Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

Background: Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.Methods: Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22). The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.Results: All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.Conclusions: LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

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Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

10.21203/rs.3.rs-34226/v1 ◽

2020 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Radial Nerve Palsy ◽

Consecutive Series ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Despite the majority humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

10.21203/rs.3.rs-34226/v2 ◽

2020 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Radial Nerve Palsy ◽

Consecutive Series ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Despite the majority of humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03743-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Nerve Palsy ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Ulnar Nerve Palsy ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

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An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416651574 ◽

2016 ◽

Vol 42 (2) ◽

pp. 170-175 ◽

Cited By ~ 2

Author(s):

L. Latheef ◽

P. Bhardwaj ◽

A. Sankaran ◽

S. R. Sabapathy

Keyword(s):

Tendon Transfer ◽

Objective Assessment ◽

Radial Nerve Palsy ◽

Dash Score ◽

Functional Evaluation ◽

Postoperative Function ◽

Wrist Extension ◽

Wrist Motion ◽

Flexor Carpi Ulnaris ◽

The Mean

This study reports an objective assessment of postoperative function of 11 triple transfers for high radial palsies, using pronator teres for wrist extension, flexor carpi ulnaris for finger extension and palmaris longus for thumb extension. The mean follow-up was 3.3 years. Assessment was done by recording the active ranges of wrist motion, grip strength, wrist and finger strength and work simulation. The mean strength and range of wrist extension were 42% and 86%, respectively, of the contralateral wrist. Other measured movements were within the functional range and work simulation confirmed good restoration of function. The mean DASH score was 3.45, with no patient reporting any specific functional complaints. This study shows that even though the range of wrist motion and the strength of the wrist and fingers are less than normal, hand function remains good. We conclude that the flexor carpi ulnaris set of tendon transfer works well. Level of evidence: 3

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Two-Plate Fixation for Humeral Shaft Nonunions

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700201 ◽

2009 ◽

Vol 17 (2) ◽

pp. 135-138 ◽

Cited By ~ 14

Author(s):

Angel Antonio Martinez ◽

Jorge Cuenca ◽

Antonio Herrera

Keyword(s):

Bone Grafting ◽

Radial Nerve ◽

Nerve Palsy ◽

Plate Fixation ◽

Functional Results ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Non Union ◽

Upper Third ◽

With Screws

Purpose. To review 22 patients who underwent 2-plate fixation for non-union of the humeral shaft. Methods. 13 women and 9 men aged 32 to 76 (mean, 48) years underwent fixation for non-union of the humeral shaft, using a 2-plate construct, together with decortication, debridement, and bone grafting. The two 3.5-mm reconstruction plates were parallel and lying at 90° to each other and fixed with screws purchasing into at least 6 cortices of each fragment for both plates. Fractures were located in the upper third (n=8) or middle third (n=14) of the humerus. Initial treatments included casting (n=9), coaptation splinting (n=8), multiple retrograde pinning (n=4), and Marchetti-Vicenzi nailing (n=1). 18 non-unions were atrophic and 4 were hypertrophic. Shoulder and elbow range of motion as well as functional results were evaluated. Results. The time for union was 4.6 (range, 4–6) months. No implants were loose or broken. No nonunion or infection was noted. Functional results were excellent in 17 and good in 5 patients. One patient had iatrogenic radial nerve palsy that recovered within 3 months. Conclusion. Two-plate fixation achieves good results for humeral shaft non-unions.

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Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

10.21203/rs.3.rs-34226/v3 ◽

2021 ◽

Author(s):

Dongxu Feng ◽

Xiaolong Wang ◽

Liang Sun ◽

Xiao Cai ◽

Kun Zhang ◽

...

Keyword(s):

Bone Grafting ◽

Nerve Palsy ◽

Iliac Crest ◽

Humeral Shaft ◽

Autogenous Bone ◽

Salvage Procedure ◽

Iliac Crest Bone Grafting ◽

Ulnar Nerve Palsy ◽

Humeral Shaft Nonunion ◽

The Mean

Abstract Background: Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion.Methods: A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study cohort comprised six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

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Management of distal femur fractures with locking compression plate: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180459 ◽

2018 ◽

Vol 4 (2) ◽

pp. 208

Author(s):

Sridhar Reddy Konuganti ◽

Sreenath Rao Jakinapally ◽

Vennamaneni Pratish Rao ◽

Sivaprasad Rapur

Keyword(s):

Prospective Study ◽

Distal Femur ◽

Femoral Fractures ◽

Locking Compression Plate ◽

Functional Score ◽

Non Union ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Compression Plate ◽

The Mean

Background: Distal femur fractures need to be treated operatively to achieve optimal outcomes. Different types of internal fixation devices have been used but, the number of revisions for non-union, loss of reduction and implant failure has been high.Methods: This prospective study reviewed 20 cases of distal femoral fractures surgically managed with distal femoral locking compression plate between December 2013 and December 2015 at Mediciti Institute of medical sciences, Ghanpur, Medchal, tertiary care referral and trauma centre. Fractures were categorized according to OTA classification by Muller.Results: Highest number of patients was in their 3rd decade (25%) 18 out of 20 patients had closed injury. Type A2 Muller’s fracture was the most common fracture type 7 out of 20 patients (35%).The mean follow up period in this study was 8 months. The average range of knee flexion achieved was about 109°. The mean score 81.75 points were rated using Neer’s functional score (Max 100). Conclusions: The locking compression plate is the treatment of choice in the management of comminuted distal femoral fractures especially Type A fractures where we have found higher Neer scores. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is valuable in the management of these fractures.

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FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH A LOCKING COMPRESSION PLATE: A CROSS SECTIONAL STUDY

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1407 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3266-3269

Author(s):

Abhishek Patil

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Constant Score ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures ◽

The Mean

Proximal humerus fractures account for about 4% to 5% of all fractures. Following distal forearm fracture, proximal humeral fracture is the second most common upper extremity fracture. Kirschner (K)-Wires, external fixation, tension band wiring, and rush pins, intramedullary nails, ORIF with plates, and shoulder hemiarthroplasty have all been offered as therapeutic options. The purpose of this study was to assess the functional outcome and complication rates following internal fixation of proximal humerus fractures using a locking compression plate. Patients over the age of 18 with closed proximal humerus fractures or open proximal humerus fractures (Gustilo and Anderson type I, Type II) received open reduction and internal fixation with locking compression plate in the current study. The participants in this study were 60 people who had a proximal humerus fracture and were treated with open reduction and a proximal humerus locking compression plate. Patients ranged in age from 20 to 85 years old, with a mean age of 51.14 +/- 17.30 years. The age group 36–55 years (37 percent) was the most prevalent, followed by 56–75 years (30 %). The majority of patients (76.7 %) were men who had been in automobile accidents on the right side (83 %) (63 %). According to the Neer classification, the most prevalent type of fracture was a three-part fracture (53 %). The maximum union time observed in this study was 16 weeks, with a minimum of 10 weeks. The average time to union is 12.52 +/- 1.14 weeks. The mean flexion at the end of six months was 121.660 +/- 19.84. The mean internal rotation was 57.330 +/- 8.48, the mean external rotation was 530 +/- 11.98, and the mean abduction was 1180 +/- 19.36. 75.28 +/- 9.66 [Mean +/- SD] is the Mean Constant score. Pain 14.10, ADL 18.26, range of motion 22.46, and power 20 were the mean scores observed on Constant Score for its various aspects. According to the Constant score, the functional outcome of the 60 patients was as follows: 8 patients had excellent outcomes (13%), 34 patients had good outcomes (56.7%), 16 patients had moderate outcomes (26.7%), and two patients had poor outcomes (26.7%) and (3 %). Internal fixation of proximal humerus fractures with a locking compression plate results in anatomical reduction and secure fixation, resulting in a favorable functional outcome.

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A prospective study on surgical fixation of complex supracondylar femur fracture with distal femoral locking compression plate: our experiences at a tertiary care centre

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203731 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1057

Author(s):

Rajesh Kumar Sharma ◽

Anuradha Upadhyay ◽

Rahul Parmar

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

Clinical Results ◽

Lateral Approach ◽

Locking Compression Plate ◽

Tertiary Care Centre ◽

Non Union ◽

Femur Fractures ◽

Compression Plate ◽

Supracondylar Femur Fractures

Background: The optimal treatment of complex supracondylar femur fractures remains always challenging and controversial. the purpose of this prospective study was to evaluate the efficacy of distal femoral locking compression plate (DF-LCP) in terms of functional outcome and union rate for highly unstable complex supracondylar femur fractures and to determine the influencing factors of an unfavourable outcome.Methods: After obtaining approval from institutional ethics committee, 45 patients with complex supracondylar femur fractures were managed by open reduction and internal fixation with DF-LCP through lateral approach and as per standard protocol. The follow-up results were analysed clinically and radiologically, using the “Schatzker and Lambert criteria” at once in a month for first three months, once in three months up to one year and once in six months thereafter up to 2 years post-operatively.Results: In the present study, average duration of radiological union was 16 (range 12-22) weeks. The average range of motion of knee joint was 105 degrees. Out of 45 patients, clinical results were excellent in 48.9%, good in 17.8%, fair in 22.2% and poor in 11.1% patients according to Schatzker and Lambert criteria. Knee stiffness (7 cases), secondary arthritis (5 cases), and non-union (4 cases) were the main complications observed in this study, which were treated accordingly.Conclusions: DF-LCP holds the metaphyseal bone strongly and prevents metaphyseal collapse and mal-rotation in complex or highly unstable supracondylar femur fractures and simultaneously, it provides stable fixation to promote fracture union and allows early rehabilitation with acceptable complications.

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