The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut

Rollo, Giuseppe; Tartaglia, Nicola; Falzarano, Gabriele; Pichierri, Paolo; Stasi, Alessandro; Medici, Antonio; Meccariello, Luigi

doi:10.1007/s00068-016-0755-5

Cited by 32 publications

(32 citation statements)

References 26 publications

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“…It is an excellent choice in the treatment of limb salvage and nonunion. 4,9,[27][28][29][30][31] Rollo G et al [28][29][30][31] reported that the use of allograft in the treatment of aseptic nonunion has achieved good results, and it also has significant advantages in fracture revision surgery. However, its application has been limited because of potential complications and controversial prognosis.…”

Section: Discussionmentioning

confidence: 99%

<p>Intercalary Allograft to Reconstruct Large-Segment Diaphysis Defects After Resection of Lower Extremity Malignant Bone Tumor</p>

Liu¹,

He²,

Duan³

et al. 2020

CMAR

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Aim: To evaluate the clinical effect of intercalary allograft transplantation and reconstruction in the treatment of diaphyseal defect after resection of lower extremity malignant bone tumor. Methods: Clinical data of 17 patients diagnosed with malignant lower-limb bone tumors and having undergone segmental allograft reconstruction with a mean follow-up of 49.8 (26-78) months were included. Segmental allografts of average 17-cm length preserved by deep-freezing were used and fixed using intramedullary nail, double plate, and intramedullary nail and plate combination in 2, 5, and 10 patients, respectively. Host-donor junctions were perfectly and roughly matched in 5 and 12 patients, respectively. Allograft union, local recurrence, and complications were assessed using clinical and radiological tests. Allograft union was evaluated using the International Society of Limb Salvage (ISOLS) scoring system. The functional prognosis was evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system. Results: Intercalary allograft reconstruction of femoral shaft, tibial shaft, and distal tibia with ankle arthrodesis was performed in eight, four, and five patients, respectively. Two patients had local recurrence and underwent amputation; one died of metastasis. Host-donor junctions in two patients showed nonunion; 12 patients achieved bone union. The average union time was 12.1 months. No allograft fracture or infection occurred. Union rates were 100% and 88.2% at metaphyseal and diaphyseal junctions, respectively. Healing time differed significantly between the precisely and roughly matched groups (p<0.01). The incidence of nonunion was higher after intramedullary nailing than after the other two methods (p<0.05). The mean MSTS score was 24.2 (14-29) at the end of follow-up. Conclusion: Intercalary allograft transplantation is an effective strategy for diaphyseal defect following post-tumor resection in the lower extremity. Good bone healing after allograft reconstruction is achieved with stable internal fixation and perfectly matched host-donor interfaces.

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Section: Discussionmentioning

confidence: 99%

<p>Intercalary Allograft to Reconstruct Large-Segment Diaphysis Defects After Resection of Lower Extremity Malignant Bone Tumor</p>

Liu¹,

He²,

Duan³

et al. 2020

CMAR

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“…The AFFIXUS Hip Fracture Nail System, with its two variants, short and long, is intended to treat stable and unstable proximal femoral fractures, nonunions, or malunions, either pertrochanteric, intertrochanteric, high subtrochanteric, or their combinations, with extended use in case of bone loss due to tumor resections, ipsilateral fractures of the proximal femur and its shaft, impending pathological fractures, etc. Nonunion of trochanteric fractures is relatively uncommon, with a reported incidence of 1–5% [ 7 ]. In order to decrease the incidence of failure, several variations of intramedullary nails have been devised [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nonunion of trochanteric fractures is relatively uncommon, with a reported incidence of 1–5% [ 7 ]. In order to decrease the incidence of failure, several variations of intramedullary nails have been devised [ 7 ]. Nevertheless, the newer nail designs and materials can still result in complications such as cut-out of the implant, fracture of the femoral shaft distal to the tip of the implant, or medial migration of the implant [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature

Rollo

Rinonapoli

Pichierri

et al. 2018

Case Reports in Orthopedics

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Introduction Trochanteric fractures of the femur are common in elderly individuals with osteoporosis. The use of cephalomedullary nails is increasing, and they are now the most commonly used fixation devices, especially for the treatment of unstable trochanteric fractures. The nail breakage is not the most common complication of intramedullary nailing. Many scientific papers report nail breakage in a specific location: through the lag screw hole, the nail shaft, or the distal locking hole. Materials and Methods We present a case of an 84-year-old patient treated with modular revision hip arthroplasty due to the breakage in two points of a cephalomedullary nail implanted 3 years earlier for a subtrochanteric fracture. Results After modular revision hip arthroplasty, the functional results and quality of life have been excellent. Conclusions As far as we could determine, this appears to be the first case of a breakage of a cephalomedullary nail in two points after nonunion in a very active elderly female.

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“…One of the complications of proximal femoral fractures is nonunion and fractures around devices that bring the patient back to surgery [30]. However, since our primary objective was to investigate relationships between the AB0 blood system and hip fracture patterns, duration of hospitalization, and amount of blood transfusion, we did not investigate complications related to these fractures.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the AB0 Blood System and Proximal Femoral Fracture Patterns in the Turkish Population

Kuru

Olçar

2020

BioMed Research International

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Objective. AB0 blood groups have shown to be associated with increased risk of several orthopedic disorders such as Achilles tendon rupture and hip osteoarthritis. The objective of this study was to investigate relationships between the AB0 blood system and hip fracture patterns, duration of hospitalization, and amount of blood transfusion. Methods. Data of 308 patients treated due to hip fractures in our hospital between 2017 and 2019 were evaluated. Epicrisis reports and X-rays of the patients included in this study were retrospectively screened, and hip fractures were classified as intracapsular and extracapsular fractures. Patients were divided into A, B, 0, and AB groups according to blood groups. Results. The mean age of the patients was 75.54±13.5 years. Of all patients, 103 had an intracapsular fracture and 205 had an extracapsular fracture. No statistically significant correlation was found between blood groups and fracture patterns. No statistically significant difference was found between the amounts of transfusion according to the blood groups, and no significant difference between the durations of hospitalizations according to the blood groups. Conclusion. In our study population, we could not find a significant relationship between the AB0 blood system and fracture patterns. We think that these potential relationships could be explained with further comprehensive studies with larger populations.

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The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut

Abstract: We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

Cited by 32 publications

References 26 publications

<p>Intercalary Allograft to Reconstruct Large-Segment Diaphysis Defects After Resection of Lower Extremity Malignant Bone Tumor</p>

<p>Intercalary Allograft to Reconstruct Large-Segment Diaphysis Defects After Resection of Lower Extremity Malignant Bone Tumor</p>

Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature

Relationship between the AB0 Blood System and Proximal Femoral Fracture Patterns in the Turkish Population

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