scholarly journals Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

2021 ◽  
Vol 9 (C) ◽  
pp. 118-123
Author(s):  
Falih Waheed Hashmi ◽  
Mohammed Baqir Al-Shara ◽  
Mohammed Al-Edanni
Keyword(s):  
Functional Outcome ◽  
Nonoperative Treatment ◽  
Humeral Shaft ◽  
Teaching Hospitals ◽  
Previous Surgery ◽  
Infected Nonunion ◽  
Hardware Failure ◽  
Non Union ◽  
Onlay Graft ◽  
Compression Plate

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

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

2016 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
Rajesh Govindasamy ◽  
Ramkumar Gnanasundaram ◽  
Saravanan Kasirajan ◽  
Fawas Thonikadavath ◽  
Jeff Walter Rajadurai
Keyword(s):  
Bone Grafting ◽  
Locking Compression Plate ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Non Union ◽  
Humeral Shaft Nonunion ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><strong>Conclusions:</strong> LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

scholarly journals Randomized controlled trial comparing dynamic compression plate versus intramedullary interlocking nail for management of humeral shaft fractures

1970 ◽  
Vol 9 (2) ◽  
pp. 61-66 ◽  
Author(s):  
P Chaudhary ◽  
NK Karn ◽  
BP Shrestha ◽  
GP Khanal ◽  
R Rijal ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Blood Loss ◽  
Functional Outcome ◽  
Dynamic Compression ◽  
Operating Time ◽  
Humeral Shaft ◽  
Dynamic Compression Plate ◽  
Interlocking Nail ◽  
Humeral Shaft Fractures ◽  
Compression Plate

Background: The optimal method of humeral shaft fracture fixation remains debatable. With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that IM-ILN might be more appropriate for humeral shaft fractures than DCP. Objectives: To compare the fixation of fracture shaft of humerus with interlocking nail and dynamic compression plate in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site, time to achieve union, functional outcome (DASH score) and complications of surgery. Methods: This was randomised control trial study. All patients with fractures of shaft of humerus that met the criteria for operative interventions presenting to the Department of Orthopaedics, BPKIHS in the study period and giving informed consent were included in the study. Sample size was taken 30 in each group. Results: The usual mode of injury in both the groups were road traffiic accident followed by fall from height, work place injury. The operating time for nailing was 100 mins with standard deviation of 11.24 while that of humerus plating was 90.25 with standard deviation 15.6.The mean blood loss in nail group was 148.75 with standard deviation of 36.70 while that in plate group was 205.00 with standard deviation of 45.60. Post operative hospital stay was similar in both groups with mean stay of 4.5 days. DASH was significantly higher in plating group at 6,12,18 and 24 weeks follow up. This showed better functional outcome in nailing group. Conclusion: Dynamic compression plating is better than interlocking nail for fracture shaft of humerus. Keywords: shaft of humerus; interlocking nail; plate fixation DOI: http://dx.doi.org/10.3126/hren.v9i2.4974 Health Renaissance 2011: Vol.9 (No.2): 61-66

scholarly journals Minimally Invasive Helical Plating for Shaft of Humerus Fractures: Technique and Outcome

2012 ◽  
Vol 6 (1) ◽  
pp. 184-188 ◽  
Author(s):  
James Chung Hui Tan ◽  
Fareed Husain Yusuf Kagda ◽  
Diarmuid Murphy ◽  
Joseph S Thambiah ◽  
Kok Sun Khong
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Lateral Approach ◽  
Humeral Shaft ◽  
Fixation Failure ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Elbow Function ◽  
Helical Plate

Introduction: The humerus is subjected to substantial amount of torsional stress. Conventional plating may not address this sufficiently and may lead to fixation failure or non-union. A helical plate may offer the solution. We present the surgical technique and functional outcome of 5 cases of humeral shaft fractures treated with this technique in a minimally invasive way. Materials and Methods: The operations were performed between 2004 and 2010, by three surgeons. All the patients had closed humeral shaft fractures, either simple transverse or with mild comminution. Two small incisions were made. The proximal incision was placed along the deltopectoral groove over the shaft, and the distal incision was placed as in an antero-lateral approach. The radial nerve was identified and protected. A pre-selected plate was contoured and introduced in the submuscular plane. The plate was placed in a proximal-lateral and distal-anterior position. Screws were inserted through stab incisions. The patients were followed for an average of 6 months. Functional recovery of the shoulder and elbow was assessed using the Constant and Mayo elbow performance score systems. Results: All incisions healed by first intention without complications and all the fractures went on to unite. All patients achieved good to excellent shoulder and elbow function. Conclusion: The helical plate technique is a safe and effective method of treating humeral shaft fractures and has good functional outcome.

Functional Outcome of Antibiotic Impregnated Nail in Infected Non-Union of Tibia and Femur - A Prospective Observational Study, Trichur, Kerala

2021 ◽  
Vol 8 (29) ◽  
pp. 2620-2624
Author(s):  
Arjun Dev Naroth Palakandy ◽  
Manoj Murungodiyil Kunjappan ◽  
Jose Francis
Keyword(s):  
Side Effects ◽  
Functional Outcome ◽  
Bone Grafting ◽  
Bony Union ◽  
High Concentration ◽  
Duration Of Treatment ◽  
Infected Nonunion ◽  
Non Union ◽  
Open Injury ◽  
Systemic Side Effects

BACKGROUND Infected non-union is a complex, debilitating and challenging disorder affecting orthopaedic surgeon and patient in terms of cost and time.1 Antibiotic impregnated nail has been a cheap and effective method used for treatment of infected nonunion. Factors that may lead to infected non-union are many.2,3 High local concentrations of antibiotics with minimal systemic levels and without systemic side effects make local antibiotic therapy a very useful technique in treating infected non-union. 4 Buchholz and Engelbrecht were the first to use antibiotic impregnated cement.5 Major advantage of using antibiotic impregnated cement is, it provides high concentration of antibiotics locally with less systemic side effects.6 The purpose of this study was to determine the functional outcome of antibiotic impregnated nail in treatment of infected non-union of femur and tibia. Antibiotic cement impregnated intra-medullary nail can provide stability, help in control of infection,7 is easy to remove, and also provides all the advantages of the cement beads.8,9 METHODS This prospective study was done on 25 cases at Government Medical College Thrissur from 01 September 2016 to 01 April 2018. Functional results were evaluated with regard to control of infection, bony union, deformity, limb leg discrepancy and complications (both intra and post-operative complications). RESULTS Most of the cases had type 2 open injury initially, accounting for 49 %. Staphylococcus aureus was reported in 56 % of cases. Infection control was achieved in 23 cases. Bony union was visualised in 18 cases, remaining 5 cases united following bone grafting. In 2 cases there was no control of infection and no bony union was achieved, later antibiotic nail removal and Ilizarov fixation was planned. Bone grafting was done in 10 cases. CONCLUSIONS Antibiotic impregnated cement nailing is a simple, economical and very effective procedure with less complication and shorter duration of treatment when compared with other conventional procedures. KEYWORDS Infected Non-Union, Long Bones, Antibiotic Impregnated Cement Nail

scholarly journals Functional Outcome of Shaft of Humerus Fractures Managed Surgically by Dynamic Compression Plating Technique

2021 ◽  
pp. 101-104
Author(s):  
Midhun Krishnan
Keyword(s):  
Functional Outcome ◽  
Plate Osteosynthesis ◽  
Dynamic Compression ◽  
Dynamic Compression Plate ◽  
Non Union ◽  
Compression Plate ◽  
Male Preponderance ◽  
Humerus Fractures ◽  
Compression Plating ◽  
Dynamic Compression Plating

The study analyzed 20 cases of fracture shaft of hummers treated with Dynamic Compression Plate. There was a male preponderance in our study 17 (85%). Almost Also 13% of patients treated by functional bracing end up with cosmetically unacceptable angulation of>15%, whereas all operative procedures achieve good alignment of the fractured bone was observed. The rate of union in Plate osteosynthesis is 93% and the time of union is 16 - 20 weeks, and more than 90% united in 18 weeks and 7% went for non union.

scholarly journals Non-Vascularised Fibular Graft as an Intramedullary Strut for Infected Non-Union of the Humerus

2011 ◽  
Vol 19 (3) ◽  
pp. 341-345 ◽  
Author(s):  
G Gopisankar ◽  
Arockiaraj SV Justin ◽  
Manasseh Nithyananth ◽  
Vinoo M Cherian ◽  
VN Lee
Keyword(s):  
Donor Site ◽  
Activity Level ◽  
Implant Removal ◽  
Fibular Graft ◽  
Tissue Cultures ◽  
Infected Nonunion ◽  
No Donor ◽  
Non Union ◽  
Compression Plate ◽  
The Mean

Purpose. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. Methods. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected nonunion who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2–4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3–10) months. Results. The mean length of the fibulae harvested was 13 (range, 12–15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4–8) months. The mean follow-up period was 15 (range, 13–24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. Conclusion. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.

scholarly journals Potential outcome of locking compression plate in proximal humerus fractures

2018 ◽  
Vol 4 (6) ◽  
pp. 835
Author(s):  
J. P. V. Jebaraj ◽  
B. Sundararaja
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus ◽  
Bone Fractures ◽  
Plate Fixation ◽  
Locking Compression Plate ◽  
Proximal Humerus Fractures ◽  
Non Union ◽  
Compression Plate ◽  
Humerus Fractures

<p class="abstract"><strong>Background:</strong> Fractures of proximal humerus bone needs immediate attention as the delayed treatment might result in non-union, malunion, and avascular necrosis which are responsible for the pain and dysfunction. The aim of the present study is to evaluate the functional outcome of displaced proximal humerus bone fractures that are surgically managed by locking compression plate and to assess the potential complication.</p><p class="abstract"><strong>Methods:</strong> The present study is the combination of both prospective and retrospective in which 30 patients with either Neer’s three part or Neer’s four-part proximal humerus fractures which were fixed with locking plate by a single surgeon. Functional outcome was measured by Constant Murley scoring (CMS) system.<strong></strong></p><p class="abstract"><strong>Results:</strong> The final follow-up of the study showed that 21 patients (70%) had the result that ranged from good to excellent score whereas, 6 patients (20%) had moderate score and 3 patients had poor score in functional outcome according to CMS system. During follow-up, 3 complications (10%) were encountered.</p><p class="abstract"><strong>Conclusions:</strong> The study concluded that proximal humerus locked compression plate is a valuable surgical method for the fixation of comminuted fractures of the proximal humerus as it is associated with excellent functional outcome. It also provides a stable fixation to permit early mobilization. Regaining medial cortical contact and establishing anatomical reductions decreases the complications that are associated with plate fixation.</p>

scholarly journals Managing lateral end clavicle fracture at a tertiary level hospital in India

2018 ◽  
Vol 4 (6) ◽  
pp. 909
Author(s):  
Swaroop Solunke ◽  
Vivek Patole
Keyword(s):  
Functional Outcome ◽  
Operative Treatment ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Non Union ◽  
Excellent Outcome ◽  
Medical College ◽  
Cortical Screw ◽  
Clinical Dilemma

<p class="abstract"><strong>Background:</strong> With numerous methods and recommendations for managing fracture of lateral end of the clavicle, it always creates a clinical dilemma for the treating surgeon. This study is aimed to compare the functional outcome in patients with lateral end clavicle fracture treated either with operative and non-operative modalities.</p><p class="abstract"><strong>Methods:</strong> This non-randomized comparative study was conducted at Department of Orthopedics, DY Patil Medical College, Pimpri between September 2017 till June 2018, in which all patients with lateral end clavicle fracture were included. Patients were managed either non-operatively or with precontoured locking compression plate was fixed with 4 mm locking screw or 3.5 mm cortical screw. At the final follow up (at least one year) patients’ functional outcome was assessed using the Constant and Murley score.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 57 patients were included in the study and 93% of the patients with operative management and 66% with non-operative treatment had a union time of 8 weeks or less. Out of the 27 patients who underwent non-operative treatment, three had malunion, two had non-union and five had deformity. Based on the Constant and Murley score, 27% of the patients in the operative group had an excellent outcome, and in the non-operative group, 8% had excellent functional outcome. The functional outcome was significantly better in the operative group (p=0.034).</p><p class="abstract"><strong>Conclusions:</strong> A better understanding of the risk factors for nonunion would help us to make decision between operative and nonoperative treatment. Randomized trials comparing the operative and non-operative treatments would help in understanding the merits of one method over other.</p>

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