Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion

Shetty, Karan; Cheppalli, Naga Suresh; Kaki, Deepak

doi:10.7759/cureus.24293

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Two studies reported a case of humerus shaft nonunion operated with 2 nd generation IM interlock nailing with unstable construct complicated with peri-implant benign diaphyseal expansive lesion managed with implant removal curettage of lesion and stabilized with extraarticular distal humerus locking plate after strut fibular autobone grafting. The result was evaluated based on disability [7,8].…”

Section: Discussionmentioning

confidence: 99%

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Alejandro Antonio,

Fernando Alonso,

José Enrique

et al. 2024

Int Arch Orthop Surg

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Introduction: Epidemiological studies suggest that proximal humerus fractures are very common, representing 4-10% of all fractures. This proportion is increased when surgical intervention cases are examined, as approximately 30% of proximal humerus fractures are treated surgically.Clinical case: 38-year-old male, who was admitted for severe pain and functional limitation of his left shoulder. No background of importance to the case. He suffered a car accident while driving his motorcycle, lost his balance and fell, suffering a direct impact on his left shoulder, causing pain, edema and functional limitation. Upon arrival, he was conscious, oriented, cooperative, calm, cardiopulmonary system without compromise, abdomen without compromise, left upper extremity with presence of edema +/+++ in the shoulder, ecchymosis, incomplete range of motion. Crepitus are palpable at the time of examination, without distal neurovascular compromise. Discussion:The autogenous fibula is a source of bone grafts for the treatment of bone defects. Its advantages include easy access, absence of immune rejection, and considerable strength. However, its disadvantages include the requirement of an additional surgical incision, postoperative pain in the harvested bone area, and the risks of bleeding, infection, and nerve injury. Using structural bone grafts comprising autogenous fibula for the treatment CASE REPORtCheck for updates of severe proximal humeral comminuted fractures can re-establish medial support of the proximal humerus and increase fixation strength. Fibular allograft and shoulder arthroplasty are also effective treatments for proximal humerus comminuted fractures among elderly individuals. However, these procedures cannot be performed in all regions. Compared to the aforementioned treatments, the use of the autologous fibular segment is more convenient and less expensive.

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Section: Discussionmentioning

confidence: 99%

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Alejandro Antonio,

Fernando Alonso,

José Enrique

et al. 2024

Int Arch Orthop Surg

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“…Several authors have shown successful results with the non-vascularized fibular graft. The drawbacks to this technique are possibility of disruption of both endosteal and periosteal blood supply, iatrogenic fracture during insertion of graft and possible nerve palsy while harvesting [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Windshield Wiper Effect in Human Bone-Peri-Implant Benign Diaphyseal Expansile Lesion with Humerus Shaft Fracture Non-Union with Implant in situ – Case Report

Thakkar,

Bava,

Phunde

et al. 2023

jocr

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Introduction: Humerus shaft fractures account for 3% of all adult fractures. Union rate after surgical management is around 84–97% with no difference between compression plating and intramedullary (IM) nailing. Non-union of humeral shaft fracture is not unusual complication of both conservative and operative treatment. IM nailing has been known to have several benefits from its relative stability with minimal soft-tissue dissection but with drawbacks such as less perfect reduction with higher risk of distraction, inability to take down interpositional tissue, risk of radial nerve injury and technical difficulty to pass guide wire and locking of nail. Many methods have been described for nonunion of humeral fracture with good results. However, treatment of a long-standing nonunion of the humerus with bone defect is challenging, as it may be complicated by broken implants. Very less research documented for long standing nonunion of humeral bone with diaphyseal bone defect. Case Report: We report a case report of middle-aged female who suffered a closed traumatic humeral shaft fracture which was managed with open reduction and fixation with IM nailing with some distraction and distal locking screw missing the nail making it an unstable construct traditionally called Wind shield, wiper effect was noticed in this patient and was the cause of nonunion in this case at some other institute 5 years back lending up in to nonunion with diaphyseal bone defect showing peri-implant expansile benign lesion treated at our institute with implant removal, excision of lytic lesion, and stabilized with extra articular distal humerus locking plate after strut fibular auto bone grafting. Conclusion: Humerus shaft non-union in a middle-aged patient is heterogeneous entity and has to be managed after ruling out neoplastic (metastasis) as well as infective etiology, and locking plate is the gold standard for its management along with strut grafting being osteoporotic bone with some bony defect. Keywords: Nonunion, windshield wiper, humerus, peri-implant lytic lesion, disabilities of arm shoulder and hand score.

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“…Plating with an autologous non-vascularized fibular graft (ANVFG) has occurred. This design improves long bone gaps, atrophic nonunion biology, and biomechanical strength [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Functional and Radiological Outcomes of Humeral Shaft Fracture Treated With Locking Compression Plate

Bandaru¹,

Shanthappa²

2023

Cureus

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BackgroundThe best surgical procedure for humeral shaft fractures is still plate and screw fixation. Researchers have shown that plate fixation lessens the occurrence of malunion and nonunion. This study aims to describe the functional and radiological outcomes of a humerus shaft fracture treated with a locking compression plate (LCP) using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scoring systems. MethodFrom December 2020 to July 2022, 25 patients with humerus shaft fractures were enrolled in the prospective observational study at RL Jalappa Hospital, which is affiliated with Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar. We have included closed and open type 1 fractures as per the Gustilo-Anderson classification and excluded humerus shaft fractures associated with neurovascular injury, pathological fractures, and ipsilateral upper limb long bone (radius and ulna) fractures. For a humerus shaft fracture, open reduction and internal fixation (ORIF) + LCP was done on patients who were fit for surgery, had normal test results, and were given the right kind of anesthesia. Every six weeks, every three months, and every six months, patients had regular reviews. A check X-ray was taken each time a patient attended, and we assessed them clinically and radiologically for fracture union, functional outcome, and comorbidities. The patient's DASH and VAS ratings were assessed at the follow-up visit. The Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Armonk, NY, USA) was used to analyze the data. ResultThe mean age of the study participants was 33 years, with a standard deviation of 8.9 years. Among the study participants, about 60% of the individuals were males. About 40% of the individuals had injuries due to motorcycle accidents, and 88% of the individuals had direct injuries. Only 12% of the individuals had disease complications. This study recorded a 100% union rate among the study samples. Among the study participants who have histories of hypertension, closed fractures have shown significant improvement according to VAS scores. Among the study participants who were males, those who presented with indirect injury, no history of fracture, right side involvement, and absence of complications showed significant improvement according to the DASH score. ConclusionLCP is reliable for the union of fractures in patients of any age and activity level since we can use it at all levels of the humeral shaft and can achieve 100% union when used with the right principles and osteogenic stimulus. LCPs repair humeral shaft fractures well because they can achieve good functional and radiological results and have few adverse effects.

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Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion

Cited by 3 publications

References 18 publications

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Windshield Wiper Effect in Human Bone-Peri-Implant Benign Diaphyseal Expansile Lesion with Humerus Shaft Fracture Non-Union with Implant in situ – Case Report

Evaluation of Functional and Radiological Outcomes of Humeral Shaft Fracture Treated With Locking Compression Plate

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