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PubMed2005

Application of recombinant BMP-7 on persistent upper and lower limb non-unions.

The purpose of this study was to evaluate the efficacy and safety of recombinant bone morphogenetic protein 7 (rhBMP-7 or OP-1) as a bone-stimulating agent in the treatment of persistent fracture non-unions. Twenty-five consecutive patients [19 males, mean age 39.4 years (range: 18-79)] with 26 fracture non-unions were treated with rhBMP-7. There were 10 tibial non-unions, eight femoral, three humeral, three ulnar, one patellar, and one clavicular non-union. The mean follow-up was 15.3 months. The mean number of operations performed prior to rhBMP-7 application was 3.2, with autologous bone graft and bone marrow injection being used in 10 cases (38.5%). Both clinical and radiological union occurred in 24 (92.3%) cases, within a mean time of 4.2 months and 5.6 months, respectively. Of the remaining two cases, one patient ultimately underwent a below knee amputation, secondary to recurrence of deep sepsis. The other patient with recalcitrant ulnar non-union although the radiological union was incomplete, declined further intervention, as he was asymptomatic. No complications or adverse effects from the use of rhBMP-7 were encountered. This study supports the view that the application of rhBMP-7 as a bone-stimulating agent is safe and a power adjunct to be considered in the surgeon's armamentarium for the treatment of these challenging clinical conditions.

Adolescent↗
PubMed2004

Marchetti nailing of closed fresh humeral shaft fractures.

INTRODUCTION: The purpose of this study was to analyse the results of Marchetti nailing. METHOD: Between 1995 and 2003, 143 patients with closed fresh humeral shaft fractures were treated with the Marchetti-Vicenzi nail. The fractures were classified according to the AO classification: 37 A1, 24 A2, 25 A3, 22 B1, 15 B2, 7 B3, 7 C1, 4 C2 and 2 C3. RESULTS: Fracture healing was obtained in 136 cases. The mean healing time was 11 weeks. There were seven non-unions. The range of motion of the shoulder was excellent in 95 patients (66.4%), moderate in 43 (30%) and poor in five (4.2%). The elbow had an excellent range of motion in 89 patients (62.2%), moderate in 48 (33.5%) and poor in six (4.2%). The functional result was excellent in 56 patients (39.1%), good in 62 (43.3%), fair in 18 (12.6%) and poor in seven (4.9%). CONCLUSION: Marchetti-Vicenzi nailing appears to be a good method for the treatment of humeral shaft fractures. It is technically easy and its results are satisfactory.

Adolescent↗
PubMed2005

[Retrograde intramedullary nailing for humeral shaft fractures in adults. Evaluation of anatomical and functional results in 63 cases].

PURPOSE OF THE STUDY: Many methods have been proposed for treatment of displaced humeral shaft fractures in adults. This study was designed to evaluate the anatomical and functional results of patients treated by retrograde intramedullary nailing through the lateral condyle. MATERIALS AND METHODS: Sixty-three fresh traumatic fractures of the humerus were treated between January 2000 and January 2003. Five patients were lost to follow-up. The AO classification and the Hackethal classification modified by De La Caffinière were used. Outcome was assessed according to the modified Stewart and Hundey classification. RESULTS: We had 23 very good results, 26 good results, five passable results and four bad results. The bad results were three cases of non-union and one case with poor function (stiffness of elbow and shoulder). Mean delay to union was ten weeks four days. There were no cases of iatrogenic radial nerve palsy or pin migration. CONCLUSION: Retrograde intramedullary nailing is a reliable method, easy to perform and of low economic cost. We propose it for all types of displaced shaft humeral fractures.

Adolescent↗
PubMed2000

Treatment of acute closed humeral shaft fractures with Ender nails.

The effect of semirigid Ender nails (EN) in the treatment of closed humeral shaft fractures was reviewed and analyzed. Clinical study was set retrospectively with detailed parameters. One hundred and eighteen closed humeral shaft fractures, treated with closed reduction and internal fixation with ENs, were collected. The follow-up period was 78 (24-175) months. The average operation blood loss was 105 cc, operation time was 57 min, hospital stay was 6.5 days, and union time was 10.5 weeks. The postoperative complications included three superficial infections, one iatrogenic radial nerve palsy, eight nail backouts, and eight nonunions. In our experience, for closed humeral shaft fractures fixed surgically, EN is a good choice for its simplicity and efficacy, but the fracture gap should be minimized after fixation and postoperative care should be closely observed.

Adolescent↗
PubMed2001

Treatment of non-union of the humerus using the Orthofix external fixator.

An Orthofix monolateral axial external fixator was used to treat 31 patients with non-union of the humeral shaft, 30 of whom had been previously treated surgically. In seven cases the non-union was hypertrophic and one of these cases had been treated by simple fixation anol compression, the others by fixation, bone grafting and decortication; in 20 cases the non-union was hypotrophic and had been treated by fixation and decortication with bone grafting. The remaining four cases had septic non-union, treated by debridement of the focus of infection and fixation, followed in three cases by a bone graft and osteomuscular decortication once the infection had been eradicated. The fracture site consolidated in all patients in a mean time of 4.9 months. Five patients required further surgery: three in the group with infected non-union and two who had had a new bone graft and application of the external fixator, one because of a refracture (the patient was receiving chronic treatment with antimitotic agents) and one because of persistent non-union. There were no major complications (e.g. radial nerve palsy, joint stiffness, deep infection), and only six cases of pin track infection (5% of the screws implanted). The authors believe that this method is reliable, effective and low risk provided that the patient is cooperative; furthermore, the monolateral axial external fixator is tolerated well and allows movement of the shoulder and elbow throughout the period of treatment.

Adolescent↗
PubMed2002

The Marchetti-Vincenzi humeral nail--a useful device in fresh fractures.

Whilst most humeral fractures may be treated by closed methods, humeral nailing has gained popularity where a surgical option is indicated. Concern has been expressed regarding placement of proximal and distal locking screws whilst the efficiency of the ingenious intra-medullary locking device of the Seidel nail has also been questioned. The Marchetti-Vincenzi nail, which "locks" proximally with the spreading of intra-medullary pins and distally with a single screw inserted via the surgical wound, apparently avoids potential neurovascular and tendon injury. Prospectively recorded data was analysed in 19 "fresh" fractures, i.e. within 3 weeks of injury, and in 13 "late" fractures (total of 32 humeral fractures) treated with the Marchetti nail. All fresh fractures thus treated progressed to union, whilst in the late fracture group there were three non-unions all of whom were in osteoprotic females. Whilst we commend the use of the Marchetti humeral nail in fresh fractures, we have reservations about its use in "late" fractures particularly where the patient is female and osteoporotic.

Adolescent↗
PubMed2003

The use of a locking custom contoured blade plate for peri-articular nonunions.

A retrospective chart and radiographic review was performed of 37 operative procedures over 7 years period for peri-articular nonunions. This was a consecutive cohort from a single orthopedic trauma service of a Level 1 center. Nonunions of the tibia and humerus were treated with blade plates fashioned from standard compression plates. Twenty-nine operative sites were treated successfully. The average age was 45.0 years; the average follow-up being 5.3 years. The average number of operations before blade plate was 4.0 (range 1-16). Sixteen blade plates were performed in patients with a diagnosis of clinical infection and all progressed to union and resolution of infection. Seven tissue transfers were used as adjunctive therapy. Five other patients with blade plate surgery had persistent nonunion, of which four united after a second custom contoured blade plate procedure. This study illustrates that surgeon contoured blade plates are an option for peri-articular nonunions even in the presence of infection. This technique resulted in a high union rate and a low complication rate compared to other options.

Accidental Falls↗
PubMed2004

Delayed and non-union of the humeral diaphysis--compression plate or internal plate fixator?

In a retrospective study, two groups of patients with delayed or non-union of the humeral diaphysis were compared. In group A, a 4.5-mm low-contact dynamic compression plate (LCDCP) was used for internal fixation and in group B, an internal plate fixator with locked screws was used. In all patients autologous bone grafting was performed. Group A consisted of 14 patients (mean age 38.9 years) and group B consisted of 19 patients (mean age 54.3 years). The mean duration of the delayed or non-union was 9.3 months (range 3-26 months) in group A and 24.8 months (range 3-216 months) in group B. In group A an average of 1.1 (range 0-2) previous operations had been performed, and in group B an average of 1.6 (range 0-4). One primary nerve palsy was diagnosed in group A and six in group B. Although the patients of group B were older, had longer-lasting non-unions, more previous operations and more severe initial injuries, only in group A was there a hardware failure due to osteoporosis which required re-osteosynthesis. All other patients showed bony consolidation without further operations. The LCDCP and the internal plate fixator both showed high consolidation rates, but we feel that the internal plate fixator may be the more reliable implant, especially in patients with poor bone stock.

Adolescent↗
PubMed2004

Marchetti nailing of humeral shaft delayed unions.

The purpose of this study is to present the results of Marchetti nailing in humeral shaft delayed unions. Fifteen humeral shaft delayed unions were treated with the Marchetti nail. The average age of patients was 52.3 years. All had been treated initially by conservative methods. Delay from trauma to surgery averaged 4.8 months. The nailing technique was retrograde, and reaming of the fracture focus was always performed. Bone graft was not added. Thirteen patients achieved union, in an average of 3.3 months. Two patients require further surgery to gain union. Shoulder and elbow motion was excellent in 10 patients, moderate in four and poor in one. The functional result was excellent in nine patients, good in two, fair in two, and poor in two. Marchetti nailing seems to be an acceptable alternative for humeral shaft delayed unions.

Adult↗
PubMed2004

Supracondylar Femoral Nail in the management of non-union of humeral shaft fractures.

We reviewed seven patients with established non-union of a shaft of humerus fracture, treated by locked intramedullary nailing using the Intramedullary Supracondylar Nail (IMSC Nail; Smith & Nephew Richards, Memphis TN). The mean age of the patients was 65 years (range 48-78 years). Three of the fractures involved the proximal third of the diaphysis while the remaining four involved the middle third. Six of the original fractures were closed and one was an open fracture. The time interval between the original injury and final surgery averaged 9.3 months. All the nailings were done by the ante-grade approach with static locking. Six of the patients had closed nailing and one had open nailing with bone grafting. The mean follow-up was 8 months and osseous union was achieved in all seven cases at a mean of 5.6 months. We conclude that the Supracondylar Femoral Nail is a useful alternative implant in the management of non-union of fractures of the humeral shaft with wide medullary canals.

Aged↗
PubMed1976

Non-union in fractures of the humeral shaft.

Twenty-nine patients with non-union of the humeral shaft, who were treated in 3 major Vancouver hospitals, were studied. Reasons for non-union, effectiveness of various treatment methods, and complications are discussed. Fractures occurring in the middle third of the humeral shaft, comminuted or open fractures and those treated early by open reduction, are more prone to non-union. Nearly 50% of the patients with non-union were chronic alcoholics. Compression plating with cancellous bone grafting gave the best rate of healing. However, both early and late operative treatment gave a relatively high complication rate.

Adult↗
PubMed1978

The treatment of non-union and pseudarthrosis of the long bones with thick nails.

This paper is based on Küntscher's method of operative treatment of the long bones(Küntscher, 1962) and is a review of 197 cases of non-union and pseudarthrosis of long bones fixed internally with thick metal nails after preliminary reaming of the medullary canal. New reamers and a new nail have been designed and the results are satisfactory. The rigid fixation of the fragments allowed early movement of the limb and so avoided the complications of prolonged immobilization. Anabolic steroids were administered as a routine to this group of patients. Weight bearing and full function of the limb were regained within 3-5 months of the operation. Poor results occurred in 6 cases (3.2 per cent) due to exacerbation of chronic osteomyelitis.

Adult↗
PubMed1985

Treatment of un-united fractures of the shaft of the humerus with bent nail.

The results of operative treatment of 78 cases of un-united fractures of the humeral diaphysis are reported. The operation consisted of medullary nail fixation, the nail being bent at the fracture site in order to engage the cortex above and below the fracture, and was followed by plaster splintage. Forty-nine cases showed evidence of union within 20 weeks and 21 united between 20 and 30 weeks. Of the remaining cases, two had broken nails and five were lost to follow-up.

Adult↗