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At least 775 records · Page 43Linked to original sources
PubMed1986

Nonunion of the humerus: rigid fixation, bone grafting, and adjunctive bone cement.

Five patients with humeral nonunions were treated by open reduction and internal fixation with compression plating and adjunctive methylmethacrylate inserted by use of several techniques to gain secure screw purchase in markedly osteoporotic bone. The rigid fixation was supplemented in each case with cortical-cancellous bone grafting. Postoperative abduction splinting was applied in each case. The average follow-up examination was 24 months, with all five nonunions having healed at an average of five months postoperation. The shoulder arc of motion averaged 120 degrees, and the elbow arc of motion averaged 125 degrees.

Aged↗
PubMed1987

Nonunion of the humeral shaft.

Retrospective review of records of 26 patients with nonunion of the humeral shaft revealed several factors frequently associated with the development of nonunion. The fractures were transverse and short oblique and treated per primam with hanging casts or open reduction. Surgical fixation was unstable. The types of nonunion were atrophic in 19 patients, hypertrophic in five patients, and synovial pseudarthrosis in two patients. Twenty-four of 26 nonunions (92%) treated with bone grafts and rigid internal fixation healed in an average of 5.6 months. Overall, 47 surgical procedures, including prior procedures, were performed on these 26 nonunions. The average number of operations per patient was 1.8. Successful platings produced immobilization, consisting of an average of 6.8 points of cortical fixation above the nonunion and 7.1 cortices below. Rigid fixation was not obtained in the unsuccessful procedures. Unsuccessful platings were noted to have unstable fixation, with an average of 2.7 points of cortical fixation above the nonunion and 3.0 cortices below. Bone grafting was performed in only 55% of the unsuccessful platings. Optimal treatment of nonunions of the humeral shaft consists of resecting atrophic nonunions, shortening the bones, drilling sclerotic areas, and apposing bleeding diaphyseal surfaces; open reduction with internal fixation with a broad compression plate, including at least six points of cortical fixation above and below the nonunion; compression of the nonunion by means of interfragmentary lag screws, prestressing of the plate, dynamic compression by the plate, or direct compression by the external compression device; and autogeneic cancellous iliac bone grafts.

Adolescent↗
PubMed1979

[Plate osteosynthesis using the support principle].

In the operative treatment of fractures there are special principles for plating by support. Osteosynthesis is indicated for comminnuted fractures and bone defects in the metaphysis. Plating for distance also is established for fractures and pseudarthroses with defects in the diaphysis. This method is especially recommended for fractures of the head of the tibia and for reconstructing the pilon tibial.

Biomechanical Phenomena↗
PubMed1985

Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study.

We performed ninety-six internal-fixation procedures for fracture or non-union of the humeral shaft in eighty-four patients, with a mean follow-up of 32.6 months (range, three months to fourteen years). The primary indications for operative intervention included humeral shaft fracture in a patient with multiple trauma, non-union, inadequate reduction of a humeral shaft fracture by closed methods, pathological humeral-shaft fracture, and progressive radial-nerve palsy. Methods of internal fixation included compression plates and screws and intramedullary Küntscher nails or Rush rods. The use of an AO/ASIF compression plate or interfragmentary lag screws with an AO/ASIF neutralization plate in twenty-seven multiply-injured patients resulted in a union rate of 100 per cent and generally good motion of the shoulder and elbow. Five multiply-injured patients also obtained good results through fixation by a modified Hackethal technique using two Rush rods. The use of intramedullary Küntscher nails resulted in a rate of union of 91 per cent in eleven multiply injured patients. Ten patients with non-union of a humeral shaft fracture had an 80 per cent rate of union with the use of an AO/ASIF compression plate. The use of a Küntscher nail in eleven patients with non-union resulted in a rate of union of only 73 per cent and frequently caused subacromial impingement. Fractures of the humeral shaft that had had an inadequate reduction by closed means or were associated with progressive radial-nerve palsy were best managed by a compression plate or the modified Hackethal technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗