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PubMed1964

BONE GRAFTING.

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Antisepsis↗
PubMed1992

Treatment for nonunion of the shaft of the humerus: comparison of plates and Seidel interlocking nails.

From July 1986 to November 1989, fractures of the humeral shaft in 35 adults who had nonunion of the fracture were managed by plate fixation (19 patients) or antegrade nailing of the fracture fragments with the Seidel interlocking nail (16 patients) together with cancellous bone grafting. The follow-up period ranged from 12 to 52 months. Of the patients who had plate fixation, 89.5% had fracture union within 4.5 +/- 1.7 months; of the patients whose fracture was managed with the Seidel interlocking nail, 87.5% had fracture union within 4.4 +/- 1.8 months. The range of shoulder motion was improved with both techniques. Patients who had plate fixation had more complications than those whose fracture was managed by interlocking nailing (21% v. 12%). The authors prefer interlocking nailing because it is a relatively simpler technique, resulting in fewer complications. It may replace plating in the treatment of nonunion of humeral shaft fractures. However, rotatory instability with interlocking nailing cannot be disregarded, and if this is evident plate fixation should be done.

Adult↗
PubMed2003

Total elbow replacement for distal humerus fractures and traumatic deformity: results and complications of semiconstrained implants and design rationale for the Discovery Elbow System.

Recent advances in elbow replacement design have further extended its usefulness as an expedient reconstructive method for restoring elbow function following trauma. This is particularly true in elderly patients, for whom treatment is complicated by the frequent presence of osteoporosis, severe comminution with small condylar fracture fragments, and diminished bone-healing capacity. This article addresses the role of elbow replacement for fracture, traumatic deformity, post-traumatic arthritis, and instability. Indications, techniques, and results are presented. Complications of semiconstrained implants are presented, and the design rationale for, and examples of, the latest-generation Discovery Elbow System (Biomet Orthopedics, Warsaw, Indiana) are discussed.

Aged↗
PubMed1992

Immunologic studies of nonunited fractures.

We studied tissue samples of noninfected delayed union or nonunion of diaphyseal bones in 10 patients immunopathologically and neuroimmunologically 4 to 25 months after the primary injury. Samples mostly consisted of vascularized connective tissue of varying density with the proline-4-hydroxylase-containing fibroblast as the major cell type. Most inflammatory cells were CD4 T-lymphocytes and their number was always twice that of the CD8 positive cells. Staining for CD11b positive monocyte/macrophages showed in all samples positive cells scattered in the connective tissue stroma with perivascular enrichments. Mast cells were absent or very rare. Our findings suggest that delayed union and nonunion tissue consists of vascularized connective tissue, which mostly contains 5B5 fibroblasts, CD11b macrophages and vascular endothelial cells with only few immigrant recently recruited monocytes or lymphoid cells. Almost all resident cells seem to be involved in tissue remodeling as suggested by their content of fibroblast-type MMP-1 and its proteolytic activator MMP-3 or stromelysin. The most striking finding was the paucity or total lack of peripheral innervation, which may have to do with the nonunion of the fracture.

Adolescent↗
PubMed2004

Treatment of non union of humerus using G. A. Ilizarov technique.

The management of the non union of humerus is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 36 cases with non union has been treated by G.A. Ilizarov technique. The age range were: 21-62 years with an average of 32 years. The initial treatment were done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the application of Ilizarov fixator a good range of elbow & shoulder motion were achieved. The average follow up period was 5 years with a range of 1-8 years. Union was achieved in all the 36 cases.

Adult↗
PubMed2004

Factors affecting rates of infection and nonunion in intramedullary nailing.

We report a retrospective study over five years to determine the incidence of infection and nonunion after intramedullary nailing in fractures of 214 long bones; 122 femoral, 75 tibial and 17 humeral. The indications for nailing were trauma (n = 161), pathological fracture (n = 30) and nonunion (n = 23). There were 30 open fractures. The overall rates of deep infection and nonunion were 3.8% and 14.2%, respectively. Using multiple logistic regression analysis, we determined the relationships between deep infection and nonunion and the pre- and peri-operative factors of age, ASA score, indication for nailing, the use of reaming, the use of antibiotics, whether the fracture was open and the operating time. Open fractures were found to be significantly associated with deep infection. The length of the operation may also affect the outcome. Opening of the fracture at the time of surgery and the ASA score were found to be significantly associated with the development of nonunion after intramedullary nailing. We have compared our findings with previously published data from large teaching hospital units.

Adolescent↗
PubMed2004

Nonunion of the humeral shaft: long lateral butterfly fracture--a nonunion predictive pattern?

Retrospective review of 30 patients with nonunion of the humeral shaft treated from 1984-1999 revealed nine patients with an initial fracture pattern which to our knowledge was not described previously. Humeral fractures originated at the junction of the proximal and middle thirds of the diaphysis as an hemitransverse medial fracture that extended with a great lateral butterfly third fragment with its distal portion long and sharp. The patients were women approximately 60 years old. Eight fractures progressed to nonunion after initial conservative treatment. All fractures followed the same pattern: the proximal humeral fragment healed with the proximal portion of the third fragment, but an atrophic nonunion between the proximal humeral fragment, the distal humeral fragment, and the distal portion of the third fragment developed. The treatment required a technique adapted to this type of nonunion consisting of retrograde flexible intramedullary nailing, cerclage wires, and bone grafts.

Aged↗
PubMed2004

Biomechanical and clinical effects of adding interfragmentary wiring to locked nailing for humeral nonunions.

BACKGROUND AND PURPOSE: The use of locked nailing for the treatment of humeral nonunions is threatened by the potential of initial instability which may result in residual fracture gap and motion and is detrimental to fracture healing. This study investigated the biomechanical and clinical effects of adding interfragmentary wiring to reduce the initial instability in the treatment of humeral nonunion. METHODS: The biomechanical study compared the mechanical properties of 3 fixation methods: locked nail alone, with staple, and with interfragmentary wiring. Composite humeri were transected to simulate nonunion and were retrograde nailed. Nail-bone constructs were examined by non-destructive bending tests and destructive torsional tests. The initial instability, fixation stiffness and strength were measured and compared. The clinical study compared 21 nonunions treated by locked nailing alone and 30 nonunions treated by locked nailing with interfragmentary wiring. The indication for wiring was persistent nonunion gap or motion during operation. The union rate, time to union, functional recovery of the adjacent joints and the time for functional recovery were compared between the treatment groups. RESULTS: Biomechanically, in both bending and torsional tests, locked nailing with a staple or wiring resulted in significantly less initial instability than locked nailing alone. Test results for bending stiffness, torsional stiffness, or torsional strength did not differ significantly among the 3 fixation methods. In the clinical study, interfragmentary wiring had the advantage of providing tight nonunion compression, which was beneficial for nonunion healing and promoted early postoperative exercise. Patients treated with locked nailing with interfragmentary wiring had significantly shorter time to union and faster shoulder functional recovery (p < 0.05). CONCLUSIONS: Adding interfragmentary wiring was an effective and safe procedure in humeral nonunions treated with locked nailing.

Biomechanical Phenomena↗
PubMed2004

[Treatment results of aseptic non-unions of long bones with medullary canal reaming followed by intramedullary nailing].

This paper presents results of treatment of 46 consecutive patients with pseudoarthroses of the long bones treated with closed intramedullary reaming followed by intramedullary nailing. There were 22 nonunions of the tibia, 15 of the femur, 3 of the humerus and 6 of the forearm. The union occurred in 40 cases, among them in 3 of 4 treated atrophic, that gives 87% success. None of treated pseudoarthrosis of the humerus united.

Adult↗