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Campanacci DA, Scanferla R, Innocenti M, Muratori F, Puccini S, Scoccianti G, Beltrami G, Capanna R, Innocenti M. Are Vascularized Fibula Autografts a Long-lasting Reconstruction After Intercalary Resection of the Humerus for Primary Bone Tumors? Clin Orthop Relat Res 2023; 481:2185-2197. [PMID: 37364172 PMCID: PMC10566995 DOI: 10.1097/corr.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A vascularized fibula graft (VFG) is the vascular autograft most frequently used to restore large segmental long bone defects, particularly in the upper limb. Because the use of a vascularized fibula involves an operation in an uninvolved extremity with potential morbidity, it is important to document that this type of reconstruction is successful in restoring function to the humerus. However, the long-term results of VFG after intercalary resection of the humeral diaphysis for bone tumors are still unknown. QUESTIONS/PURPOSES (1) What was the complication rate of reconstruction? (2) What was the functional result after surgical treatment, as assessed by the Musculoskeletal Tumor Society (MSTS) score, the American Shoulder and Elbow Society (ASES) score, and Constant score? (3) What was the survivorship of these grafts free from revision and graft removal at 5, 10, and 15 years? METHODS Between 1987 and 2021, 127 patients were treated at our institution with en bloc resection for a primary malignant or an aggressive benign bone tumor of the humerus; we excluded patients treated with extra-articular resection or amputation. Of those, 14% (18 of 127) were treated with intercalary resection of the humeral diaphysis for primary bone tumors and reconstruction with VFG, with or without a bulk allograft, and were analyzed in this retrospective study. Generally, our indications for reconstruction with VFG are intercalary resection of the humerus for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands, in whom adequate bone stock of the proximal and distal epiphysis can be preserved. In 13 patients, VFG was used alone, whereas in five patients, a massive allograft was used. Our policy was to use VFG combined with a massive allograft in patients undergoing juxta-articular joint-sparing resections in which proximal osteotomy was performed close to the anatomic neck of the humerus to obtain more stable fixation and better tendinous reattachment of the rotator cuff and deltoid. All 18 patients who were treated with a VFG were available for follow-up at a minimum of 2 years (median follow-up 176 months, range 26 to 275 months), and although three have not been seen in the past 5 years and are not known to have died, they had 172, 163, and 236 months of follow-up, and were included. The median age at surgery was 25 years (range 2 to 63 years), the median humeral resection length was 15 cm (range 8 to 21 cm), and the median fibular length was 16 cm (range 12 to 23 cm). Complications and functional scores were ascertained by chart review that was performed by an individual not involved in patient care. Functional results were assessed with the MSTS score (range 0 to 30), the ASES score (range 0 to 100), and the Constant score (range 0% to 100%). Survivorship was estimated using a Kaplan-Meier survivorship estimator, which was suitable because there were few deaths in this series. RESULTS Seven patients underwent a revision procedure (one radial nerve transient palsy because of screw impingement, four nonunions in three patients with one humeral head avascular necrosis, treatment for screw-related pain in one patient, and two VFG fractures), and one patient underwent VFG removal. Donor site complications were observed in four patients (one ankle valgus deformity and three claw toes-the first toe in two patients and the other toes in the third). At the final clinical control, at a median follow-up of 176 months (range 26 to 275 months), the median MSTS score was 30 of 30 (range 28 to 30), the median ASES score was 98.3 (range 93 to 100), and the median Constant score was 93.5% (range 79% to 100%). Revision-free survival was 71% (95% CI 53% to 96%) at 5 years and 57% (95% CI 37% to 88%) at 10 and 15 years; VFG removal-free survival was 94% (95% CI 83% to 100%) at 5, 10, and 15 years. CONCLUSION VFG appears to be an effective reconstructive option after humeral intercalary resection for primary bone tumors. These are complex procedures and should be performed by an experienced team of surgeons who recognize that complications may occur frequently in the first years after the procedure. The frequency of mechanical complications observed in the first 5 years postoperatively may be lessened by using long spanning-plate fixation, and if successful, this reconstruction provides a long-term, durable reconstruction with excellent functional results. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Scanferla
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Serena Puccini
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Meyer University Hospital, Florence, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Cisanello University Hospital, Pisa, Italy
| | - Marco Innocenti
- Department of Plastic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
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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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Bellringer S, Jukes C, Dirckx M, Guryel E, Phadnis J. Strain reduction screws for nonunions following fixation around the elbow - A case series and review of the literature. J Clin Orthop Trauma 2023; 38:102129. [PMID: 36860994 PMCID: PMC9969280 DOI: 10.1016/j.jcot.2023.102129] [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] [Received: 06/10/2022] [Revised: 01/20/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Background Nonunions following fracture fixation result in significant patient morbidity and financial burden. Traditional operative management around the elbow consists of removal of metalwork, debridement of the nonunion and re-fixation with compression, often with bone grafting. Recently, some authors in the lower limb literature have described a minimally invasive technique used for select nonunions where simply placing screws across the nonunion facilitates healing by reducing inter-fragmentary strain. To our knowledge, this has not been described around the elbow, where traditional more invasive techniques continue to be employed. Aims The aim of this study was to describe the application of strain reduction screws for management of select nonunions around the elbow. Methods & Results We describe 4 cases (two humeral shaft, one distal humerus and one proximal ulna) of established nonunion following previous internal fixation, where minimally invasive placement of strain reduction screws were used. In all cases, no existing metal work was removed, the nonunion site was not opened, and no bone grafting or biologic stimulation was used. Surgery was performed between 9 and 24 months after the original fixation. 2.7 mm or 3.5 standard cortical screws were placed across the nonunion without lagging. Three fractures went on to unite with no further intervention required. One fracture required revision fixation using traditional techniques. Failure of the technique in this case did not adversely affect the subsequent revision procedure and has allowed refinement of the indications. Conclusion Strain reduction screws are safe, simple and effective technique to treat select nonunions around the elbow. This technique has potential to be a paradigm shift in the management of these highly complex cases and is the first description in the upper limb to our knowledge.
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Affiliation(s)
- S.F. Bellringer
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - C. Jukes
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - M. Dirckx
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - E. Guryel
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - J. Phadnis
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
- Brighton and Sussex Medical School, UK
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Bégué T, Mouchantaf M, Aurégan JC. Aseptic humeral shaft nonunion. Orthop Traumatol Surg Res 2023; 109:103462. [PMID: 36942794 DOI: 10.1016/j.otsr.2022.103462] [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] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
Aseptic humeral shaft nonunions are rare lesions, with less than 700 cases per year in France. This low frequency explains why they are difficult to manage. They can be hypertrophic or atrophic, with or without a defect. The diagnosis is made based on radiographs and/or CT scan images. Nonunion is suspected early on when a patient presents with abnormal motion at the fracture site 6 weeks after the initial injury event in the context of conservative treatment or has large residual displacement after initial treatment or an open fracture. The treatment for hypertrophic nonunion consists in applying stable, rigid fixation, most often using a large-fragment plate with 4.5 mm screws, combined with cancellous autograft. When combined with the osteoperiosteal decortication first described by Judet, it produces union in 98% of cases. Intramedullary (IM) nail fixation with an autograft is another possibility. In atrophic nonunions, resecting the ends and ensuring the soft tissues have good vitality will generally lead to fracture union. Nonunions with critical size defects (larger than 5 cm), which have a high risk of infection, are a treatment challenge that requires stable fixation and recourse to more complex treatments like the two-step induced membrane technique or vascularized fibular graft. In all cases, to avoid complex repeat revision, internal fixation with plate or IM nail must be combined with a bone graft in situ to maximize the chances of union.
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Affiliation(s)
- Thierry Bégué
- Service de chirurgie orthopédique et traumatologique, hôpital Antoine Béclère, université Paris-Saclay, AP-HP, 157, rue de la Porte de Trivaux, 92140 Clamart, France.
| | - Mark Mouchantaf
- Service de chirurgie orthopédique et traumatologique, hôpital Antoine Béclère, université Paris-Saclay, AP-HP, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Jean-Charles Aurégan
- Service de chirurgie orthopédique et traumatologique, hôpital Antoine Béclère, université Paris-Saclay, AP-HP, 157, rue de la Porte de Trivaux, 92140 Clamart, France
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Masquelet's induced membrane technique associated with Reamer Irrigation Aspiration grafting and intramedullary Nailing (MaRIAN) for chronic diaphyseal osteomyelitis of the lower limb. Orthop Traumatol Surg Res 2022; 108:103395. [PMID: 36084914 DOI: 10.1016/j.otsr.2022.103395] [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] [Received: 06/07/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Masquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails. MATERIAL AND METHOD This retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique. RESULTS Among this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3cm (±6.7). The mean time between the 2 stages was 2.7months (±3) with a mean antibiotic period of 3.25weeks (±3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18months, with an average of 5years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR=-7.68 95% CI [-13.33 to -2.08] (p=0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR=-0.86 95% CI [-1.39 to -0.33] (p=0.007)). DISCUSSION AND CONCLUSION This short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest. LEVEL OF EVIDENCE IV, retrospective study.
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Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction. Mil Med Res 2022; 9:48. [PMID: 36050805 PMCID: PMC9438145 DOI: 10.1186/s40779-022-00411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Because of its simplicity, reliability, and replicability, the Masquelet induced membrane technique (IMT) has become one of the preferred methods for critical bone defect reconstruction in extremities. Although it is now used worldwide, few studies have been published about IMT in military practice. Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury, early wound infection, and even delayed management in austere conditions. Based on our clinical expertise, recent research, and a literature analysis, this narrative review provides an overview of the IMT application to combat-related bone defects. It presents technical specificities and future developments aiming to optimize IMT outcomes, including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
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Assessment of fibular regeneration after graft harvesting in patients with benign bone tumors: A retrospective study comparing different age groups. Orthop Traumatol Surg Res 2022; 108:103108. [PMID: 34634503 DOI: 10.1016/j.otsr.2021.103108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Using non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HYPOTHESIS Growth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. PATIENTS AND METHODS This is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12-18, and 80 above the age of 18. RESULTS In children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DISCUSSION Complete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. LEVEL OF EVIDENCE IV; case series, retrospective comparative study.
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Bridge plating with decortication, autologous bone graft, and tight closure: a “stepwise surgical diamond concept” for treatment of nonunion in a series of fifty five patients. INTERNATIONAL ORTHOPAEDICS 2022; 46:1241-1251. [DOI: 10.1007/s00264-022-05379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Sadek AF, Fouly EH, Allam AFA, Mahmoud AZ. Non-vascularized fibular autograft for resistant humeral diaphyseal nonunion: Retrospective case series. Orthop Traumatol Surg Res 2021; 107:102843. [PMID: 33548560 DOI: 10.1016/j.otsr.2021.102843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is a great surgical challenge when humeral diaphyseal fractures are initially open, complex, or associated with segmental bone loss. The challenge becomes even greater with previous multiple unsuccessful surgeries. The question of this study was: Does combining locked compression plating with non-vascularized fibular autograft in cases of resistant humeral diaphyseal nonunion yield reliable bony union and satisfactory functional outcome? HYPOTHESIS The use of non-vascularized fibular autograft in conjunction with locked compression plating will provide stable construct, enhance bony union and improve functional outcome in cases of resistant humeral diaphyseal nonunion. MATERIALS AND METHODS Thirty-three patients with resistant humeral diaphyseal nonunion who were surgically managed combining non-vascularized fibular autograft fixed with locked compression plating in the period from January 2011 to June 2017, were retrospectively studied. All patients were followed-up for a minimum of 24 months. The time to union, the postoperative disability of arm, shoulder and hand (DASH) score, in addition to the possible complications including infection or nonunion were reported and analyzed. RESULTS Twenty-nine patients have achieved union at the final follow-up with a mean time to radiological union of 7.5±2.6 months (range: 3-12). The mean postoperative DASH score was 7.7±8.9 (range: 0-38.8) which was significantly better than the preoperative value (p<0.001) and superior in the patients of aseptic nonunion (p=0.04). Eight patients showed complications in the form of infection (four), nonunion (two cases), transient radial nerve palsy (one case) and one case of septic nonunion that was managed by two-stage reconstruction using vascularized fibular autograft. There were comparable results in patients with either open or closed fractures. However, patients with septic nonunion experienced more significant complications (p=0.02). DISCUSSION The use of non-vascularized fibula autograft in cases of resistant humeral diaphyseal nonunion provides adequate fracture stability, quadrilateral screw purchase, enhances bony union in addition to promoting satisfactory functional outcome particularly in aseptic nonunion. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Ahmed Fathy Sadek
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Ezzat Hassan Fouly
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Alaa Zenhom Mahmoud
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [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: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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Masquelet AC. The induced membrane technique. Orthop Traumatol Surg Res 2020; 106:785-787. [PMID: 32782174 DOI: 10.1016/j.otsr.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Alain C Masquelet
- Service de chirurgie orthopédique, hôpital Saint-Antoine, Sorbonne university, 184, rue du Faubourg St-Antoine, 75571 Paris, France.
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