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PubMed1994

The Orthofix external fixator for fractures of long bones.

The Orthofix external fixator was used to treat 112 fractures of the long bones in 101 patients, and 22 patients with infected nonunions. Our results compared favourably with those reported in other series where external fixation was used. The overall rate of uncomplicated union was 69.6% with 24.1% of patients requiring a further operation. The overall incidence of nonunion (30.4%) was due to the relatively large number of severe open fractures in the series. The apparatus was simple to apply, and safe and effective in practice. We recommend its use for the primary treatment of open and segmental fractures, and for infected nonunion.

Adolescent↗
PubMed1983

[The risk non-union following closed-focus nailing and reaming. Results of 1059 interventions using the Kunstcher method].

The authors have studied a series of 1059 compound and closed fractures of the diaphysis of long bones treated by intramedullary nailing according to the technique of Kuntscher, to assess the incidence of non-union. Between January 1st 1967 and December 31st 1980, 503 fractures of the tibia, 440 of the femur and 116 of the humerus were so treated in both adolescents and adults. The fractures were mostly sustained in road traffic accidents. The risk of aseptic non-union was small, but occurred more readily when the skin was damaged and when the site of the fracture was at the junction of the lower two quarters of the tibia; the incidence was highest when the technique of nailing was incorrect or when the going was undertaken too late. The incidence of non-union and infection are compared with those of other series using the same closed technique and with reports describing insertion of the nail of the plate by opening the fracture. It is concluded that intramedullary nailing using the Kuntscher technique is the most reliable treatment for this type of injury for routine use in an acute fracture service. In this series the incidence of aseptic non-union was approximately 1%, of infection with non-union less than 0.5% and of early infection with eventual union less than 1.5%.

Adolescent↗
PubMed1993

Osteosynthesis for longstanding nonunion of the lateral humeral condyle.

Six patients with symptomatic longstanding nonunion of the lateral humeral condyle were treated by internal fixation with iliac bone graft. The indication for surgery was pain and weakness in the elbow. Follow-up ranged from 18 months to 4 years, with an average of 28 months. Bony union was achieved in all cases. Stability and strength of the elbow were restored in all cases, but postoperative elbow motion was decreased in three patients, with an average loss of 6.7 degrees of the motion present before surgery. All patients were painfree in the elbow upon strenuous activities and satisfied with the outcome of the procedure.

Adolescent↗
PubMed1992

Non-invasive treatment of long-bone pseudarthrosis by shock waves (ESWL).

Non-invasive treatment of non-union of diaphyses by application of the shock waves known from lithotripsy has proved successful in three out of four cases. Two thousand shock waves with a single-wave energy of 18 kV were applied by the MFL 5000 and HM3 Lithotripters of the Dornier Medizintechnik Company with manual detection of the lesion. The shock waves induced a kind of callus formation in the non-union soft tissue within about 6 weeks, which was successfully maintained and transformed into bony union in all cases but one by dynamic fixation less rigid than a plaster cast. Four cases are documented and the effects of the shock waves and principles of bony union discussed.

Adult↗
PubMed1982

[Non unions of the humerus shaft (author's transl)].

The clinical evaluation of 121 cases of non union of the humerus shaft shows that 46 of these occurred after conservative and 75 after operative treatment. The main failures could be found after conservative treatment by traction methods. Operative treatment by intramedullary splinting did not achieve sufficient stability. The high rate of non unions after plate osteosynthesis is caused by basic technical faults in nearly all cases. The number of postoperative nerve palsy is remarkable. All cases could be healed by means of proper plate osteosynthesis after decortication combined with cancellous bone grafting in 12 atrophic non unions. The high rate of non unions of the humerus shaft gives occasion to reflect upon the correct indications for fracture treatment. From our point of view a more conservative attitude should be required.

Adolescent↗
PubMed1995

[Expanded indications for the Herbert-screw osteosynthesis].

Since 1984 the typical headless double threaded Herbert/Whipple screw is known in managing scaphoid fractures and scaphoid non-unions. We resume technical, biomechanical and histological aspects to point out advantages and disadvantages of this osteosynthesis. Our case review of 39 patients illustrate the same good results as achieved in treating scaphoid injuries, when using the Herbert/Whipple screw of a larger diameter for expanded indications other than scaphoid fractures, such as humeral- or radial-head fractures, Jones fractures and others.

Adolescent↗
PubMed2007

[TGF-beta1 as a pathophysiological factor in fracture healing].

AIM: TGF-beta1 is an important local and systemic regulatory molecule during fracture healing. Various authors have shown differences in the systemic levels of TGF-beta1 over the time taken for bone healing in distraction osteogenesis and osteotomies. Previous studies have shown characteristic differences in the physiological levels of growth factors between normal fracture healing and delayed fracture union. The aim of the present study was to evaluate possible differences in sera levels of patients with normal and delayed union fracture healing. METHODS: Patients with long bone shaft fractures were recruited prospectively. Peripheral blood samples were collected over a period of 1 year using a standardized time schedule. At the end of the individual's investigation period, TGF-beta1 levels were determined. To achieve a homogeneous collective of patients, only those with a maximum of two fractures were included in the study. After matching for four criteria, we compared patients with normal fracture healing to patients with delayed unions. The fact of delayed union was accepted in case of failed consolidation 4 months after trauma. RESULTS: During a prospective study period of 1 year, 15 patients with normal fracture healing could be compared to 15 patients suffering from delayed union. By determining the absolute sera levels we found a typical increase of TGF-beta1 up to 2 weeks after fracture in both groups, with a subsequent decrease up to the sixth week after fracture. However, a decline in serum concentration occurred earlier in patients with delayed union, causing significantly lower TGF-beta1 levels in the non-union group 4 weeks after trauma (P=0.00006). CONCLUSION: Even with a relatively small number of patients, we could show a significant difference in serum concentrations of TGF-beta1 between the investigated groups. If these results can be verified within a larger collective, TGF-beta1 could be used as a predictive cytokine for delayed fracture healing.

Adult↗
PubMed2002

Non-union of the humeral shaft treated by internal fixation.

We reviewed 40 cases with non-union of the humeral shaft. There were 31 men and nine women patients with an average age of 38.5 (35-65) years. Thirty-four non-unions were of the atrophic type. Non-union was most often found at the transition of the middle third to the lower third of the humeral shaft. Six fractures were classified as open at the time of the initial injury. All patients were treated by open reduction and internal fixation with a dynamic compression plate (DCP). Cancellous bone graft was used in all atrophic non-unions. In one patient an additional fibular graft was used. The average follow-up was 13 (6-18) months. Final results were available for 34 patients. Thirty-one fractures (91%) healed in an average of 4.5 (3-9) months. Main complications were temporary radial nerve palsy in two patients and deep infection in one.

Adult↗
PubMed2001

Surgical treatment of distal intraarticular humeral fractures in adults.

We reviewed 17 patients with distal intraarticular humeral type C fractures, treated by open reduction and internal fixation, followed by an early rehabilitation programme. The results, as judged by the criteria of Jupiter, were excellent in ten, good in five and fair in two. Non-union of the olecranon osteotomy occurred in one patient.

Activities of Daily Living↗
PubMed1999

Complications of Marchetti locked nailing for humeral shaft fractures.

In this retrospective study 50 humeral fractures (36 acute, 6 pathological fractures and 8 non-unions) were treated by retrograde locked bundled Marchetti nailing. No intraoperative complications occurred. Postoperative complications included 7 non-unions (4/36 acute fractures and 3/8 delayed union), and 2 intraarticular penetrations of the secondary nails. However, at the subsequent removal of the implant 5 supracondylar fractures occurred.

Adult↗
PubMed2001

Treatment of humeral shaft non-unions by the Ilizarov method.

Thirty-five humeral shaft non-unions treated by the Ilizarov external fixator were studied after an average of 39 months. Bone union was achieved in all but one. The mean time to union was 5.5 months (range: 3-10 months). Major pin tract problems leading to removal of the Schanz screws occurred in three patients. A radial nerve palsy developed in three patients, two recovered spontaneously and one was treated with a triple tendon transfer.

Adolescent↗
PubMed2003

Treatment of humeral shaft nonunions: nailing versus plating.

INTRODUCTION: The aim of this study was to compare plating and nailing for treating nonunions of the upper two-thirds of the humerus. MATERIALS AND METHODS: Fifty nonunions of the upper two-thirds of the humerus were treated by two different methods: 24 of them by unreamed locked nailing and bone graft (group A), and the other 26 by plate fixation and bone grafting (group B). RESULTS: All fractures healed in both groups. In group A, the time required for healing was 4.2 months (range 4-6 months), whereas in group B it was 4.7 months (range 4-6 months). This difference was statistically significant ( p<0.05). Functional results and the range of motion of the shoulder and elbow were similar with both techniques. In group B there were 3 cases of transient, iatrogenic, radial nerve palsy. CONCLUSIONS: We feel that both plate fixation and the unreamed humeral locked nail are good alternatives for the treatment of humeral shaft nonunions, although nailing achieves union earlier and has fewer complications.

Adolescent↗
PubMed2001

Adaptation of Ilizarov ring fixator to the economic situation of developing countries.

Especially in countries with low per capita income, poor patients with open fractures and non-unions are unable to purchase modern, commercially produced surgical implants. To alleviate this situation, we initiated the production of a locally made ring fixator. The rings were cut from tubes cast from scrap aluminium. It was applied in 40 patients to test its utility for the typical indications for the Ilizarov technique. The fixator was tolerated well. All fractures united except in one case where there was refracture of the consolidate due to too early removal of the fixator. Two arthrodeses were successful. Bone transport showed adequate regeneration. A single radial non-union united successfully. Loosening occurred in 11 wires and breakage in 6. The subacute infections in 11 (27.5%) patients were not due to the fixator itself but to low standards of hygiene and the delay of treatment in the prehospital phase. Reusing the fixator at least three times reduces the cost for the individual patient to US$ 13.60. A locally made fixator is cost-effective and can be recommended for surgical treatment under similar economic situations.

Adolescent↗
PubMed1998

Staple augmentation to treat a humeral nonunion after failed Seidel locked nailing.

Seidel locked nailing has been successfully used to treat a humeral shaft fracture or nonunion. However, if union fails despite this treatment, the next approach to try has not been well defined. We, therefore, developed a technique using a staple to enforce the local stability without removing the failed nail. The technique was very simple, and the outcome was always satisfactory.

Adult↗
PubMed1998

Interlocking nailing of humeral shaft fractures.

: In this retrospective study 48 humeral shaft fractures in 48 patients were operated on using the Seidel interlocking nail. The length of follow-up ranged from 6 to 60 months (median, 26 months). The treatment of fractures was satisfactory with the Seidel nail, but we emphasize the importance of countersinking the tip of the nail into the humeral head to avoid impingement. In 5 of 12 patients with non-unions, the procedure failed, and we found that the distal locking seemed to be inadequate. Pathological fractures (i.e., those caused by metastatic tumors) were all efficiently treated with the Seidel nail.

Adult↗
PubMed1998

One-stage open cancellous bone grafting of infected fracture and nonunion.

Nineteen patients with either infected fractures or nonunions were managed by a one-stage protocol consisting of thorough debridement of the septic focus, followed by stabilization with an external fixator or a cast and fresh autogenous cancellous bone grafting; the wound was then left open. Nineteen fractures were healed and free of infection at an average of 3.5 years follow-up. Some considerations, including debridement, stabilization, bone grafting, and wound coverage, are discussed.

Adult↗