragment displacement are the most important features which affect the fracture healing time. CONCLUSIONS The third fragment size (cutoff 40 mm) is the leading parameter to influence the fracture healing within or in more than six months. The mean third fragment displacement (cutoff 12 mm); on the other hand, impacts on the fracture delayed rather than absent healing.
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Affiliation(s)
- Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy.
| | - Vincenzo Caiaffa
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Antonella Abate
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Davide Bizzoca
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Roberto Maddalena
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Giulia Colasuonno
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Vittorio Nappi
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Francesco Rifino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
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The ideal timing for nail dynamization in femoral shaft delayed union and non-union. INTERNATIONAL ORTHOPAEDICS 2018; 43:217-222. [PMID: 30167836 DOI: 10.1007/s00264-018-4129-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/21/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Nail dynamization is one of the proposed surgical options to manage femoral shaft non-union. This study aims to assess the efficacy and the ideal timing for dynamization in patients with femoral shaft delayed union or non-union. MATERIAL AND METHODS Sixty-eight patients (38 male and 30 female, mean age 36.85 years old, range 22-58) were recruited. The patients were divided into three groups according to the fracture healing time: groupa A, fracture healing occurred within nine months; group B, fracture healing occurred between nine and 12 months; and group C, fracture healing after 12 months or secondary procedure needed for union. Callus-to-diaphysis ratio was calculated on femur X-rays at the time of dynamization. RESULTS In 30 patients out of 68, the fracture healing was observed at nine month follow-up; in 26 patients, the fracture healed within 12 months; eight fractures healed in more than 12 months and only four fractures required a secondary procedure for union. Dynamization was successful in 64 patients out of 68 (94.12%). The mean callus-diaphysis ratio was significantly different in group A (p = 0.001) and in group B (p = 0.03), compared with group C. The timing of dynamization resulted significantly different between the three groups. Linear regression analysis revealed that nail dynamization should be performed between three and six months after trauma. The optimal callus-to-diaphysis ratio should be comprised between 1.47 and 1.19, at the time of dynamization. DISCUSSION Nail dynamization revealed safe and effective in the treatment of femoral delayed union and non-union. It should be considered as a first-line treatment for femoral non-union or delayed union.
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Ru JY, Chen LX, Hu FY, Shi D, Xu R, Du JW, Niu YF. Factors associated with development of re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing. J Orthop Surg Res 2018; 13:180. [PMID: 30029657 PMCID: PMC6054735 DOI: 10.1186/s13018-018-0886-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/06/2018] [Indexed: 12/21/2022] Open
Abstract
Background Currently, there remains a lack of consensus regarding factors predictive of complication such as re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing (IMN). A better understanding of prognostic factors could potentially reduce the risk of re-nonunion happening and allow patients to maximize their recovery in the most expeditious manner. Our study aims to identify risk factors in the development of re-nonunion after primary revision inclusive of exchanging reamed nailing (ERN) and augmentative compression plating (ACP) with IMN in situ for femoral shaft nonunion subsequent to failed IMN. Methods A retrospective study was performed for 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, who were made primary revision with either ERN or ACP from June 2007 to June 2015. The following set of variables was selected based on the speculation that they would contribute to the outcome: sex (male or female), age, body mass index(BMI), smoking, alcohol abuse, cause of injury, fracture type, type of IMN (antegrade or retrograde), use of IMN locking screws(dynamic or static), site of nonunion, primary nonunion time, pathological type of nonunion, bone defect (mm), primary revision method (ERN or ACP), and adjuvant autogenous bone grafting (ABG) (yes or no). Univariate analysis and multiple regression were used to identify risk factors in the development of re-nonunion after primary revision with either ERN or ACP for femoral shaft nonunion subsequent to failed IMN. The minimum follow-up time was 1.5 years (standard deviation [SD] = 1.2, range 1.5–8 years). Results Of 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, primary revision with ERN was performed in 33 (52.4%) cases and primary revision with ACP was performed in 30 (47.6%) cases. Adjuvant ABG procedure was undertaken in 39 (61.9%) cases during primary revisions. Re-nonunion was diagnosed as in 18 (28.6%) cases after primary revision with either ERN or ACP. There was a significant difference in time to union between patients treated with primary ERN and those with primary ACP (log-rank, p = 0.006). Furthermore, the difference was also statistically significant between patients with adjuvant ABG procedure and those without it (log-rank, p = 0.009). The relative risk factors included smoking, BMI, site of nonunion, bone defect, primary revision method, and adjuvant ABG procedure. However, primary revision method and adjuvant ABG procedure were shown to be two independent risk factors in multiple logistic regression analysis. Conclusions Patients with excessive tobacco use, BMI ≥ 30 kg/m2, bone defect ≥ 5 mm, primary revision with ERN, and no adjuvant ABG procedure had a higher likelihood of developing re-nonunion. Of these risk factors, primary revision with ERN and no adjuvant ABG procedure were two strongest risk factors.
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Affiliation(s)
- Jiang-Ying Ru
- Department of Orthopedics, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, China
| | - Li-Xin Chen
- Department of Orthopedics, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, China
| | - Fang-Yong Hu
- Department of Emergency, Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force, Yangzhou, 225003, China
| | - Dai Shi
- Department of Orthopedics, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, China
| | - Rao Xu
- Department of Orthopedics, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, China
| | - Jian-Wei Du
- Department of Orthopedics, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, China
| | - Yun-Fei Niu
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, 200433, China.
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Yadav SS. The Use of a Free Fibular Strut as a "Biological Intramedullary Nail" for the Treatment of Complex Nonunion of Long Bones. JB JS Open Access 2018; 3:e0050. [PMID: 30280135 PMCID: PMC6145563 DOI: 10.2106/jbjs.oa.17.00050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Nonunion of long-bone fractures is difficult to treat, especially when the bones are osteoporotic or there is a large bone gap as a result of repeated failure of the metallic nails or implants. In such cases, the use of an autologous intramedullary fibular strut graft may be a viable treatment option. Methods: Twenty-two patients with a complex nonunion of the shaft of the femur, humerus, or tibia were managed with a free autologous fibular strut graft for intramedullary fixation with use of closed or open methods. All patients had evidence of moderate to severe local osteoporosis and had a bone gap ranging from 4 to 20 mm. Nineteen patients had had 1 to 4 prior operations. The mean age was 51.5 years. The duration of nonunion ranged from 9 months to 4 years. Results: The mean time to union was 17 weeks (range, 8 to 26 weeks), and the mean duration of follow-up was 4 years (range, 6 months to 17 years). All but 2 patients had healing at the time of the latest follow-up. Conclusions: The identification of a viable option for the treatment of difficult nonunion in osteoporotic bones has been a challenge. The insertion of a free autologous intramedullary fibular strut graft provided mechanical stability, and osteogenesis occurred inside the medullary canal of the host bone. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Zhang R, Yin Y, Li S, Jin L, Hou Z, Zhang Y. Traction table versus double reverse traction repositor in the treatment of femoral shaft fractures. Sci Rep 2018; 8:5952. [PMID: 29654282 PMCID: PMC5899094 DOI: 10.1038/s41598-018-24317-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/27/2018] [Indexed: 01/24/2023] Open
Abstract
A novel reduction technique of intramedullary nailing (IMN) for femoral shaft fractures was introduced, and in this study, its therapeutic effect was compared with patients treated with the traditional traction table. From November 2012 to August 2015, the patients with femoral shaft fractures fixed with anterograde IMN were reviewed. Seventy-four patients treated with the traction table and forty-eight patients treated with the double reverse traction repositor (DRTR) met the inclusion criteria of this study. The surgical time, blood loss, open reduction rate and complications were reviewed in this study. The fracture healing was assessed by the radiographs conducted at each follow-up. The functional outcome (hip and knee flexion, Harris Hip Score, and Lysholm knee score) was evaluated at the final follow-up. Average surgical time, blood loss, hip and knee flexion, and Harris Hip Score showed no difference (P > 0.05) between the two groups. However, the DRTR was superior to the traction table in fracture healing, Lysholm knee score, open reduction and complications rate (P < 0.05). Thus, we concluded that minimally invasive treatment of femoral shaft fractures could be obtained with the DRTR.
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Affiliation(s)
- Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Hebei, China.
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Exchange nailing with enhanced distal fixation is effective for the treatment of infraisthmal femoral nonunions. Arch Orthop Trauma Surg 2018; 138:27-34. [PMID: 28956142 DOI: 10.1007/s00402-017-2802-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The treatment options for nonunions of infraisthmal femoral shaft fractures after internal fixation are controversial. Methods such as exchanging an existing nail with a nail of a larger size, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. Among those options, exchange nailing seems to be the most popular choice. In this study, a Poller screw, or an additional interlocking screw, was used in conjunction with exchange intramedullary nailing. The purpose of this study was to evaluate the effectiveness of treating femoral shaft nonunions using insertion of a Poller screw or an additional interlocking screw in conjunction with intramedullary nail fixation. MATERIALS AND METHODS This study included 18 patients who presented with nonunion of femur shaft fractures after internal fixation at the infraisthmal level. These patients included 13 men and 5 women, with a mean age of 46.8 years (range 15-78 years). The mean postsurgical period of nonunion was 7.8 months (range 6-12 months). The patients were classified into two groups: the atrophic nonunion group and the hypertrophic nonunion group. In all patients, nailing was enhanced with a Poller screw or additional interlocking screws. All patients were followed up with plain film examinations and were assessed for their functional recovery status to determine the osseous union conditions. RESULTS All 18 patients achieved postoperative bony union after a mean time of 7.5 months (range 3-12 months), and all patients were able to walk with full weight-bearing and without pain within 3 months. There were no significant complications, such as broken hardware, implant back-outs, axial or rotational malalignments, or deep infections. CONCLUSION Poller screws and additional interlocking screws, along with intramedullary nailing exchange, may be an effective and reliable alternative for treating infraisthmal femoral shaft nonunions.
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Zhao D, Cao M, Wang T, Wang B, Liu B, Lineaweaver WC. Pedicled iliac crest bone flap transfer for the treatment of upper femoral shaft fracture nonunion: An anatomic study and clinical applications. Microsurgery 2017; 38:882-888. [PMID: 29214678 DOI: 10.1002/micr.30278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 10/14/2017] [Accepted: 11/17/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE We present the results of a study on the anatomy of the ascending branch of the lateral circumflex femoral artery (AB-LCFA) and the use of the pedicled iliac bone flap transfer perfused by AB-LCFA combined with external fixation for the treatment of the nonunion of upper femoral shaft fractures. METHODS The orientation, diameter, length, and distribution of the AB-LCFA from 40 lower limbs of adult cadavers were dissected and measured. From 2000 to 2012, 13 patients with nonunion of upper femoral shaft fractures underwent pedicled iliac bone flap transfer perfused by the AB-LCFA combined with external fixation. The time of bone fracture union was recorded based on X-ray examination. The functional results of the femoral shaft were evaluated by the Klemm classification. RESULTS The lateral circumflex femoral artery (LCFA) divided into ascending, transverse, and descending branches in 32 specimens (80%). The diameter of the AB-LCFA at the origin was 3.15 ± 0.9 mm and the length of the AB-LCFA was 8.51 ± 3.06 cm. The postoperative course of the procedure was uneventful in all 13 patients. The average follow-up was 15 months. Bone union was achieved in all patients and the average union time was 5.3 months. 12 patients achieved excellent or good functional results based on the Klemm classification. CONCLUSION The AB-LCFA has a consistent orientation and abundant blood flow. The transfer of the iliac crest bone flap perfused by the AB-LCFA while combined with external fixation could be an option for treating the nonunion of upper femoral shaft fractures.
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Affiliation(s)
- Dewei Zhao
- Department of Orthopedic Surgery, Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Meng Cao
- Department of Orthopedic Surgery, Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Tienan Wang
- Department of Orthopedic Surgery, Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Benjie Wang
- Department of Orthopedic Surgery, Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Baoyi Liu
- Department of Orthopedic Surgery, Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
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Sasaki G, Watanabe Y, Takaki M, Yasui Y, Miyamoto W, Kawano H, Matsushita T. Chipping and lengthening over nailing technique for femoral shaft nonunion with shortening. INTERNATIONAL ORTHOPAEDICS 2017. [PMID: 28639009 DOI: 10.1007/s00264-017-3535-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Chipping and lengthening over nailing (CLON) technique was developed to treat femoral shaft nonunion with shortening more than 10 mm. The purpose of the current retrospective case series was to clarify the effectiveness of the CLON technique on the femoral shaft nonunion following intramedullary nailing. METHODS Clinical and radiological outcomes in the patients receiving operative treatment for femoral shaft nonunion between August 2012 and December 2016 were retrospectively reviewed using the Refractory Fracture Data Registry at the authors' institution. The CLON technique was indicated for patients with the femoral shaft nonunion with shortening more than 10 mm. RESULTS Five patients with median follow-up of 32 months (range, 14 to 50 months) were included in this study. All patients achieved bone union at the median of 8 months after the CLON technique. The median limb length discrepancy was 2.0 mm at the most recent follow-up. CONCLUSIONS The present study demonstrated that the CLON technique for femoral shaft nonunion may be the first choice as operative treatment for femoral shaft nonunion with shortening more than 10 mm.
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Affiliation(s)
- Gen Sasaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Motoyuki Takaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
- Fukushima Medical University, Fukushima, Japan
- Southern TOHOKU General Hospital, Koriyama, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Takashi Matsushita
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
- Fukushima Medical University, Fukushima, Japan
- Southern TOHOKU General Hospital, Koriyama, Japan
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Ferreira N, Marais LC. Femoral locking plate failure salvaged with hexapod circular external fixation: a report of two cases. Strategies Trauma Limb Reconstr 2016; 11:123-7. [PMID: 27234444 PMCID: PMC4960056 DOI: 10.1007/s11751-016-0254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 04/24/2016] [Indexed: 11/14/2022] Open
Abstract
Femoral non-unions are difficult to treat even for the experienced orthopaedic trauma surgeon. If the non-union follows failure of modern stable internal fixation, the complexity of the management is further increased. We report two cases of stiff hypertrophic femoral non-unions after failed locking plate fixation that were successfully treated with a new hexapod circular external fixator. In addition to providing the necessary stability for functional rehabilitation and union, the hexapod circular fixator software allows gradual correction of deformities in order to restore the normal mechanical alignment of the limb.
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Affiliation(s)
- N Ferreira
- Department of Orthopaedic Surgery, Tygerberg Hospital, University of Stellenbosch, Cape Town, 7505, South Africa.
| | - L C Marais
- Tumour, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Pietermaritzburg, South Africa
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Vaishya R, Agarwal AK, Gupta N, Vijay V. Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union. J Orthop 2016; 13:242-5. [PMID: 27408496 DOI: 10.1016/j.jor.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Non-union after intramedullary nail fixation of femur shaft fractures is although infrequent but a challenging condition to treat. The treatment options available to deal with such a situation include exchange nailing, removal of nail and re-osteosynthesis with plating, or Ilizarov fixation. We believe that rotational instability, in the presence of a nail, is one of the main reasons for most of the non-union. We present our experience of plate augmentation leaving the nail in situ for non-union of femoral shaft fracture. METHODS In this retrospective study, we had operated 16 cases of the femoral shaft non-union, which were treated by plate augmentation and bone grafting (if needed) with retention of the intramedullary interlocking nail in situ. The cases of infected non-union and any fracture less than one-year duration were excluded from the study. RESULTS Bone grafting was done only in 4 cases with atrophic non-union. We could achieve union in all the cases at an average time of 6.25 months. The average time of surgery between the primary surgery of interlocking nail fixation and the plate augmentation was 13 months. Mean surgical time for plate augmentation and bone grafting was 71 min. No major complication or implant failure was encountered. An average residual shortening of the limb was 0.9 cm and average range of motion of the knee was 115°. CONCLUSION Plate augmentation seems an effective, reliable, safe and an easy procedure for the treatment of femoral shaft non-union after an intramedullary nailing.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Amit Kumar Agarwal
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Nishint Gupta
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Vipul Vijay
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
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Tsang STJ, Mills LA, Baren J, Frantzias J, Keating JF, Simpson AHRW. Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure. Injury 2015; 46:2404-9. [PMID: 26489394 DOI: 10.1016/j.injury.2015.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (p<0.05). Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed.
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Affiliation(s)
- S T J Tsang
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, UK.
| | - L A Mills
- Department of Trauma and Orthopaedics, Royal Aberdeen Children's Hospital, UK
| | - J Baren
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, UK
| | - J Frantzias
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, UK
| | - J F Keating
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, UK
| | - A H R W Simpson
- Department of Trauma and Orthopaedic surgery, University of Edinburgh, UK
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Successful treatment of infected femoral shaft nonunion with teriparatide after eradication of infection. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hierholzer C, Glowalla C, Herrler M, von Rüden C, Hungerer S, Bühren V, Friederichs J. Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res 2014; 9:88. [PMID: 25300373 PMCID: PMC4201668 DOI: 10.1186/s13018-014-0088-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/17/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures. METHODS Between 2003 and 2010, 72 consecutive patients with nonunion of the femoral shaft were operated using a standardized protocol in our trauma department and followed up for successful union and functional result. RESULTS Osseous healing was observed in 71 patients (98%). Only one patient was lacking bone healing following a time period of 24 months after the first exchange nailing and 5 months after the second exchange nailing. In 59 patients (82%), uneventful and timely bone healing after exchange nailing was detected. In 18% of patients (n = 13), delayed bone healing was observed and required additional therapy. In the majority of patients (61%), bone healing occurred within the first 2 to 5 months, only 18% of patients' duration of bone healing exceeded 8 months. In 62 patients (86%), no relevant or clinically apparent leg-length discrepancy prior to and after exchange nailing was detected as well as no significant axis deviation or malrotation. Functional studies including simple clinical gait and standing analysis, return to activities of daily life, return to sports activities, and return to work were all reached on a satisfying level. DISCUSSION Reamed intramedullary exchange nailing as described in this study is the treatment of choice for aseptic femoral shaft nonunion with a high rate of bone healing and a low rate of complications including length discrepancy or malrotation and a good functional outcome.
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