Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note

Yang, Kyu Hyun; Won, Young-Shin; Kim, Sang Bum; Oh, Byung Hak; Park, Young Chang; Jeong, Sang Jin

doi:10.1007/s00402-016-2522-9

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…The common causes of posttraumatic femoral nonunion with large segmental bone defect (> 6 cm) include acute bone loss, bone ischemia atrophy in nonunion sites, and surgical removal of dead bone and sclerotic bone after infection [ 1 , 2 ].Current treatment for the disease, in addition to the need of addressing the issue of bone nonunion with bone defect, soft tissue defect, nearby joint stiffness, deformities (rotation, angulation, and shortening), infection and many other issues should also be treated simultaneously [ 3 – 5 ]. At present, the common treatments include vascularized bone grafts (such as ribs, ilium, and fibula), intramembranous osteogenesis technique (Masquelet technique), and Ilizarov distraction osteogenesis [ 6 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Zhang

et al. 2017

J Orthop Surg Res

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BackgroundCurrently, the common treatment for femoral nonunion with large segmental bone defect is difficult and complex. The effective surgical methods are rare, include vascularized bone grafting, Masquelet technique and Ilizarov distraction osteogenesis. The objective of this study is to investigate the outcomes of segmental femoral defects treated with monolateral external fixation using the distraction osteogenesis.MethodsWe retrospectively analyzed patients with femoral nonunion with segmental bone defects (> 6 cm) between January 2010 and January 2014 in our single trauma center. All patients were treated by distraction osteogenesis with monolateral external fixation. All surgeries were performed by the same surgeon. Bone union, duration of distraction osteogenesis in days, time to consolidation in months, external fixation index (EFI), complications, and additional surgical interventions were recorded postoperatively. The modified Application of Methods of Illizarov (ASAMI) criteria were used to evaluate the operative effectiveness.ResultsForty-one patients were enrolled in this study for analysis. The length of the bone defect ranged from 6 to 17 cm. All patients eventually achieved healing, and no patient experienced recurrence of infection or newly developed infection. The average time needed for healing was 13 months. In terms of the incidence of complications, 3 cases axial deviations, 5 cases docking site nonunion, 23 cases pin-tract infection, 14 cases knee joint stiffness or their joint mobility declined, 2 cases osteogenesis insufficient in the distraction area,1 case refracture, and 2 cases loose external fixation pins. In terms of the evaluations of fracture healing and function, 30 patients excellent, 6 patients good, 5 patients fair, and 0 patient poor. In terms of postoperative function evaluations, 21 patients excellent, 9 patients good, 7 patients fair, and 4 patients poor.ConclusionFor patients with femoral nonunion with large segmental bone defects, the monolateral external fixation can provide effective stability, improve compliance, and reduce complications.Electronic supplementary materialThe online version of this article (10.1186/s13018-017-0684-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Zhang

et al. 2017

J Orthop Surg Res

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“…Publications show that the healing rate for femoral shaft non-union is as high as 90% [ 14 – 18 ]. In our study, 29 patients (96%) finally achieved fracture healing, which is similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, 29 patients (96%) finally achieved fracture healing, which is similar to previous reports. The fracture healing time with DP has been reported to be 5.2–6 months [ 14 – 16 ], which is dramatically shorter than that with EN/AP (6–13 months) [ 17 , 18 ] in previous reports. However, different results were observed in our study for the both healing time and the time to return to work, which were significantly shorter with EN/AP versus DP.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the mechanical instability of revision procedures mentioned above, the failure rate is as high as 20–50% [ 7 , 10 – 13 ]. Optimal mechanical stability and deformity correction can be achieved during exposure of the non-union site in the procedures of dual plating (DP) and exchange nailing with augmentation plating (EN/AP) [ 14 – 18 ]. Evidence indicates that most patients who received either surgical procedure achieved fracture healing.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of femoral shaft non-union: dual plating versus exchange nailing with augmentation plating

Zhang

et al. 2018

J Orthop Surg Res

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BackgroundBy comparing clinical outcomes between dual plating (DP) and exchange nailing with augmentation plating (EN/AP), we aimed to provide better treatment strategies for femoral shaft non-union.MethodsWe retrospectively reviewed 30 patients with aseptic femoral shaft non-union at our level 1 trauma center between January 2014 and January 2017. All patients underwent a one-stage, definitive revision procedure, including DP for 16 patients and EN/AP for 14 patients. Perioperative surgical trauma, fracture healing, complications, and the time to return to work were evaluated.ResultsTwenty-nine patients achieved fracture healing. In the EN/AP group, the fracture healing rate was 100%, the healing time was 5.7 ± 1.7 months, and the time of return to work was 8.2 ± 2.9 months. In the DP group, the fracture healing rate was 94%, the healing time was 8.4 ± 4.1 months, and the time of return to work was 18.4 ± 10.3 months. In terms of fracture healing and return to work, the patients in the EN/AP group required less time than those in the DP group, and the differences were statistically significant (p = 0.024 and p < 0.01 respectively). Except for the length of the incision, the two groups showed no statistically significant differences in operative time, postoperative deformity, and complications.ConclusionsBoth EN/AP and DP are important surgical options for femoral shaft non-union. Compared to DP, EN/AP resulted in a shorter incision, faster fracture healing, and a shorter time to return to work.Trial registration ChiCTR-ORC-17014062

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“…The issue is that the intramedullary nail is unstable when xated in large segmental defects. Authors have reported to add another plate and bone grafting in dealing with nonunion after intramedullary nail xation [5]. We presumed that augmented plate could be useful when instability noticed during the second stage of this technique.…”

Section: Introductionmentioning

confidence: 95%

Augmented plate causes bone resorption in reconstruction of large segmental femur defects with induced membrane technique

Shen

Yin²,

Cao

et al. 2020

Preprint

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Purposes: Large segmental femur bone defect is a serious clinical problem. Limited study have been reported to optimize the fixation during the second stage of induced membrane technique. We would like to report our new findings in two different fixation method with this technique. Methods: We retrospectively analyzed 56 cases with large segmental femur defects and treated with induced membrane technique from January 2013 to December 2017. Patients were separated into two groups according to different fixation method during the second stage and followed at least 2 years. Bacteria culture, treatment outcome, and complication were collected and analysed. Results: Patients with an average age of 41.8 years old had an average of 2.6 surgical history. Bone defects were 8.93 cm in average ( 4-16.8 cm). Though 20 complications were noticed in this series, 85.7% (48/56) of the cases acquired bone union during their final follow up. However, 57.6%(15/26) of the cases observed obvious bone resorption near the plate in augmented plate group. And this resulted to lower bone union rate was calculated when compared with intramedullary nail group (P = 0.019). Insufficient bone grafting material is another main reason resulted nonunion and verified in 5 cases. Conclusions: Augmented plate will resulted bone resorption and leads to nonunion in induced membrane technique. The plate should be fixated outside the membrane if necessary. Insufficient bone grafting material when grafting is a easily neglectful problem, and proper measures should be taken with cautious.

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Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note

Cited by 10 publications

References 21 publications

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Clinical outcomes of femoral shaft non-union: dual plating versus exchange nailing with augmentation plating

Augmented plate causes bone resorption in reconstruction of large segmental femur defects with induced membrane technique

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