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PubMed2001

Treatment of humeral shaft nonunion by external fixation: a valuable option.

We report the treatment of six patients with nonunion of the humerus, using a unilateral fixator and bone grafting. Union was obtained in all patients, with an average time to union of 4.5 months. Superficial pin tract infection was seen in five patients, but resolved uneventfully. One patient had transient radial nerve palsy. The results, according to the Stewart and Hundley criteria, were excellent in one patient, good in three, fair in one, and poor in one. The main cause of the fair and poor results was marked limitation of shoulder and elbow motion. This method, however, seems to be therapeutically effective.

Adult↗
PubMed1978

The role of osteomedullography in the management of delayed union and non-union of diaphyseal fractures of the long bones: a preliminary report.

The significance of osteomedullography was studied in 17 patients with diaphyseal fractures of long bones to determine a rational form of treatment for delayed healing and non-union. Positive osteomedullographic signs were noted in 6 cases of delayed healing and negative signs in 11 cases. All the positive cases united by prolonging the period of immobilization in plaster. Seven of the 11 negative cases were treated by bone grafting. Three patients treated by prolonged immobilization in plaster have not shown evidence of union even after a period of 20 weeks. This simple investigation could be useful in avoiding undue loss of time in the management of delayed union and non-union.

Adolescent↗
PubMed1988

Humeral medullary nailing--a new implant.

A new technique of medullary nailing of the humerus using a screw-headed nail is described. Eighteen patients with two-part fractures of the surgical neck of the humerus were reviewed. Fifteen had satisfactory results while three were unsatisfactory. Nine patients with fractures of the shaft of the humerus were also treated with satisfactory results in eight. Three patients with non-union of the humerus had unsatisfactory results.

Adolescent↗
PubMed1993

Locked intramedullary nailing of humeral fractures.

Of 46 patients, 30 with fresh fractures of the humerus, nine with non-unions and seven with pathological fractures were treated with a new locked intramedullary nail. Of 30 patients with a fresh humeral fracture, three were lost to follow-up. All fresh fractures healed within 4 months. Functional results of the fresh fracture group were excellent in eighteen patients and satisfactory in three patients. Two patients with Neer type 6 fractures had unsatisfactory shoulder function; in the four other patients poor shoulder function resulted from a pre-existing condition. Out of nine non-unions, six united within 6 months. The three other patients with atrophic non-union required bone-grafting later, after which consolidation was obtained. The long functional recovery period of the non-union group was related to the pre-existing limited shoulder function. The seven patients with a pathological fracture died within 8 months of operation. While alive they were free from pain and could be nursed well.

Adolescent↗
PubMed1994

Preliminary clinical experience with a new fluted humeral nail.

The early clinical results of humeral nailing using a fluted intramedullary nail with a locking screw are reported. The True-Flex nail has been designed with a proximal cancellous screw to prevent 'back-tracking' and with flutes to give rotational control. The design features have proved to be successful in the authors' brief clinical experience in 12 patients with complicated fractures, non-unions or pathological lesions. Eight of the 10 fractures healed uneventfully, one by delayed union; one had to be revised because of loosening due to use of a nail which was too narrow. There were no serious complications. Return of function in the arm was good. This humeral nail may be suitable for fixation of some complicated and difficult fractures and lesions of the humeral shaft.

Adult↗
PubMed1994

Double tension band osteosynthesis in supra- and transcondylar humeral fractures.

Distal intra-articular bicondylar humeral fractures are usually treated by means of cancellous screw(s) for the condylar block and one or two plates for fixation of the block to the shaft. The method and results of double tension band osteosynthesis instead of double plating for fixation of the condylar block to the shaft are described here. The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and symmetrical compression. The functional results and complications of patients treated by this method are compared with the results of patients treated with plate fixation.

Adult↗
PubMed1995

Ultrasonographic appearance of external callus in long-bone fractures.

High-resolution real-time ultrasound (US) scanning was used to monitor serially 24 patients with an acute long-bone fracture and three patients with humeral non-union, looking at the fracture site over a period of 12 months following the fracture. In both these groups, we found that US gave important information about the soft tissues surrounding the fracture site, and indicated callus formation at an early stage. US was more sensitive than conventional radiography at showing the early phases of organization of the callus, and its progression to bridging new bone formation. US also clearly showed a disorganized echopattern at the fracture site of the patients with non-union.

Adolescent↗
PubMed1995

Seidel interlocking nailing for healing problems in humeral shaft fractures.

In 14 patients aged 38 to 87 years humeral shaft fractures were operated on for failure of reduction, for delayed healing or for established non-union with the Seidel interlocking nail system. In five patients intraoperative technical problems were encountered. The healing rate was eight out of 12 patients. In cases of pseudarthrosis of the humeral shaft, bone grafting or local osteosynthesis in addition to medullary nailing seem advisable. The distal interlocking mechanism of the Seidel nail should be improved.

Adult↗
PubMed1985

Vibration analysis in the assessment of conservatively managed tibial fractures.

A simple and quantitative method for the assessment of fracture healing has been developed. this method depends on a technique of vibration analysis evolved from a study of 30 intact human tibiae and has been applied to the study of 22 tibial fractures. Real time vibration analysis will allow quantitative comparisons of different methods of non-operative fracture management, and, in addition to providing a uniquely powerful research tool, may have value in aiding clinical management decisions.

Biomedical Engineering↗
PubMed1994

Fractures of the supracondylar process of the humerus.

The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.

Adolescent↗
PubMed2006

Current concepts in delayed bone union and non-union.

Healing of a fracture is a continuous process that involves various types of histologic regeneration at different sites. This article describes current approaches to managing delayed union and non-union of fracture.

External Fixators↗
PubMed2005

Pulsed low-intensity ultrasound for fracture healing.

A large body of evidence confirms the stimulatory effect of pulsed low-intensity ultrasound on fresh fractures, nonunions, and other osseous defects such as osteotomies. This article presents the findings of some of these studies and briefly discusses our current understanding of its molecular mechanisms.

Animals↗
PubMed2005

Failure of reamed nailing in humeral non-union: an analysis of 26 patients.

The use of an intramedullary nail in the treatment of humeral non-unions remains controversial. This study evaluated the treatment of humeral delayed and non-unions with reamed nailing and compression. In a retrospective analysis of prospectively gathered data from 26 cases all treated with the Telescopic Locking Nail (TLN), the healing rate after the first intervention for non-union was 58%. After one or more re-interventions combined with an external cancellous bone graft at some time during follow-up, 90% of the 21 patients with complete follow-up eventually healed after a mean of 22 months. A total of 49 procedures with a mean of 1.9 per patient were needed. After a mean follow-up of 65 (range 24-88) months, we conducted a study to assess the functional results in the shoulder and elbow. Twelve patients were suitable for inclusion. We used the Neer and Morrey score for shoulder and elbow function, respectively. For the Neer score the median was 91 points and for the Morrey score 94 points. The outcome suggests that simple reamed nailing of humeral non-union is insufficient. Reamed interlocked nailing is feasible, provided that the primary intervention for non-union is combined with an external cancellous bone graft.

Adult↗