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Nistor DV, Melinte RM, von Mengershausen R. Anterograde Intramedullary Nailing without Bone Grafting for Humeral Shaft Nonunion Associated with Early Exploration of Secondary Radial Nerve Palsy: A Case Report. Neurol Int 2024; 16:1014-1025. [PMID: 39311350 PMCID: PMC11417706 DOI: 10.3390/neurolint16050077] [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: 08/09/2024] [Revised: 09/10/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Humeral shaft fractures are relatively common. Complications associated with this type of fracture and its treatment include nonunion and radial nerve palsy. Plate osteosynthesis with autologous bone grafting is considered the gold standard for treating nonunion. However, bone grafts might not always be necessary in cases of hypertrophic nonunion, and treatment should be tailored to the specific type and characteristics of the nonunion. The treatment of radial nerve palsy is debated, with some favoring expectant management based on the nerve's ability to regenerate, and others preferring early surgical exploration to prevent possible lasting nerve damage. METHODS We present the case of a 46-year-old male patient with a six-year-old humeral shaft fracture resulting in hypertrophic nonunion. We treated the nonunion with anterograde intramedullary nailing without bone grafting. Postoperatively, the patient developed severe radial nerve palsy. After repeated electrophysiological studies, a decision was made to surgically explore the nerve 10 days after the nonunion surgery. The nerve was subsequently found to be intact and treated with neurolysis. RESULTS Bony union was shown at six months after nonunion surgery. Four months after the nonunion surgery, the patient started to show clinical signs of nerve recovery, and at 12 months he achieved nearly full clinical recovery of radial nerve function. CONCLUSIONS Anterograde intramedullary nailing without autologous bone grafting may be considered an option for treating hypertrophic nonunion. The management of radial nerve palsy requires effective cooperation and communication between patient and physician. Further research is necessary to be able to better predict nerve recovery.
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Affiliation(s)
| | | | - Romana von Mengershausen
- Department of Orthopedics and Traumatology, Iuliu Hațieganu University of Medicine and Pharmacy, Strada Victor Babes 8, 4000132 Cluj-Napoca, Romania; (D.V.N.); (R.M.M.)
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Qawasmi F, Qawasmi L, Safadi H, Dasari SP, Yassin M. Triceps aponeurosis and deltoid tuberosity as a landmarks for radial nerve dissection: a cadaveric study. JSES Int 2024; 8:1122-1125. [PMID: 39280145 PMCID: PMC11401578 DOI: 10.1016/j.jseint.2024.03.017] [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] [Indexed: 09/18/2024] Open
Abstract
Background The radial nerve, originating from the posterior cord of the brachial plexus, traverses the posterior humerus. Incidences of radial nerve injury have been noted following surgical interventions like fracture fixation and exploration in this area. There's a paucity of literature detailing soft tissue anatomical cues for radial nerve dissection. This study aimed to identify reliable soft tissue and bony landmarks (triceps aponeurosis and deltoid tuberosity) that can be of substantial importance in dissecting the radial nerve and reducing iatrogenic nerve injury utilizing the posterior approach. Methods Thirty-two fresh-frozen cadaver specimens underwent dissection using a posterior triceps-splitting approach to expose the radial nerve. The distance between the apex of the triceps aponeurosis and the radial nerve was measured, alongside noting the radial nerve's position relative to the deltoid tuberosity. Results Of the cadavers, 78% were female, and 22% were male, with a mean age of 76 (range: 62-85). The average distance between the aponeurosis apex and the radial nerve was 40.3 mm (range: 28-60). The radial nerve was consistently found in all specimens, situated posteriorly at the humerus's mid-axial level at the distal part of the deltoid tuberosity. Conclusion The triceps aponeurosis and distal deltoid tuberosity serve as reliable and practical landmarks for dissecting and exploring the radial nerve during posterior humeral approaches. These landmarks prove especially valuable when fractures obscure conventional anatomical cues.
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Affiliation(s)
- Feras Qawasmi
- Department of Orthopedic Surgery, Hasharon Hospital, Petah Tikva, Israel
| | - Lena Qawasmi
- Jerusalem Shoulder and Elbow Center, Jerusalem, Israel
| | - Hazem Safadi
- Jerusalem Shoulder and Elbow Center, Jerusalem, Israel
| | - Suhas P Dasari
- Orthopedic Department, University of Washington Medical Center, Seattle, WA, USA
| | - Mustafa Yassin
- Department of Orthopedic Surgery, Hasharon Hospital, Petah Tikva, Israel
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Mühlenfeld N, Wagner FC, Hupperich A, Heykendorf L, Frodl A, Obid P, Kühle J, Schmal H, Erdle B, Jaeger M. Clavicle Shaft Non-Unions-Do We Even Need Bone Grafts? J Clin Med 2024; 13:4850. [PMID: 39200992 PMCID: PMC11355853 DOI: 10.3390/jcm13164850] [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: 06/29/2024] [Revised: 08/02/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0-196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases.
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Affiliation(s)
- Nils Mühlenfeld
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Ferdinand C. Wagner
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Andreas Hupperich
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Lukas Heykendorf
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Andreas Frodl
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Peter Obid
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Jan Kühle
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
- Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Benjamin Erdle
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (F.C.W.); (A.H.); (L.H.); (A.F.); (P.O.); (J.K.); (H.S.); (B.E.); (M.J.)
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Gan JH, Bearne L, Walters S, Room J, Booth G, Trompeter A, Nikoletou D. The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures - a scoping review. Disabil Rehabil 2024:1-12. [PMID: 38753460 DOI: 10.1080/09638288.2024.2351594] [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: 10/13/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. . METHODS Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. RESULTS 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients' perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. CONCLUSION There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.
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Affiliation(s)
- Jia Hui Gan
- Haslemere Community Hospital, Royal Surrey NHS Foundation Trust, Surrey, UK
- Population Health Research Institute, St George's University of London, London, UK
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Lindsay Bearne
- Population Health Research Institute, St George's University of London, London, UK
| | - Samuel Walters
- Department of Trauma and Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jon Room
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Greg Booth
- Population Health Research Institute, St George's University of London, London, UK
- Therapies Department, Royal National Orthopaedic Hospital Trust, London, UK
| | - Alex Trompeter
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Department of Trauma and Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dimitra Nikoletou
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Chang HH, Lim JR, Yoon TH, Chun YM, Kim HS. The Treatment of Periprosthetic Fracture Revision of the Humerus with "Bamboo Support" Structural Allograft Technique-Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report. J Clin Med 2024; 13:825. [PMID: 38337518 PMCID: PMC10856593 DOI: 10.3390/jcm13030825] [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: 12/11/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the "bamboo support technique", fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure.
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Affiliation(s)
- Hsien-Hao Chang
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Lipphardt M, Zamzam M, Saleh ES. Pediatric Humeral Shaft Fracture Nonunion: A Case Report. Cureus 2023; 15:e51019. [PMID: 38264390 PMCID: PMC10804219 DOI: 10.7759/cureus.51019] [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] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Humeral shaft fractures in the pediatric population are a commonly encountered injury in everyday practice. Most patients with these injuries are treated without surgery and go on to have an uneventful recovery. Nonunion of these injuries in the pediatric population has been reported only once in the literature. This case report follows a 13-year-old female after a seemingly standard transverse humeral shaft fracture. The patient was treated with a fracture brace initially. No signs of healing were noted at the eight-week post-injury follow-up. The family elected for continued conservative management until the patient returned at four months post-injury with persistent gross motion at the fracture site and no healing on radiographs. Laboratory testing did show that she has mild-to-moderate vitamin D deficiency, which was addressed. The patient underwent nonunion treatment with open reduction, internal fixation, and bone grafting. She went on to full union with an uncomplicated postoperative course. This case presents an interesting and unique case presentation. This report shows that, while rare, it is a potential outcome of humeral shaft fractures in the pediatric population. This case also demonstrates that using the standard adult operative technique for nonunion treatment with rigid internal fixation and bone grafting in a pediatric patient will lead to full-bone healing.
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Affiliation(s)
| | - Mazen Zamzam
- Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Ehab S Saleh
- Orthopaedic Surgery, Beaumont Health, Royal Oak, USA
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Massin V, Laumonerie P, Bonnevialle N, Le Baron M, Ollivier M, Flecher X, Argenson JN, Lami D. What treatment for humeral shaft non-union? Case-series assessment of a strategy. Orthop Traumatol Surg Res 2023; 109:103532. [PMID: 36572380 DOI: 10.1016/j.otsr.2022.103532] [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: 02/09/2022] [Revised: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Humeral shaft non-union is frequent, with severe clinical impact. Management, however, is poorly codified and there is no clear decision-tree. HYPOTHESIS Analyzing our experience over the last 15years could enable a reproducible strategy to be drawn up, with a decision-tree based on the 2 main causes: failure of internal fixation, and infection. MATERIAL AND METHOD Sixty-one patients were included in a retrospective cohort, with a mean 94 months' follow-p. The treatment strategy was based on screening first for infection then for mechanical stability deficit in case of prior internal fixation. Any fixation revision was associated to cancellous autograft. In case of suspected or proven infection, 2-stage treatment was implemented. In case of primary non-operative treatment, the strategy was based on the non-union risk on the Non-Union Scoring System (NUSS), with internal fixation and possible graft. RESULTS There were 6 failures, for a consolidation rate of 90%; excluding patients not managed according to the study protocol, the consolidation rate was 95%. There was 1 case of spontaneously resolving postoperative radial palsy, and 3 patients required surgical revision. DISCUSSION The present strategy achieved consolidation in most cases, providing the surgeon with a decision-tree for these patients. Infectious etiologies are often overlooked and should be a focus of screening. LEVEL OF EVIDENCE IV, retrospective or historical series.
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Affiliation(s)
- Valentin Massin
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
| | - Pierre Laumonerie
- Service de chirurgie orthopédique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Nicolas Bonnevialle
- Service de chirurgie orthopédique, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Marie Le Baron
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Flecher
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Damien Lami
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
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Walter N, Hierl K, Brochhausen C, Alt V, Rupp M. The epidemiology and direct healthcare costs of aseptic nonunions in Germany - a descriptive report. Bone Joint Res 2022; 11:541-547. [PMID: 35920100 PMCID: PMC9396925 DOI: 10.1302/2046-3758.118.bjr-2021-0238.r3] [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] [Indexed: 11/13/2022] Open
Abstract
Aims This observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany? Methods Data consisting of annual International Classification of Diseases (ICD)-10 diagnosis codes from German medical institutions from 2009 to 2019, provided by the Federal Statistical Office of Germany (Destatis), were analyzed. Nonunion incidence was calculated for anatomical localization, sex, and age groups. Incidence rate ratios (IRRs) were determined and compared with a two-sample z-test. Diagnosis-related group (DRG)-reimbursement and length of hospital stay were retrospectively retrieved for each anatomical localization, considering 210 patients. Results In 2019, a total of 11,840 nonunion cases (17.4/100,000 inhabitants) were treated. In comparison to 2018, the incidence of nonunion increased by 3% (IRR 1.03, 95% confidence interval (CI) 0.53 to 1.99, p = 0.935). The incidence was higher for male cases (IRR female/male: 0.79, 95% CI 0.76 to 0.82, p = 0.484). Most nonunions occurred at the pelvic and hip region (3.6/100,000 inhabitants, 95% CI 3.5 to 3.8), followed by the ankle and foot as well as the hand (2.9/100,000 inhabitants each). Mean estimated DRG reimbursement for in-hospital treatment of nonunions was highest for nonunions at the pelvic and hip region (€8,319 (SD 2,410), p < 0.001). Conclusion Despite attempts to improve fracture treatment in recent years, nonunions remain a problem for orthopaedic and trauma surgery, with a stable incidence throughout the last decade. Cite this article: Bone Joint Res 2022;11(8):541–547.
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Affiliation(s)
- Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department for Psychosomatic Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Katja Hierl
- Department for Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Jia Q, Liu Y, Alimujiang A, Guo J, Chen D, Wang Y, Yusufu A, Ma C. Nine-year-long complex humeral nonunion salvaged by distraction osteogenesis technique: a case report and review of the literature. BMC Surg 2022; 22:77. [PMID: 35241038 PMCID: PMC8892714 DOI: 10.1186/s12893-022-01524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Humeral nonunion with significant bone loss or shortening is uncommon and poses a complex clinical problem. We present a case of humeral nonunion with a large segmental bone defect treated with the distraction osteogenesis technique and remedy the radial nerve palsy produced during distraction osteogenesis by forearm tendon transfers. The reconstruction of upper limb function was achieved with satisfactory results. This case provides a referenceable alternative method for repairing large segmental bone defects due to complex nonunion of the upper extremity, as well as a remedy in the unfortunate event of radial nerve palsy, providing a reference and lessons learned for the treatment of similar cases and the management of possible complications. Case presentation A 31-year-old male patient experienced 9 years of hypertrophic nonunion due to an unreliable internal fixation. The radiographs showed the absence of bone bridging between the two fragments, loosening of the screws, and extensive osteolysis around the internal screws. The patient was treated with distraction osteogenesis. At the end of the distraction period, the patient unfortunately developed right radial nerve paresis, which was salvaged by forearm tendon transplantation, and finally reconstructed hand function and achieved bone union of the humerus. Conclusion Distraction osteogenesis, although not a panacea for all humeral nonunions with significant segmental bone loss, does offer a viable salvage procedure in this unusual and often complex clinical problem. When irreversible radial nerve palsy occurs during distraction, forearm tendon transfers can have a good clinical effect.
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Affiliation(s)
- Qiyu Jia
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Abudusalamu Alimujiang
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jian Guo
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dongsheng Chen
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yingbo Wang
- College of Chemical Engineering, Xinjiang Normal University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Knobloch K. [Bone stimulation 4.0-Combination of EMTT and ESWT in humeral nonunion : A case report]. Unfallchirurg 2021; 125:323-326. [PMID: 34136941 PMCID: PMC8940790 DOI: 10.1007/s00113-021-01025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Karsten Knobloch
- SportPraxis Prof. Knobloch, Heiligerstr. 3, 30159, Hannover, Deutschland.
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11
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Polat O, Toy S, Kibar B. InSafeLOCK® humeral nailing for humeral nonunions: Clinical and radiological results. Jt Dis Relat Surg 2021; 32:446-453. [PMID: 34145823 PMCID: PMC8343851 DOI: 10.52312/jdrs.2021.81535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives
This study aims to evaluate the clinical and functional results of patients treated with InSafeLOCK® humeral nail and iliac crest autograft for humeral nonunion. Patients and methods
A total of 15 patients (11 males, 4 females; mean age: 52.1±15.3 years; range, 31 to 78 years) who were followed conservatively for humeral fractures and operated with the InSafeLOCK® humeral nail and iliac bone graft in our center between June 2018 and January 2020 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, operative data, and pre- and postoperative Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Constant-Murley Scores (CMS) were recorded. Results
The mean time from injury to nonunion treatment was 10.9±1.6 months. Five patients had atrophic, eight patients had oligotrophic, and two patients had hypertrophic nonunion. Preoperatively, the mean DASH was 37.7±9.1, the mean CMS was 69.7±6.3, and the mean VAS was 3.8±0.7. In all patients, union was achieved. The mean operation time was 59.0±16.2 min. The mean postoperative DASH score was 16.1±8.7, CMS 87.4±3.4, and VAS score 0.8±0.7. Regarding the shoulder joint, the mean abduction was 164.7±11.3 degrees, the mean internal rotation was 82.0±6.8 degrees, the mean external rotation was 81.3±8.3 degrees, and the mean flexion was 162.0±12.1 degrees. During follow-up, complications such as vascular-nerve injury, reflex sympathetic dystrophy, screw migration or loosening, implant failure, and loss of reduction did not occur in any of our patients. Conclusion
Considering the satisfactory functional and radiological results, the InSafeLOCK® humeral nail can be used safely in humeral nonunions.
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Affiliation(s)
- Oktay Polat
- Ağrı Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 04200 Ağrı, Türkiye.
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12
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Closed Compression Nailing Using a New-Generation Intramedullary Nail without Autologous Bone Grafting for Humeral Shaft Nonunion. Case Rep Orthop 2021; 2021:5548729. [PMID: 33936826 PMCID: PMC8055420 DOI: 10.1155/2021/5548729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/23/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Although the recommended treatment for humeral shaft nonunion is compression plating with autologous bone grafting, we treated a case of humeral shaft nonunion with an intramedullary nail (IMN) without bone grafting. Presentation of Case. Osteosynthesis with IMN was performed on a 24-year-old man with a humeral shaft fracture at another hospital. However, bony union was not obtained 1 year after the first surgery, and he was referred to our institution. We treated the nonunion with exchange nailing without autologous bone grafting using compression function of the nail, leading to bony union at 7 months postoperatively. At the final follow-up 2 years and 4 months postoperatively, the patient had full range of motion in the left shoulder and elbow joints. Discussion. Compression plating with autologous bone grafting is reported to be the gold standard for the treatment of humeral shaft nonunion. IMN is advantageous for minimal invasion; however, the conventional type of IMN cannot apply compression force between fragments and does not have sufficient stability against rotational force. In this case, we used an IMN that could apply compression between the fragments and which had rotational stability via many screws. We did not perform bone grafting because the current nonunion was adjudged to be biologically active, and we achieved good functional results. Conclusion We treated humeral shaft nonunion using IMN with compression, but without bone grafting, leading to successful clinical outcomes. This strategy might be an appropriate choice for the treatment of humeral shaft nonunion with biological activity.
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13
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Surgical outcome of upper extremity fractures in patients with Parkinson's disease. Sci Rep 2020; 10:21016. [PMID: 33273640 PMCID: PMC7713347 DOI: 10.1038/s41598-020-78168-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Patients with Idiopathic Parkinson’s Disease (PD) have an increased risk for fractures. Currently, many studies have reported inferior outcomes in PD patients after orthopedic procedures. However, there are very few studies assessing the outcome of upper extremity fractures (UEF) in PD patients. In this study, we reviewed 40 patients with PD that received surgical intervention for an UEF. We retrospectively reviewed patients with PD that received surgical fixation for an UEF at a tertiary trauma center. The primary objective was to determine the treatment failure rate after surgical fixation. The secondary outcomes include mode of failure, time to treatment failure, length of hospital stay, readmission rate, reoperation rate, and postoperative complications. A total of 40 patients with PD (42 fractures) underwent surgery. The most common fracture type was radius fracture (n = 19), followed by humerus fracture (n = 15), metacarpal/phalangeal fracture (n = 5), clavicle fracture (n = 2) and olecranon fracture (n = 1). The overall treatment failure rate was 40.5% (n = 17). The time to treatment failure was 1.24 ± 3.1 months and length of hospital stay was 6 ± 3.9 days, the readmission rate within 30 days was 14% (n = 6), and reoperation rate was 14% (n = 6). The complication rate was 16.6% (n = 7) and patients with humeral fractures appeared to have the longest hospital stays (6.6 days) and increased complication rates (13%, n = 2). Patients with PD have high treatment failure rates despite surgical fixation of an UEF. These patients often have a frail status with multiple comorbidities which may complicate their postoperative course. Level of evidence level 4 case series.
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14
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Feng D, Wang X, Sun L, Cai X, Zhang K, Wang Z, Zhu Y. Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion. BMC Musculoskelet Disord 2020; 21:769. [PMID: 33220703 PMCID: PMC7680597 DOI: 10.1186/s12891-020-03743-y] [Citation(s) in RCA: 6] [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: 06/10/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.
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Affiliation(s)
- Dongxu Feng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Xiaolong Wang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Liang Sun
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Xiao Cai
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Zhan Wang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China.
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Sallemi S, Sahnoun N, Maatoug M, Trigui M, Zouch I, Keskes M, Abid A, Keskes H. Continuous external compression for the treatment of humeral pseudarthrosis: a single center experience. Pan Afr Med J 2020; 35:105. [PMID: 32637003 PMCID: PMC7320759 DOI: 10.11604/pamj.2020.35.105.21533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022] Open
Abstract
Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.
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Affiliation(s)
- Sami Sallemi
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Nizar Sahnoun
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mahdi Maatoug
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Moez Trigui
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouch
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariem Keskes
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ameur Abid
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hassib Keskes
- Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
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Janko M, Verboket RD, Plawetzki E, Geiger EV, Lustenberger T, Marzi I, Nau C. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 2019; 91:67-75. [DOI: 10.1007/s00104-019-01050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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