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PubMed1983

Experience with electrical stimulation of nonunions.

The use of electrical stimulation modalities for the treatment of nonunions in the orthopaedic patient population is receiving increasing attention. The following report briefly describes the early results obtained from using three commercially available devices in 33 patients.

Electric Stimulation Therapy↗
PubMed1984

Free vascularized bone grafting for large-gap nonunion of long bones.

In conclusion, vascularized bone grafts provide a useful technique for difficult skeletal reconstructive problems. The advantages, indications, and method of this technique have been reviewed. The experience of the literature has been summarized, and our current experience with microvascular grafting was presented.

Adult↗
PubMedDate not supplied

Detection of synovial pseudarthrosis by 99mTc scintigraphy: application to treatment of traumatic nonunion with constant direct current.

A prospective study utilizing technetium scintigraphy to evaluate nonunion patients prior to the electrical stimulation of osteogenesis is reported. Roentgenographic evaluation and scintigraphy must include four views (anteroposterior, lateral and both obliques). Although all nonunion technetium scans showed increased uptake of the radionuclide at the fracture site, three bone scan patterns were identified: (1) intense, uniformly increased uptake at the nonunion site (69.5%); (2) photon deficient (cold) cleft between two intense areas of uptake (23.4%); and (3) indeterminate pattern (7.1%). The presence of a cold cleft between two intense areas of uptake on scintigraphy correlated closely with the presence of a synovial pseudarthrosis at surgery. Nonunions of the humerus were most frequently associated with synovial pseudarthrosis (57.1%). The presence of a synovial pseudarthrosis as suggested by technetium scintigraphy mandates open excision of the lining membrane at the time of electrode insertion.

Diphosphonates↗
PubMed1984

Intramedullary fixation of humeral shaft fractures.

In this paper we document seventy fractures of the humeral shaft that were treated by intramedullary fixation between 1970 and 1981. Complications developed in forty-seven (67 per cent) of the fractures, and forty-five (64 per cent) required at least one additional operative procedure. Of the sixty fractures that were internally fixed within six weeks after injury, nine (15 per cent) had a delayed union and five (8.3 per cent) had a non-union, two of which persisted despite subsequent surgery. Three of the ten fractures that were internally fixed more than six weeks after injury never united despite additional procedures that were done to secure union. Delayed union and non-union were more common in open fractures (33 per cent) than in closed fractures (21 per cent), and with open reduction (39 per cent) than with closed or so-called semi-open reduction (9 per cent). Deep infection occurred in three (5 per cent) of the fractures and was more common in open (17 per cent) than in closed fractures (2 per cent). One of the three open fractures that were treated by immediate fixation became infected, as compared with only one of the nine open fractures treated by delayed fixation. Painful adhesive capsulitis of the shoulder developed in thirty-four (56 per cent) of the patients who had fractures treated with distally directed pins, but motion of the elbow was not restricted in the nine patients with fractures treated with proximally directed pins.

Adolescent↗
PubMed1982

Surgical treatment of nonunions of the surgical neck of the humerus.

End-to-end alignment of the fragments usually does not provide good bone contact or stability for fractures of the surgical neck of the humerus because cavitation of the head fragment and comminution constitute bone stock deficiency. Painful and disabling nonunion of the surgical neck of the humerus in five patients was repaired by impaling one fragment into the other, usually the shaft into the head. A corticocancellous iliac graft bridged the nonunion by extending from the interior of the head to the shaft, where it was fixed by screws. Rush rods were used for internal fixation. All five patients obtained union without evidence of avascular necrosis during the period of observation (12 to 39 months), had good pain relief, and regained satisfactory function.

Adult↗
PubMed1981

Modified Nicoll-graft treatment of gap non-unions in the upper extremity.

Sixteen gap non-unions (seven in the radius, eight in the ulna, and one in the humerus) in fifteen patients were treated with a full-thickness corticocancellous iliac-crest graft, 1.2 to 2.5 centimeters in length, to replace the bone loss, and with a compression plate to provide stability. Thirteen of the fifteen fractures with adequate follow-up united and the grafts were incorporated in an average of 13.5 weeks, an 87 per cent success rate. The stability achieved by the compression plate allowed early removal of the plaster cast and institution of active exercises. In the two failures, the graft was not resorbed, and it filled the gap in the bone but failed to unite at one end.

Adult↗
PubMed1993

Treatment of difficult fractures and nonunions of the humerus and elbow with a modified Küntscher nail.

A series of fourteen difficult fractures and nonunions of the humerus and elbow have been treated over a period of twenty-eight years with a modified Kuntscher Nail. A total of twenty-six operative attempts had been previously made in this group of fourteen patients. One patient had eight failed surgeries prior to treatment. Slots were placed along the spine of the nail for transfixion with screws. In two instances additional modification of the Kuntscher nail was made by attaching a plate to the end of the nail for fixation to the ulna after retrograde insertion into the humerus. One such device was used to fuse the elbow. The other was used to stabilize a low nonunion in which the elbow was already fused. Union was obtained in nine cases with failure in five. Four of the failures united with one additional surgery. The one failed case had a surgical neck fracture which was eventually treated with a Neer prosthesis. The method described may not be superior to other methods; however, it can be successful in obtaining union in difficult elbow and humerus fractures or nonunions resulting from multiple failed prior procedures.

Adult↗