PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “FRACTURES, UNUNITED”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 739 records · Page 41Linked to original sources
PubMed2005

[Repair of refractory bone nonunion in the distal humerus].

OBJECTIVE: To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humerus. METHODS: Twelve cases of bone defects and nonunion in distal humerus were repaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. RESULTS: After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 3-8 months. The fibular graft thickened as time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of forearm were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. CONCLUSION: With the support of anatomical bone plate, the fibular graft can help the recovery of joint function and repair bone defects and nonunion as to avoid joint replacement with prosthesis.

Adolescent↗
PubMed2005

Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.

UNLABELLED: We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

A case series and review of salvage surgery for refractory humeral shaft nonunion following two or more prior surgical procedures.

The orthopedic surgery literature is replete with techniques for managing primary humeral shaft nonunions, with success rates upwards of 90 percent with plate fixation and autogenous bone grafting. Despite this success, persistent nonunion following one or more initial failed nonunion interventions can occur, imposing a significant clinical and surgical challenge. We report the application of a standard treatment protocol for refractory humeral shaft nonunions including optimization of patient co-morbidities in the peri-operative period, rigid 4.5mm compression plating with a minimum of eight cortices of fixation proximal and distal to the nonunion site, and utilization of autogenous bone grafting. This study, a retrospective review of seven patients, all managed based on this standard treatment protocol, revealed that all achieved fracture nonunion within six months of revision surgery. Six of seven patients were clinically satisfied with the outcome of surgery; one remained dissatisfied secondary to a chronic neuropathic pain syndrome. Although more complex surgical options such as Ilizarov external fixation and allograft cortical strut augmentation have been reported, and are available in the salvage situation of refractory humeral nonunions, we conclude strict application of basic nonunion principles can result in successful salvage of humerus nonunions in patients who have failed two or more prior surgical interventions.

Adult↗
PubMedDate not supplied

Outcome of plating, bone grafting and shortening of non-union humeral diaphyseal fracture.

BACKGROUND: Humeral diaphyseal fracture usually heals with closed methods but when non union develops then it needs surgical intervention in the form of plating and bone grafting, intramedulary nailing (open or closed simple or interlocking nails) and external fixators (circular or one plane fixator). In our unit we treated non union humeral diaphyseal fracture with plating and bone grafting and shortening of fracture ends up to 4 to 5 cm when needed. METHODS: This study was conducted at Orthopaedic Department of Ayub Teaching Hospital Abbottabad from January 2002 till December 2003. We included 15 cases with atrophic non-union in 9 (60%) and hypertrophic non-union in 6 (40%) patients. All atrophic non-union were treated with plating, bone shortening by transverse osteotomy and bone grafting, while hypertrophic non-union were treated with decortications of non-union ends and fixation with compression plates, with bone grafting in old age. Follow up measures were based on clinical (range of joints motion) and radiological (healing) findings. Follow up was done for up to 6 months. RESULTS: Out of 15 patients the age range was 20-80 years, 12 (80%) were male and 03 (20%) female. Right humerus involved in 5 (33.33%) while left humerus in 10 (66.66%) patients. In 9 (60%) patients with atrophic non union bone shortening by transverse cut osteotomy was done while in remaining patients with hypertrophic non-union plating was done in 2 (13.33%) cases and plating with bone grafting in 4 (26.66%) patients. Union was achieved in all patients after 16 to 20 weeks of surgery. In one patient (6.66%) of 75 years age with hypertrophic non-union implant was loosened after 03 months of surgery. At that time healing (Union) was evident on X-rays and humeral brace was applied for further 03 months. Two patients (13.33%) got neuropraxia of radial nerve which resolved with in 3 months time. 02 patients (13.33%) developed shoulder stiffness which resolved after exercise. CONCLUSION: In Non Union of Humerus shortening by transverse osteotomy & rigid fixation with plates give excellent results in selected cases.

Adult↗
PubMed2005

Risk factors, treatment, and outcomes associated with nonunion of the midshaft humerus fracture.

Charts of 28 patients with a diagnosis of delayed union or nonunion were reviewed. There were four delayed unions and 25 nonunions. Comorbidities, risk factors, treatments, and outcomes were evaluated. Comorbidities were common and included cardiovascular, pulmonary, and renal compromise, as well as endocrinopathies and rheumatologic disease. Consensus risk factors included: unstable fractures (comminuted or short oblique, 83% (24/29); advanced age, 57% (16/28); obesity, 35% (9/28); daily tobacco use, 38% (10/28); and multiple long bone fractures, 21% (6/29). Sixty-nine percent (20/29) of the fractures united; 21% (6/29) failed to heal. Healing outcome for 11% (3/29) could not be determined because of death or loss to follow-up. Patients presenting for primary treatment with any of the aforementioned risk factors should be cautioned regarding possible nonunion.

Adult↗
PubMed2005

[Intramedullary interlocking of humeral fractures and nonunions with Seidel nail].

The advantages and disadvantages of interlocking Seidel's nails determined by their construction and the way of insertion were presented on the basis of own experience and literature. The advantages are strength and shape of the nails which are conductive to fragments stability and make insertion into humerus medullar canal easier. The tools set for insertion and locking of distal part. It doesn't truly protect from torsion displacements. Locking takes place by draw for a few weeks by external immobilization. The Seidel's nail has also disadvantages associated with proximal insertion. Unavoidable injury of supraspinatus tendon insertion can be the reason of loss of shoulder function. The antegrade fixation can cause pushing distal fragment downward by tip of the nail. It is necessary to control it's insertion under image intensifier. Presented disadvantages of Seidel's nail fixation didn't result in any problems in humerus fractures or pseudoarthroses healing. In one case it was necessary to perform additional decortication and space of fracture fulfillment with bone grafts.

Bone Nails↗
PubMed1991

Treatment of humeral nonunions with the Ilizarov technique.

Eighteen patients with nonunions of the humerus were treated by the Ilizarov method at the General Hospital in Lecco, Italy, between 1982-1989. This report is based upon 16 of those patients. The results are encouraging. Union was achieved in 14 patients. There were two failures: one patient had been irradiated 14 years earlier for what was thought to be plasmocytoma of the proximal humerus; the other had a humeral nonunion of the proximal third with advanced disuse osteopenia of the surrounding bone. Complications were few, and none compromised the achievement of union.

Adult↗
PubMed2005

Osteogenic protein-1 (bone morphogenic protein-7) combined with various adjuncts in the treatment of humeral diaphyseal nonunions.

A prospective study was conducted to determine the efficacy of using recombinant BMP-7 (rhOP-1) as an adjuvant in the treatment of diaphyseal humeral nonunions. Twenty-three consecutive patients with atrophic humeral diaphyseal nonunions were treated at seven separate institutions. All nonunions were fixed with either a compression plate or an intramedullary nail in conjunction with various bone grafting techniques. Recombinant OP-1 was delivered to the fracture site in a Type I collagen carrier at the time of fixation. All fractures went on to eventual union. There were no serious complications and no adverse reactions to the rhOP-I implant. Our study suggests that rhOP-1 may be a safe and effective adjuvant for the treatment of humeral diaphyseal nonunions.

Adult↗
PubMedDate not supplied

Treatment of long-bone fractures, malunions, and nonunions: experience at Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Long-bone fractures are common in the field of orthopedic trauma and require careful treatment to avoid refractory disabilities. Through advancements of modern medicine and technology, many excellent techniques and devices are continually being invented. Currently, the success rates of treatment have markedly increased while complication rates have been greatly lowered. Even so, complications of failed fracture treatment still occasionally occur. Among these complications, malunions and nonunions are relatively common and disturbing. However, both complications can be reduced if the principles of fracture treatment are strictly followed. All fractures may be treated with nonoperative or operative methods according to individual advantages and disadvantages. In principle, nonoperative methods should be given priority. In this article, principles of treatment of long-bone fractures, malunions, and nonunions are clarified. Current practices which have been published and which are representative of treatment of these issues at the author's institution are reported. Inconsistencies of important viewpoints concerning fracture-related treatment between the author's institution and published articles are discussed. The aims of this study were to assess the academic level of fracture treatment at the author's institution. Then, improved techniques for fracture treatment might be continually developed. Some studies at the author's institution have revealed that the success rates are comparable to those of articles with the highest success rates in the world.

Femoral Fractures↗
PubMed2006

[Nonunion of the lateral humeral condyle--operative treatment, case report].

The nonunion of the lateral humeral condyle is the most important complication in course of the treatment of the fractures lateral humeral condyle. The cause of the occurrence is the articular liquid penetration to the fracture site, minor blood supply of the fractured fragment based only on the vessels penetrating from the metaphysis, insufficient immobilization period and fragment relocation. The operative treatment of a condyle nonunion previously was performed cautiously because of the high risk of the condyle necrosis and the mild nature of the deformity. The elbow with nonunion condyle is usefull and satisfactory even after bringing increasing valgus deformity and a high risk of the ulnar nerve neuropathy into consideration. A 7-YEAR-old boy with a condyle nonunion was treated operationaly. Operative procedure shouldn,t be prolonged for more than a year after the trauma because of the increased deformity and condyle remodelling. A Tahdjian technique was used. The operation focused on an intraarticular approach with an olecranon ostotomy for the avoidance of the vessels penetrating from the condyle metaphysis. After debridgement and cortical grafts filling of the nonunion site a Kirschner fixation combined with olecranon wire loop fixation were performed. Satisfactory results were achieved in a form of fragments union within six weeks of the surgery and the total range of motion of the elbow joint within 6 months of the operation. During the treatment no signs of the neurovascular complications were observed.

Bone Wires↗
PubMed1991

Treatment of nonunion by percutaneous injection of bone marrow and demineralized bone matrix. An experimental study in dogs.

Successful treatment of nonunited fractures remains a major clinical challenge. Because bone marrow and demineralized bone matrix (DBM) are capable of stimulating osteogenesis, experiments were designed to test the effectiveness of bone marrow or DBM or both when injected percutaneously into a canine nonunion model. Six-millimeter segmental defects were created in the midtibial diaphysis of 24 adult mongrel dogs and held distracted by external fixation. For comparative purposes, a 0.5-mm osteotomy was created in five dogs. Five weeks later, the 6-mm defects were injected with either saline, autogeneic marrow, DBM powder, a composite of bone marrow and DBM, or treated by open grafting techniques with autogenic cancellous bone. Healing of the defect was evaluated roentgenographically, biomechanically (three-point bending), histologically, and biochemically 13 weeks postsurgery. Marrow and DBM stimulated defect healing. However, the combination of bone marrow with DBM produced a synergistic response in the defect, which was greater than the sum of either marrow or DBM alone. Healing in the composite-grafted dogs was comparable to those treated by standard cancellous bone grafting. These data suggest that percutaneous injection of bone marrow and DBM may be a potential alternative that offers numerous advantages over standard open grafting techniques in the treatment of fractures with nonunited defects.

Animals↗
PubMed1990

The treatment of nonunions and pseudarthroses of the humeral shaft.

In summary, if one follows the AO/ASIF principles of open reduction and stable internal fixation of nonunions and pseudarthroses of the humerus, mostly with plate fixation supplemented by shingling or petaling, cement for loose screws when necessary, and bone grafting of defects or atrophic nonunions, then successful healing with one operative procedure can be achieved in over 95%, with almost full correction of preoperative deformity. Return of useful function and range of motion can also be achieved in 75% to 90% by early active exercises, physiotherapy, and occasional continuous passive motion, supported by hinged braces or cast braces in the postoperative period until union occurs. Union was achieved in an average of 6.6 months after the operative procedure.

Adult↗
PubMed1990

Nonunion of the proximal humerus. A review of 25 cases.

Records of 25 patients with nonunion of the proximal humerus were reviewed retrospectively. The initial fractures included 19 two-part surgical neck fractures and six three-part fractures. Fourteen fractures were treated nonoperatively and 11 surgically. Nine of 11 of the initial internal fixations were unsatisfactory. At the time of fracture 16 patients had one or more significant medical illnesses. Nonunion of the proximal humerus was associated with considerable morbidity. Patients complained of pain, stiffness, and disability in association with shoulder dysfunction. Four treatment groups were evaluated. Patients who declined treatment and patients treated with nonreamed intramedullary nails had limited shoulder motion and pain without union. Patients treated with proximal humeral hemiarthroplasty had relief of pain but limited motion despite rotator cuff reconstruction. The best results of treatment occurred after open reduction with internal fixation and bone grafting. A tension band construction that fixed the rotator cuff and proximal humerus to a plate/shaft composite was used successfully in seven patients. Although satisfactory reconstruction of nonunion of the proximal humerus can be obtained, the results of treatment in this series were only fair. Only 48% (12 of 25 patients) had good results.

Adolescent↗
PubMed1990

[Reconstructive surgery following malunion of fractures of the proximal humerus in adults].

Malunion, avascular necrosis of the head segment and nonunion of the neck are the most frequent complications of displaced fractures of the proximal humerus. Malunion of the tuberosities may be well tolerated or it can require surgical treatment. Cranial displacement of the greater tuberosity appears to be much better tolerated than dorsal displacement. If power and active mobility are maintained but pain persists, the malunion may have led to impingement, which can be relieved by coraco-acromioplasty. If active mobility is reduced, tubercular osteotomy and relocation using tension band wiring techniques may be warranted. Malunion at the neck level may be treated with subcapital, usually flexion-abduction, osteotomies and yield excellent results. A collapsed head segment after avascular necrosis of the head requires either hemiarthroplasty or total joint replacement. As the nonunions are usually fairly distal and almost always extra-articular, they are treated with open reduction and internal fixation using tension band-wiring techniques and autogenous bone grafting. Arthrodesis has essentially lost its role in reconstructive surgery after fracture complications and is only used if severe additional problems are present such as infection, neurological problems, or severe soft tissue defects.

Adult↗
PubMed1990

Osteosynthesis for old, established non-union of the lateral condyle of the humerus.

In thirty elbows that had an established non-union of a fracture of the lateral humeral condyle that had occurred more than five years before, treatment consisted of one of three operations: anterior transposition of the ulnar nerve (nine patients), corrective osteotomy of the humerus and anterior transposition of the ulnar nerve (four patients), or osteosynthesis of the non-union combined with neurolysis and anterior transposition of the ulnar nerve, with or without corrective osteotomy of the humerus (seventeen patients). Of the thirty patients, fifteen had been apprehensive when using the elbow, due to lateral instability, or had had pain in the elbow. In thirteen of these fifteen patients, the non-union was treated by osteosynthesis. Afterward, the pain and apprehension disappeared, but the range of motion of the elbow decreased in all but three patients. Three patients had clicking between the humerus and radius, and the bone failed to unite in three others. Osteosynthesis is indicated for the treatment of non-union of the lateral humeral condyle only if the patient has serious pain in the elbow or apprehension when using the elbow, due to lateral instability.

Adolescent↗
PubMed1990

Complex non-union of the humeral diaphysis. Treatment with a medial approach, an anterior plate, and a vascularized fibular graft.

Four obese patients who had atrophic synovial non-union of the humeral shaft were treated with a medial approach, application of a plate anteriorly, a vascularized fibular bone graft, and cancellous grafts from the iliac crest. The average age of the patients was forty years; the average weight, 105 kilograms (232 pounds); and the average duration of the non-union, 33.5 months. Each patient had had one to five unsuccessful previous operations in an attempt to gain union. At an average follow-up of twenty-seven months, all four non-unions had healed. Three patients had regained full function of the shoulder and elbow, and the fourth patient had some limitation of motion of the shoulder due to an antecedent lesion of the rotator cuff. In one patient, a second plate had been applied because of inadequate fixation of the original plate proximally. Another patient had a superficial, partial wound slough, which healed spontaneously.

Adult↗