Treatment of nonunions of the humeral shaft with nonvascularized fibular strut allograft: postoperative outcomes and review of a surgical technique (original) (raw)
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Humeral shaft aseptic nonunion: treatment with opposite cortical allograft struts
La Chirurgia degli organi di movimento, 2009
Plate fixation with cortical allograft struts has been used at our Institute for decades to treat aseptic shaft nonunion. The aim of this study was to assess the results of this technique in humeral nonunion. We retrospectively reviewed 57 consecutive patients with humeral diaphyseal nonunion treated by internal fixation combined with cortical allograft struts in the last 7 years in our Department. The patients were followed-up for a mean of 48 months. We had union in 53 cases out of 57. There were 3 cases of infection out of 15 patients previously treated with an external fixator. In our experience the cortical allograft strut is a well standardised and reproducible technique that enables the treatment of severe atrophic non-union with a relatively low complication rate and quick functional recovery.
Journal of Clinical Orthopaedics and Trauma
Background: Non-union humeral shaft fractures are seen frequently in clinical practice at about 2-10% in conservative management and 30% in surgically operated patients. Osteosynthesis using dynamic compression plate (DCP), intramedullary nailing, locking compression plate (LCP), Ilizarov technique along with bone grafting have been reported previously. In cases of prior failed plate-screw osteosynthesis the resultant osteopenia, cortical defect, bone loss, scalloping around screws and metallosis, make the management of non-union more complicated. Fibular graft as an intramedullary strut is useful in these conditions by increasing screw purchase, union and mechanical stability. This study is a retrospective and prospective follow up of revision plating along with autologous nonvascularised intramedullary fibular strut graft (ANVFG) for humeral non-unions following failed plate osteosynthesis. Materials and methods: Seventy eight cases of nonunion humeral shaft fractures were managed in our institute between 2008 and 2015. Of these, 57 cases were failed plate osteosynthesis, in which 15 cases were infected and 42 cases were noninfected. Out of the 78 cases, bone grafting was done in 55 cases. Fibular strut graft was used in 22 patients, of which 4 cases were of primary nonunion with osteoporotic bone. Applying the exclusion criteria of infection and inclusion criteria of failed plate osteosynthesis managed with revision plating using either LCP or DCP and ANVFG, 17 cases were studied. The mean age of the patients was 40.11 yrs (range: 26-57 yrs). The mean duration of non-union was 4.43 yrs (range: 0.5-14 yrs). The mean follow-up period was 33.41 months (range: 12-94 months). The average length of fibula was 10.7 cm (range: 6-15 cm). Main outcome measurements included bony union by radiographic assessment and pre-and postoperative functional evaluation using the DASH (Disabilities of the Arm, Shoulder and Hand) score. Results: Sixteen out of 17 fractures united following revision plating and fibular strut grafting. Average time taken for union was 3.5 months (range: 3-5 months). Complications included one each of implant failure with bending, transient radial nerve palsy and transient ulnar nerve palsy. No case had infection, graft site morbidity or peroneal nerve palsy. Functional assessment by DASH score improved from 59.14 (range: 43.6-73.21) preoperatively to 23.39 (range: 8.03-34.2) postoperatively (p = 0.0003). Conclusion: The results of our study indicate that revision plating along with ANVFG is a reliable option in humeral diaphyseal non-unions with failed plate-screw osteosynthesis providing adequate screw purchase, mechanical stability and high chances of union with good functional outcome.
2004
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The Corkscrew Technique for Removing a Fibular Strut Allograft From the Proximal Humerus
Cureus, 2022
A fibular strut allograft is a reliable option for augmentation in open reduction internal fixation (ORIF) of proximal humerus fractures, but techniques to remove a fibular strut during revision shoulder arthroplasty are limited. Currently published techniques on extracting fibular strut grafts from humeral shafts include using a Midas burr, flexible osteotomes, humeral shaft osteotomy, and reaming. To our knowledge there has not been a technique that uses a corkscrew to remove the fibular strut from the proximal humerus in preparation for revision shoulder arthroplasty. This is a case report and description of a simple and reproducible technique that can be implemented in the setting of conversion from a proximal humerus lateral locking plate with fibular strut allograft to shoulder arthroplasty.
Management of humeral nonunions following failed surgical fixation
Archives of Orthopaedic and Trauma Surgery, 2020
Introduction Management of humerus nonunions with previously failed fixation presents a complex problem. There are multiple revision fixation strategies, of which compression plating is a mainstay. The aim of this study was to assess the results of open reduction and direct compression plating without the need for autograft or allograft in the setting of revision humerus open reduction internal fixation. Methods This study is a retrospective analysis of 19 patients treated between 2008 and 2017 for humerus nonunions following failed fixation who were treated by a single surgeon using direct compression plating with bone graft substitutes. Patients were treated with neurolysis of the radial nerve, hardware removal, debridement of the nonunion site with shortening osteotomies, compression plating, and augmentation with bone graft substitutes. All patients were followed until radiographic and clinical union. Results Nineteen patients were identified for the study and 17 had adequate follow-up for final analysis. Humeral union was achieved in 16/17 (94.1%) patients with a mean time to union of 23 weeks. Two patients required a repeat compression plating with bone graft substitute to achieve union. The one patient with a nonunion radiographically reported minimal clinical symptoms and opted for no revision surgery. An association with the index procedure was seen, as three out of four of the patients who experienced radial nerve palsies after their index procedure subsequently experienced a radial nerve palsy after the procedure to repair their nonunion. All patient's all experienced a return of function in their radial nerve either back to baseline or improved from before the revision nonunion surgery. Conclusion The use of humeral shortening osteotomy and compression plating without autograft or allograft is a viable option for management of humeral nonunions which avoids the morbidity associated with autograft harvest. The patients with radial nerve palsy after the index procedure are likely to have a transient radial nerve palsy as well after the revision surgery necessitating proper informed consent prior to the operation.
Allograft reconstruction of the humerus: Complications and revision surgery
Journal of Surgical Oncology, 2018
Background and ObjectivesAllograft reconstruction of the humerus after resection is preferred by many because of bone stock restoration and biologic attachment of ligaments and muscles to the allograft, theoretically obtaining superior stability and functionality. Our aim was to assess the prevalence of complications and the incidence and etiology for revision surgery in humeral allograft reconstructions.MethodsWe included patients 18 years and older who underwent wide resection and allograft reconstruction of the humerus for primary and metastatic lesions at our institution between 1990 and 2013. Our primary outcome measures were complications and revision surgery. We used competing risk regression to assess allograft survival.ResultsOf the 84 patients we included, 47 patients (51%) underwent allograft reconstructions of the proximal humerus, 30 (36%) intercalary, and seven (8%) of the distal humerus. Fifty‐one patients (61%) had at least one complication after surgery. Eighteen pa...
Grafting and fixation after aseptic non-union of the humeral shaft: A case series
Journal of Clinical Orthopaedics and Trauma, 2019
Non-unions after humeral shaft fractures are seen frequently in clinical practice at about 2e10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. Methods: From 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. Results: In all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. Conclusion: Given the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft.
A lifelong story: Case report of a humeral shaft nonunion successfully treated after 30 years
Injury-international Journal of The Care of The Injured, 2018
Nonunion of the humeral shaft occurs in 2%-10% of nonsurgically treated fractures and in up to 15% of fractures treated by primary open reduction and internal fixation. Gunshot humerus shaft fractures are a frequent type of injury; the degree of comminution and bone loss, as well as soft tissue disruption may influence the healing process, causing major sequelae with loss of function. Here we describe a 30 years old midshaft nonunion of the humerus, that occurred in a young woman after a gunshot. She was initially treated with hanging cast with definitive nonunion and secondary loss of limb function. After 30 years, careful management of the non union fracture ends, locked intramedullary nailing and bone grafting harvested from the femoral canal using the Reamer Irrigator Aspirator (RIA) system led to union with recovery of limb function.
Treatment of humeral shaft nonunion by external fixation: a valuable option
Journal of Orthopaedic Science, 2001
We report the treatment of six patients with nonunion of the humerus, using a unilateral fixator and bone grafting. Union was obtained in all patients, with an average time to union of 4.5 months. Superficial pin tract infection was seen in five patients, but resolved uneventfully. One patient had transient radial nerve palsy. The results, according to the Stewart and Hundley criteria, were excellent in one patient, good in three, fair in one, and poor in one. The main cause of the fair and poor results was marked limitation of shoulder and elbow motion. This method, however, seems to be therapeutically effective.