To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients wit...To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients with severe osteoporosis or with nonunion site close to the artificial surface,the head of the buttress plate was added,making the screws to fixate easily.Iliac bone autograft including iliac block and scum of spongy bone was used in order to fully arouse the inductive and conductive effect of the graft.Continuous postoperative passive motion (CPM) was performed for a short period,and the active and passive motion were intensively advised for one year long.The cases were followed up from 12 to 70 months (mean 34 months).Results All cases were healed,with average healing time of five months (3～6 months).The motion range for the knee joint was increased from 73 degrees (5～135 degrees) to 97 degrees (30～135 degrees).Excellent and good results were achieved in 13 cases,satisfactory in four and poor in one.Conclusion DCS with rigid fixation and compression effect,combined with porous condylar plate if necessary,with iliac bone autograft and long period of post-operative exercises of the knee joint,provides one efficacious technique for treating the supracondylar non-unions of the femur.11 refs,2 figs.展开更多
Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonu...Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.展开更多
BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enha...BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.展开更多
Management of post-traumatic long-bone defects remains relevant and cha-llenging despite the rapid development of approaches to their treatment.Do-minant positions are occupied by the Ilizarov method,bone autogenous g...Management of post-traumatic long-bone defects remains relevant and cha-llenging despite the rapid development of approaches to their treatment.Do-minant positions are occupied by the Ilizarov method,bone autogenous grafting and the Masquelet induced membrane technique(IMT).The IMT is aimed at reducing extensive defect treatment duration and for this reason has gained great popularity.However,the assessment of its effectiveness is difficult due to a limited number of clinical series.The varying clinical manifestations of bone defect severity do not allow a comprehensive evaluation of IMT effectiveness.One of them is infection in the defect area.The purpose of our literature review is an analysis of studies on IMT application in infected vs non-infected long-bone defects of the lower extremities published over the last 10 years.It focuses on the investigation of similarities and fundamental differences in the need for antibiotics,timing of spacer fixation,methods of collecting donor bone and fixators used for consolidation.The studies show that the IMT has been globally used in aseptic and osteomyelitic defects due to its clinical effectiveness.Authors’variations and improvements in its practical implementation indicate the ongoing development and the interest of researchers in this technique.展开更多
To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center...To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center retrospective comparative study included 50 adult patients with aseptic nonunion of femoral or tibial diaphyseal fractures treated at our institution between January 2015 and January 2025.Patients underwent either locking-plate(LP)fixation(n=25)or intramedullary nailing(IMN)(n=25).The primary outcome was radiographic union at 12 months postoperatively.Secondary outcomes included time to union,operative time,intraoperative blood loss,length of hospital stay,incidence of complications(superficial/deep infection,implant failure,malunion),and 12-month functional status assessed by the Lower Extremity Functional Scale(LEFS).Statistical comparisons used Welch t tests for continuous variables andχ²or Fisher exact tests for categorical variables.The protocol received institutional review board approval with waiver of informed consent.Results:Among 50 patients(LP=25;IMN=25),the 12-month union rate was 88.00%(22/25)in the LP group and 96.00%(24/25)in the IMN group(p=0.609).Time to union was shorter with IMN(6.20±1.83 vs 7.51±2.12 months;p=0.023).Operative time(110.52±25.23 vs 145.81±30.21 min;p<0.01)and intraoperative blood loss(250.41±80.64 vs 350.22±95.30 ml;p<0.01)favored IMN.Length of hospital stay was similar(6.24±1.83 vs 6.82±2.11 days;p=0.284).The incidence of superficial wound infection did not differ significantly(12.00%vs 4.00%;p=0.609).Twelve-month LEFS scores were comparable(65.44±10.21 vs 67.10±9.83;p=0.451).Conclusion:Both locking plate and intramedullary nail fixation are effective in the treatment of femoral and tibial nonunion,with high rates of union and good functional outcomes.Intramedullary nailing may be associated with a shorter time to union,reduced operative time and blood loss,and a lower risk of superficial wound infection compared to locking plate fixation.The choice of implant should be individualized based on fracture characteristics,patient factors,and surgeon preference.展开更多
This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for de...This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for developing effective treatment strategies and improving patients’ quality of life. It also points out the challenges of current treatment, such as patient compliance and limitations of treatment methods, and looks at future treatment directions.展开更多
BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive ...BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive scores of nonunion used in clinical practice to determine the most accurate score for predicting nonunion.METHODS We collected data from patients with tibial shaft fractures undergoing surgery from January 2016 to December 2020 in three different trauma hospitals.In this retrospective multicenter study,we considered only fractures treated with intramedullary nailing.We calculated the tibia FRACTure prediction healING days(FRACTING)score,Nonunion Risk Determination score,and Leeds-Genoa Nonunion Index(LEG-NUI)score at the time of definitive fixation.RESULTS Of the 130 patients enrolled,89(68.4%)healed within 9 months and were classified as union.The remaining patients(n=41,31.5%)healed after more than 9 months or underwent other surgical procedures and were classified as nonunion.After calculation of the three scores,LEG-NUI and FRACTING were the most accurate at predicting healing.CONCLUSION LEG-NUI and FRACTING showed the best performances by accurately predicting union and nonunion.展开更多
Objective: To investigate the curative effect and mechanism of Xuduan Jiegu Decoction in the treatment of rabbit bone defect bone nonunion. Methods: The experiment was randomly divided into three groups;1) The control...Objective: To investigate the curative effect and mechanism of Xuduan Jiegu Decoction in the treatment of rabbit bone defect bone nonunion. Methods: The experiment was randomly divided into three groups;1) The control group that was given neither the modeling nor the treatment;2) The model group that was not given the treatment after the operation to model a bone defect;3) The treatment group that was given intermittent bone decoction after modeling (i.e., the operation), the dose was 105 g/piece, twice a day, for 4 consecutive weeks. For the three groups, Anterolateral X-rays of the left forearm were taken 14 days after the surgery to observe the bone nonunion healing with pretherapy and post-treatment. The expression levels of TGF-β, BMP-2 and VEGF in the blood of each group were measured by ELISA at 4 weeks after treatment. The peri-fracture histopathological changes between each group of pretherapy and post-treatment were evaluated by using tissue sections. Results: Compared with the control group, there was no obvious healing in the model group on the 14th day after the operation. Compared with the model group, the treatment group was treated with Xuduan Jiegu Decoction, and there was a trend of healing and callus formation on the 14th day. HE staining showed that the cells in the control group were closely arranged without any pathological changes. In the model group, the tissues around the fracture end were arranged loosely, and the cells were vacuolated and infiltrated by inflammatory cells. Compared with the model group, the peripheral cell arrangement was better and the peripheral lesions were reduced in the treatment group. The content of TGF-β, BMP-2 and VEGF in blood detected by ELISA was significantly higher in the treatment group than in the control group and the model group, with statistical significance. Conclusion: Xuduan Jiegu Decoction can promote callus formation and accelerate fracture healing in rabbit radius bone defect, and the mechanism of promoting fracture healing is related to the increases of TGF-β, BMP-2 and VEGF levels.展开更多
We are describing a transverse incision that we have found very useful in performing surgical procedures where the fractured site needs freshening, excision of the necrotic bones or shortening. Operative procedures us...We are describing a transverse incision that we have found very useful in performing surgical procedures where the fractured site needs freshening, excision of the necrotic bones or shortening. Operative procedures using this technique have been extensively used by us since 1980 and we have registered 1187 cases with average follow up of 10 years. The incision is transverse and can be performed in any part of leg and extends from 1 cm lateral to anterior border of the tibia and runs medially till 1 cm medial to medial border of tibia. The incision allows adequate visualization of the interested area, less of periosteal stripping, ease of closure, no post operative wound dehiscence and cosmetically very much acceptable.展开更多
We reported a case of atrophic nonunion after humeral shaft fracture in a patient with severe psychiatric disorders that advised against hospital admission and surgery. He was treated with teriparatide (recombinant hu...We reported a case of atrophic nonunion after humeral shaft fracture in a patient with severe psychiatric disorders that advised against hospital admission and surgery. He was treated with teriparatide (recombinant human 1-34 parathyroid hormon) [rh (1-34) PTH] in daily subcutaneous injections. After 4 months of treatment, healing of nonunion, associated to clinical improvement and functional recovery of the patient, was observed. No other intervention was required, and no side effects attributable to the drug occurred.展开更多
Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently,t...Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently,there is a plethora of different strategies to augment the impaired or "insufficient" bone-regeneration process, including the "gold standard" autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved "local" strategies in terms of tissue engineering and gene therapy, or even "systemic" enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.展开更多
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in...BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.展开更多
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
Femoral artery pseudoaneurysms(FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. Th...Femoral artery pseudoaneurysms(FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. The diagnosis of FAP is usually delayed because of non-specific clinical features like pain, haematoma,swelling, occasional fever and unexplained anaemia.Because of the insidious onset and of the possible delayed presentation of pseudoaneurysms, orthopaedic and trauma surgeons should be aware of this complication. We report a case of Profunda Femoris arterial branch pseudoaneurysm, diagnosed in a 40-year-old male 4 wk after revision with Kuntscher intramedullary nail of a femoral shaft nonunion. The diagnosis was achieved by computed tomography angiography and the lesion was effectively managed by endovascular repair. The specific literature and suggestions for treatment are discussed in the paper.展开更多
Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to f...Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up 0=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.展开更多
AIM To present the incidence of heterotopic ossification after the use of recombinant human bone morphogenetic protein-7(rhB MP-7) for the treatment of nonunions.METHODS Bone morphogenetic proteins(BMPs) promote bone ...AIM To present the incidence of heterotopic ossification after the use of recombinant human bone morphogenetic protein-7(rhB MP-7) for the treatment of nonunions.METHODS Bone morphogenetic proteins(BMPs) promote bone formation by auto-induction. Recombinant human BMP-7 in combination with bone grafts was used in 84 patients for the treatment of long bone nonunions. All patients were evaluated radiographicaly for the development of heterotopic ossification during the standard assessment for the nonunion healing. In all patients(80.9%) with radiographic signs of heterotopic ossification, a CT scan was performed. Nonunion site palpation and ROM evaluation of the adjacent jointswere also carried out. Factors related to the patient(age, gender), the nonunion(location, size, chronicity, number of previous procedures, infection, surrounding tissues condition) and the surgical procedure(graft and fixation type, amount of rhB MP-7) were correlated with the development of heterotopic ossification and statistical analysis with Pearsons χ~2 test was performed.RESULTS Eighty point nine percent of the nonunions treated with rh BMP-7, healed with no need for further procedures. Heterotopic bone formation occurred in 15 of 84 patients(17.8%) and it was apparent in the routine radiologi-cal evaluation of the nonunion site, in a mean time of 5.5 mo after the rh BMP-7 application(range 3-12). The heterotopic ossification was located at the femur in 8 cases, at the tibia in 6, and at the humerus in οne patient. In 4 patients a palpable mass was present and only in one patient, with a para-articular knee nonunion treated with rhB MP-7, the size of heterotopic ossification affected the knee range of motion. All the patients with heterotopic ossification were male. Statistical analysis proved that patient's gender was the only important factor for the development of heterotopic ossification(P = 0.007). CONCLUSION Heterotopic ossification after the use of rh BMP-7 in nonunions was common but it did not compromise the final clinical outcome in most cases, and affected only male patients.展开更多
BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,th...BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing.We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure.The outcomes of interest were delayed union or nonunion.Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available evidence.RESULTS A total of 120 articles were identified and screened,of which 6 articles were included for final review.Nonunion in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period.Additionally,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse side-effects.CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing.Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.展开更多
Intercalary allograft reconstruction offers a joint-sparing reconstructive option, but nonunion is a devastating complication. In this article, we want to share our experience of proper dynamization of interlocking in...Intercalary allograft reconstruction offers a joint-sparing reconstructive option, but nonunion is a devastating complication. In this article, we want to share our experience of proper dynamization of interlocking intramedullary nail for nonunion after proximal femoral intercalary allograft reconstruction. In this report, a 19-year-old girl was diagnosed proximal femoral fibroblast osteosarcoma （Enneking lib）. After neoadjuvant chemotherapy, she underwent proximal femoral intercalary allograft reconstruction fixed by retrograde interlocking intramedullary nail. At her follow-up point of one year postoperatively, nonunion was observed in the proximal host-allograft junction. Therefore she underwent the second surgery of dynamization of the interlocking intramedullary nail. After 12 months＇ partial and full weight bearing exercise, bone union occurred. Our early observations show that dynamization of interlocking intramedullary nail can still be a useful means to treat nonunion of host- allograft junction if the local condition of the host and allograft bone are good enough.展开更多
BACKGROUND Femoral shaft fractures are a common type of fracture among adults and have high union rates. However, clinical decisions are difficult to make because of the different types of nonunions. Atrophic nonunion...BACKGROUND Femoral shaft fractures are a common type of fracture among adults and have high union rates. However, clinical decisions are difficult to make because of the different types of nonunions. Atrophic nonunion usually requires revision surgery combined with bone grafting. Furthermore, no study of teriparatide administration for femoral atrophic nonunion have been previously reported. CASE SUMMARY A 60-year-old woman had a right femoral shaft fracture due to a traffic accident, and she immediately underwent closed reduction and internal fixation surgery with an intramedullary nailing. However, after 6 mo of rehabilitation, the fracture site showed no signs of healing, and her condition was diagnosed as atrophic nonunion. Subsequently, teriparatide was administered for 6 mo. Complete union was observed at the fracture site 6 mo after teriparatide discontinued. CONCLUSION The use of teriparatide can be a promising treatment to improve the healing of nonunion fractures.展开更多
文摘To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients with severe osteoporosis or with nonunion site close to the artificial surface,the head of the buttress plate was added,making the screws to fixate easily.Iliac bone autograft including iliac block and scum of spongy bone was used in order to fully arouse the inductive and conductive effect of the graft.Continuous postoperative passive motion (CPM) was performed for a short period,and the active and passive motion were intensively advised for one year long.The cases were followed up from 12 to 70 months (mean 34 months).Results All cases were healed,with average healing time of five months (3～6 months).The motion range for the knee joint was increased from 73 degrees (5～135 degrees) to 97 degrees (30～135 degrees).Excellent and good results were achieved in 13 cases,satisfactory in four and poor in one.Conclusion DCS with rigid fixation and compression effect,combined with porous condylar plate if necessary,with iliac bone autograft and long period of post-operative exercises of the knee joint,provides one efficacious technique for treating the supracondylar non-unions of the femur.11 refs,2 figs.
文摘Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.
基金Supported by National Natural Science Foundation of China,No.82172441Suzhou City Major Disease Multicenter Clinical Research Project,No.DZXYJ202312+2 种基金Special Funding for Jiangsu Province Science and Technology Plan(Key Research and Development Program for Social Development),No.BE2023737Gusu Health Talent Plan Scientific Research Project,No.GSWS2022109Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2446.
文摘BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.
文摘Management of post-traumatic long-bone defects remains relevant and cha-llenging despite the rapid development of approaches to their treatment.Do-minant positions are occupied by the Ilizarov method,bone autogenous grafting and the Masquelet induced membrane technique(IMT).The IMT is aimed at reducing extensive defect treatment duration and for this reason has gained great popularity.However,the assessment of its effectiveness is difficult due to a limited number of clinical series.The varying clinical manifestations of bone defect severity do not allow a comprehensive evaluation of IMT effectiveness.One of them is infection in the defect area.The purpose of our literature review is an analysis of studies on IMT application in infected vs non-infected long-bone defects of the lower extremities published over the last 10 years.It focuses on the investigation of similarities and fundamental differences in the need for antibiotics,timing of spacer fixation,methods of collecting donor bone and fixators used for consolidation.The studies show that the IMT has been globally used in aseptic and osteomyelitic defects due to its clinical effectiveness.Authors’variations and improvements in its practical implementation indicate the ongoing development and the interest of researchers in this technique.
文摘To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center retrospective comparative study included 50 adult patients with aseptic nonunion of femoral or tibial diaphyseal fractures treated at our institution between January 2015 and January 2025.Patients underwent either locking-plate(LP)fixation(n=25)or intramedullary nailing(IMN)(n=25).The primary outcome was radiographic union at 12 months postoperatively.Secondary outcomes included time to union,operative time,intraoperative blood loss,length of hospital stay,incidence of complications(superficial/deep infection,implant failure,malunion),and 12-month functional status assessed by the Lower Extremity Functional Scale(LEFS).Statistical comparisons used Welch t tests for continuous variables andχ²or Fisher exact tests for categorical variables.The protocol received institutional review board approval with waiver of informed consent.Results:Among 50 patients(LP=25;IMN=25),the 12-month union rate was 88.00%(22/25)in the LP group and 96.00%(24/25)in the IMN group(p=0.609).Time to union was shorter with IMN(6.20±1.83 vs 7.51±2.12 months;p=0.023).Operative time(110.52±25.23 vs 145.81±30.21 min;p<0.01)and intraoperative blood loss(250.41±80.64 vs 350.22±95.30 ml;p<0.01)favored IMN.Length of hospital stay was similar(6.24±1.83 vs 6.82±2.11 days;p=0.284).The incidence of superficial wound infection did not differ significantly(12.00%vs 4.00%;p=0.609).Twelve-month LEFS scores were comparable(65.44±10.21 vs 67.10±9.83;p=0.451).Conclusion:Both locking plate and intramedullary nail fixation are effective in the treatment of femoral and tibial nonunion,with high rates of union and good functional outcomes.Intramedullary nailing may be associated with a shorter time to union,reduced operative time and blood loss,and a lower risk of superficial wound infection compared to locking plate fixation.The choice of implant should be individualized based on fracture characteristics,patient factors,and surgeon preference.
文摘This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for developing effective treatment strategies and improving patients’ quality of life. It also points out the challenges of current treatment, such as patient compliance and limitations of treatment methods, and looks at future treatment directions.
文摘BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive scores of nonunion used in clinical practice to determine the most accurate score for predicting nonunion.METHODS We collected data from patients with tibial shaft fractures undergoing surgery from January 2016 to December 2020 in three different trauma hospitals.In this retrospective multicenter study,we considered only fractures treated with intramedullary nailing.We calculated the tibia FRACTure prediction healING days(FRACTING)score,Nonunion Risk Determination score,and Leeds-Genoa Nonunion Index(LEG-NUI)score at the time of definitive fixation.RESULTS Of the 130 patients enrolled,89(68.4%)healed within 9 months and were classified as union.The remaining patients(n=41,31.5%)healed after more than 9 months or underwent other surgical procedures and were classified as nonunion.After calculation of the three scores,LEG-NUI and FRACTING were the most accurate at predicting healing.CONCLUSION LEG-NUI and FRACTING showed the best performances by accurately predicting union and nonunion.
文摘Objective: To investigate the curative effect and mechanism of Xuduan Jiegu Decoction in the treatment of rabbit bone defect bone nonunion. Methods: The experiment was randomly divided into three groups;1) The control group that was given neither the modeling nor the treatment;2) The model group that was not given the treatment after the operation to model a bone defect;3) The treatment group that was given intermittent bone decoction after modeling (i.e., the operation), the dose was 105 g/piece, twice a day, for 4 consecutive weeks. For the three groups, Anterolateral X-rays of the left forearm were taken 14 days after the surgery to observe the bone nonunion healing with pretherapy and post-treatment. The expression levels of TGF-β, BMP-2 and VEGF in the blood of each group were measured by ELISA at 4 weeks after treatment. The peri-fracture histopathological changes between each group of pretherapy and post-treatment were evaluated by using tissue sections. Results: Compared with the control group, there was no obvious healing in the model group on the 14th day after the operation. Compared with the model group, the treatment group was treated with Xuduan Jiegu Decoction, and there was a trend of healing and callus formation on the 14th day. HE staining showed that the cells in the control group were closely arranged without any pathological changes. In the model group, the tissues around the fracture end were arranged loosely, and the cells were vacuolated and infiltrated by inflammatory cells. Compared with the model group, the peripheral cell arrangement was better and the peripheral lesions were reduced in the treatment group. The content of TGF-β, BMP-2 and VEGF in blood detected by ELISA was significantly higher in the treatment group than in the control group and the model group, with statistical significance. Conclusion: Xuduan Jiegu Decoction can promote callus formation and accelerate fracture healing in rabbit radius bone defect, and the mechanism of promoting fracture healing is related to the increases of TGF-β, BMP-2 and VEGF levels.
文摘We are describing a transverse incision that we have found very useful in performing surgical procedures where the fractured site needs freshening, excision of the necrotic bones or shortening. Operative procedures using this technique have been extensively used by us since 1980 and we have registered 1187 cases with average follow up of 10 years. The incision is transverse and can be performed in any part of leg and extends from 1 cm lateral to anterior border of the tibia and runs medially till 1 cm medial to medial border of tibia. The incision allows adequate visualization of the interested area, less of periosteal stripping, ease of closure, no post operative wound dehiscence and cosmetically very much acceptable.
文摘We reported a case of atrophic nonunion after humeral shaft fracture in a patient with severe psychiatric disorders that advised against hospital admission and surgery. He was treated with teriparatide (recombinant human 1-34 parathyroid hormon) [rh (1-34) PTH] in daily subcutaneous injections. After 4 months of treatment, healing of nonunion, associated to clinical improvement and functional recovery of the patient, was observed. No other intervention was required, and no side effects attributable to the drug occurred.
文摘Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently,there is a plethora of different strategies to augment the impaired or "insufficient" bone-regeneration process, including the "gold standard" autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved "local" strategies in terms of tissue engineering and gene therapy, or even "systemic" enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.
文摘BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
文摘Femoral artery pseudoaneurysms(FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. The diagnosis of FAP is usually delayed because of non-specific clinical features like pain, haematoma,swelling, occasional fever and unexplained anaemia.Because of the insidious onset and of the possible delayed presentation of pseudoaneurysms, orthopaedic and trauma surgeons should be aware of this complication. We report a case of Profunda Femoris arterial branch pseudoaneurysm, diagnosed in a 40-year-old male 4 wk after revision with Kuntscher intramedullary nail of a femoral shaft nonunion. The diagnosis was achieved by computed tomography angiography and the lesion was effectively managed by endovascular repair. The specific literature and suggestions for treatment are discussed in the paper.
文摘Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up 0=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.
基金The European Union(European Social Fund-ESF)Greek national funds through the Operational Program "Education and Lifelong Learning" of the National Strategic Reference Framework(NSRF)-Research Funding Program:Heracleitus Ⅱ
文摘AIM To present the incidence of heterotopic ossification after the use of recombinant human bone morphogenetic protein-7(rhB MP-7) for the treatment of nonunions.METHODS Bone morphogenetic proteins(BMPs) promote bone formation by auto-induction. Recombinant human BMP-7 in combination with bone grafts was used in 84 patients for the treatment of long bone nonunions. All patients were evaluated radiographicaly for the development of heterotopic ossification during the standard assessment for the nonunion healing. In all patients(80.9%) with radiographic signs of heterotopic ossification, a CT scan was performed. Nonunion site palpation and ROM evaluation of the adjacent jointswere also carried out. Factors related to the patient(age, gender), the nonunion(location, size, chronicity, number of previous procedures, infection, surrounding tissues condition) and the surgical procedure(graft and fixation type, amount of rhB MP-7) were correlated with the development of heterotopic ossification and statistical analysis with Pearsons χ~2 test was performed.RESULTS Eighty point nine percent of the nonunions treated with rh BMP-7, healed with no need for further procedures. Heterotopic bone formation occurred in 15 of 84 patients(17.8%) and it was apparent in the routine radiologi-cal evaluation of the nonunion site, in a mean time of 5.5 mo after the rh BMP-7 application(range 3-12). The heterotopic ossification was located at the femur in 8 cases, at the tibia in 6, and at the humerus in οne patient. In 4 patients a palpable mass was present and only in one patient, with a para-articular knee nonunion treated with rhB MP-7, the size of heterotopic ossification affected the knee range of motion. All the patients with heterotopic ossification were male. Statistical analysis proved that patient's gender was the only important factor for the development of heterotopic ossification(P = 0.007). CONCLUSION Heterotopic ossification after the use of rh BMP-7 in nonunions was common but it did not compromise the final clinical outcome in most cases, and affected only male patients.
文摘BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing.We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure.The outcomes of interest were delayed union or nonunion.Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available evidence.RESULTS A total of 120 articles were identified and screened,of which 6 articles were included for final review.Nonunion in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period.Additionally,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse side-effects.CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing.Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.
文摘Intercalary allograft reconstruction offers a joint-sparing reconstructive option, but nonunion is a devastating complication. In this article, we want to share our experience of proper dynamization of interlocking intramedullary nail for nonunion after proximal femoral intercalary allograft reconstruction. In this report, a 19-year-old girl was diagnosed proximal femoral fibroblast osteosarcoma （Enneking lib）. After neoadjuvant chemotherapy, she underwent proximal femoral intercalary allograft reconstruction fixed by retrograde interlocking intramedullary nail. At her follow-up point of one year postoperatively, nonunion was observed in the proximal host-allograft junction. Therefore she underwent the second surgery of dynamization of the interlocking intramedullary nail. After 12 months＇ partial and full weight bearing exercise, bone union occurred. Our early observations show that dynamization of interlocking intramedullary nail can still be a useful means to treat nonunion of host- allograft junction if the local condition of the host and allograft bone are good enough.
文摘BACKGROUND Femoral shaft fractures are a common type of fracture among adults and have high union rates. However, clinical decisions are difficult to make because of the different types of nonunions. Atrophic nonunion usually requires revision surgery combined with bone grafting. Furthermore, no study of teriparatide administration for femoral atrophic nonunion have been previously reported. CASE SUMMARY A 60-year-old woman had a right femoral shaft fracture due to a traffic accident, and she immediately underwent closed reduction and internal fixation surgery with an intramedullary nailing. However, after 6 mo of rehabilitation, the fracture site showed no signs of healing, and her condition was diagnosed as atrophic nonunion. Subsequently, teriparatide was administered for 6 mo. Complete union was observed at the fracture site 6 mo after teriparatide discontinued. CONCLUSION The use of teriparatide can be a promising treatment to improve the healing of nonunion fractures.
