Objective： To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing. Methods： Twelve patients with humeral nonunions were treated with interlocking intramedulla...Objective： To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing. Methods： Twelve patients with humeral nonunions were treated with interlocking intramedullary nailing. The time interval between trauma and surgery was 10.5 months on average. Open reduction with anterograde approach was performed. Axial compression was specially applied to the fracture site with humeral nail holder after insertion of distal locked screws. Iliac bone grafting was added. Results： The average follow-up period was 21 months （ranging 9-51 months）. All patients achieved osseous union 5.8 months after treatment on average. Eleven patients hadgood functions of the shoulder joints and the upper extremities. No patient experienced any permanent neurological deficit. Refracture of the original ununited region occurred in one patient after removal of the internal fixator one year later, but union was achieved after closed re-intramedullary nailing fixation. Conclusion： Humeral interlocking intramedullary nailing is an effective alternative treatment for humeral nonunion.展开更多
Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fra...Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.展开更多
Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone i...Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone injury was adapted from the threepoint bending closed fracture technique in the murine femur.Methods: The mouse femur was surgically stabilized with an intramedullary threaded rod with plastic spacers and the defect adjusted to different sizes. Healing of the different defects was analyzed by radiology and histology to 8 weeks postsurgery. To determine whether this model was effective for evaluating the benefits of molecular therapy, BMP-2 was applied to the defect and healing then examined.Results: Intramedullary spacers were effective in maintaining the defect. Callus bone formation was initiated but was arrested at defect sizes of 2.5 mm and above, with no more progress in callus bone development evident to 8 weeks healing. Cartilage development in a critical size defect attenuated very early in healing without bone development, in contrast to the closed femur fracture healing, where callus cartilage was replaced by bone. BMP-2 therapy promoted osteogenesis of the resident cells of the defect, but there was no further callus development to indicate that healing to pre-surgery bone structure was successful.Conclusions: This segmental defect adaptation of the closed femur fracture model of murine bone repair severely impairs callus development and bone healing, reflecting a challenging bone injury. It is adjustable and can be compared to the closed fracture model to ascertain healing deficiencies and the efficacy of therapeutic approaches.展开更多
Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review ...Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.展开更多
文摘Objective： To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing. Methods： Twelve patients with humeral nonunions were treated with interlocking intramedullary nailing. The time interval between trauma and surgery was 10.5 months on average. Open reduction with anterograde approach was performed. Axial compression was specially applied to the fracture site with humeral nail holder after insertion of distal locked screws. Iliac bone grafting was added. Results： The average follow-up period was 21 months （ranging 9-51 months）. All patients achieved osseous union 5.8 months after treatment on average. Eleven patients hadgood functions of the shoulder joints and the upper extremities. No patient experienced any permanent neurological deficit. Refracture of the original ununited region occurred in one patient after removal of the internal fixator one year later, but union was achieved after closed re-intramedullary nailing fixation. Conclusion： Humeral interlocking intramedullary nailing is an effective alternative treatment for humeral nonunion.
文摘Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.
基金Loma Linda Veterans Association for Research and EducationGrant/Award Number Seed Grant(to CR)+2 种基金US Department of Veterans AffairsGrant/Award Number Merit Review Award#5 I01 BX002519-04(to CR)Senior Research Career Scientist Award(to SM)。
文摘Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone injury was adapted from the threepoint bending closed fracture technique in the murine femur.Methods: The mouse femur was surgically stabilized with an intramedullary threaded rod with plastic spacers and the defect adjusted to different sizes. Healing of the different defects was analyzed by radiology and histology to 8 weeks postsurgery. To determine whether this model was effective for evaluating the benefits of molecular therapy, BMP-2 was applied to the defect and healing then examined.Results: Intramedullary spacers were effective in maintaining the defect. Callus bone formation was initiated but was arrested at defect sizes of 2.5 mm and above, with no more progress in callus bone development evident to 8 weeks healing. Cartilage development in a critical size defect attenuated very early in healing without bone development, in contrast to the closed femur fracture healing, where callus cartilage was replaced by bone. BMP-2 therapy promoted osteogenesis of the resident cells of the defect, but there was no further callus development to indicate that healing to pre-surgery bone structure was successful.Conclusions: This segmental defect adaptation of the closed femur fracture model of murine bone repair severely impairs callus development and bone healing, reflecting a challenging bone injury. It is adjustable and can be compared to the closed fracture model to ascertain healing deficiencies and the efficacy of therapeutic approaches.
文摘Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.
