Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.
Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.
Orthop Traumatol Surg Res. 2021 Dec;107(8):102843. doi: 10.1016/j.otsr.2021.102843. Epub 2021 Feb 3.
There is a great surgical challenge when humeral diaphyseal fractures are initially open, complex, or associated with segmental bone loss. The challenge becomes even greater with previous multiple unsuccessful surgeries. The question of this study was: Does combining locked compression plating with non-vascularized fibular autograft in cases of resistant humeral diaphyseal nonunion yield reliable bony union and satisfactory functional outcome?
The use of non-vascularized fibular autograft in conjunction with locked compression plating will provide stable construct, enhance bony union and improve functional outcome in cases of resistant humeral diaphyseal nonunion.
Thirty-three patients with resistant humeral diaphyseal nonunion who were surgically managed combining non-vascularized fibular autograft fixed with locked compression plating in the period from January 2011 to June 2017, were retrospectively studied. All patients were followed-up for a minimum of 24 months. The time to union, the postoperative disability of arm, shoulder and hand (DASH) score, in addition to the possible complications including infection or nonunion were reported and analyzed.
Twenty-nine patients have achieved union at the final follow-up with a mean time to radiological union of 7.5±2.6 months (range: 3-12). The mean postoperative DASH score was 7.7±8.9 (range: 0-38.8) which was significantly better than the preoperative value (p<0.001) and superior in the patients of aseptic nonunion (p=0.04). Eight patients showed complications in the form of infection (four), nonunion (two cases), transient radial nerve palsy (one case) and one case of septic nonunion that was managed by two-stage reconstruction using vascularized fibular autograft. There were comparable results in patients with either open or closed fractures. However, patients with septic nonunion experienced more significant complications (p=0.02).
The use of non-vascularized fibula autograft in cases of resistant humeral diaphyseal nonunion provides adequate fracture stability, quadrilateral screw purchase, enhances bony union in addition to promoting satisfactory functional outcome particularly in aseptic nonunion.
IV; retrospective case series.
当肱骨干骨折最初为开放性、复杂性骨折，或伴有节段性骨丢失时，会面临很大的手术挑战。如果之前有多次手术失败，挑战就更大了。本研究的问题是：在难治性肱骨干骨不连的病例中，将锁定加压钢板与游离腓骨骨移植相结合，能否获得可靠的骨愈合和满意的功能结果？
在难治性肱骨干骨不连的病例中，使用游离腓骨骨移植结合锁定加压钢板将提供稳定的结构，增强骨愈合，并改善功能结果。
回顾性研究了 2011 年 1 月至 2017 年 6 月期间采用游离腓骨骨移植联合锁定加压钢板固定治疗的 33 例难治性肱骨干骨不连患者。所有患者均随访至少 24 个月。报告并分析了愈合时间、术后上肢、肩和手残疾（DASH）评分，以及感染或骨不连等可能的并发症。
29 例患者在最终随访时达到了愈合，影像学愈合的平均时间为 7.5±2.6 个月（范围：3-12 个月）。术后平均 DASH 评分为 7.7±8.9（范围：0-38.8），明显优于术前（p<0.001），且在无菌性骨不连患者中更优（p=0.04）。8 例患者出现并发症，表现为感染（4 例）、骨不连（2 例）、桡神经一过性麻痹（1 例）和 1 例感染性骨不连，采用带血管腓骨骨移植二期重建。开放性或闭合性骨折患者的结果相似。然而，感染性骨不连患者的并发症更为严重（p=0.02）。
在难治性肱骨干骨不连的病例中，使用游离腓骨骨移植可提供足够的骨折稳定性、四边形螺钉固定，增强骨愈合，并促进满意的功能结果，特别是在无菌性骨不连中。
IV；回顾性病例系列。
