Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea.
Arch Orthop Trauma Surg. 2021 Nov;141(11):1855-1862. doi: 10.1007/s00402-020-03567-4. Epub 2020 Aug 14.
We performed revision surgeries to treat nonunion of bisphosphonate-associated ulnar fractures that had originally been treated, after misdiagnosis, using the typical open reduction/internal fixation (ORIF).
Of nine cases of ulnar nonunion initially treated at other institutions, we performed revision surgeries on four that met our inclusion/exclusion criteria. All previous implants were removed; the areas of nonunion were resected, and strut bone grafts were inserted and fixed with locking plates. Radiological assessments were performed monthly for 3 months after surgery and then every 3 months for 1 year.
All patients were female, with a mean age of 71.8 years. All patients had been taking bisphosphonate for a mean of 7.2 years. The primary fixation methods used at other institutions were intra-medullary nailing (n = 1) and placement of 3.5-mm locking plates (n = 3). In one patient (patient 1), the contralateral (right) ulna developed a new fracture at 1 month after revision surgery on the left ulna. Another patient (patient 3) exhibited an incomplete fracture in the contralateral (right) ulna. All four patients exhibited hip fractures (bilateral in three). All revisions resulted in final union at a mean of 4.8 months postoperatively.
Atypical ulnar fractures should be suspected in elderly women on long-term bisphosphonate treatment. Union will fail with standard ORIF for atypical ulnar fractures, because the fracture occurred due to compromised normal bone metabolism as reflected in the bone resorption, remodeling, and healing processes. Revision osteosynthesis using a locking plate with callus resection and strut/cancellous bone graft provided satisfactory results.
Therapeutic level IV.
我们对因误诊而采用典型切开复位内固定术（ORIF）治疗的双膦酸盐相关尺骨骨折不愈合患者进行了翻修手术。
在其他机构治疗的 9 例尺骨不愈合患者中，我们对符合纳入/排除标准的 4 例患者进行了翻修手术。所有先前的植入物均被取出；切除不愈合部位，插入并使用锁定板固定骨桥植骨。术后 3 个月每月进行影像学评估，然后每年每 3 个月评估 1 次。
所有患者均为女性，平均年龄为 71.8 岁。所有患者均服用双膦酸盐，平均 7.2 年。其他机构初次固定方法包括髓内钉（n=1）和 3.5mm 锁定钢板（n=3）。1 例患者（患者 1）左侧尺骨翻修术后 1 个月对侧（右侧）尺骨发生新骨折。另 1 例患者（患者 3）对侧（右侧）尺骨出现不完全骨折。4 例患者均发生髋部骨折（3 例双侧）。所有患者均在术后 4.8 个月最终愈合。
长期接受双膦酸盐治疗的老年女性应怀疑发生非典型尺骨骨折。非典型尺骨骨折采用标准 ORIF 治疗会导致骨折不愈合，因为骨折是由骨吸收、重塑和愈合过程中正常骨代谢受损引起的。采用锁定钢板切除骨痂和骨桥/松质骨植骨的翻修骨合成术提供了满意的结果。
治疗性 IV 级。
