Plate Fixation of Ununited Humeral Shaft Fractures

Hierholzer, Christian; Samà, Domenico; Toro, Jose B.; Peterson, Margaret G. E.; Helfet, David L.

doi:10.2106/jbjs.e.00332

Cited by 135 publications

(114 citation statements)

References 24 publications

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“…Many biological and biophysical interventions have been used in an attempt to accelerate fracture healing times including the use of bone graft substitutes [4,5], application of exogenous local recombinant growth factors [6,7], gene therapy [8], or tissue engineering approaches with biodegradable scaffolds [9,10]. Several modalities have gone on to be clinically useful such as recombinant growth factors, but high costs continue to preclude routine clinical use.…”

Section: Introductionmentioning

confidence: 99%

Identification of Novel Gene Expression in Healing Fracture Callus Tissue by DNA Microarray

et al. 2008

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Fracture healing requires controlled expression of thousands of genes. Only a small fraction of these genes have been isolated and fewer yet have been shown to play a direct role in fracture healing. The purpose of this study was threefold: (1) to develop a reproducible open femur model of fracture healing that produces consistent fracture calluses for subsequent RNA extraction, (2) to use this model to determine temporal expression patterns of known and unknown genes using DNA microarray expression profiling, and (3) to identify and validate novel gene expression in fracture healing. In the initial arm of the study, a total of 56 wild-type C57BL/6 mice were used. An open, stabilized diaphyseal femur fracture was created. Animals were killed at 1, 5, 7, 10, 14, 21, and 35 days after surgery and the femurs were harvested for analysis. At each time point, fractures were radiographed and sectioned for histologic analyses. Tissue from fracture callus at all stages following fracture yielded reproducibly large amounts of mRNA. Expression profiling revealed that genes cluster by function in a manner similar to the histologic stages of fracture healing. Based on the expression profiling of fracture tissue, temporal expression patterns of several genes known to be involved in fracture healing were verified. Novel expression of multiple genes in fracture callous tissue was also revealed including leptin and leptin receptor. In order to test whether leptin signaling is required for fracture repair, mice deficient in leptin or its receptor were fractured using the same model. Fracture calluses of mice deficient in both leptin or leptin receptor are larger than wild-type mice fractures, likely due to a delay in mineralization, revealing a previously unrecognized role of leptin signaling in fracture healing. This novel model of murine fracture repair is useful in examining both global changes in gene expression as well as individual signaling pathways, which can be used to identify specific molecular mechanisms of fracture healing.

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Section: Introductionmentioning

confidence: 99%

Identification of Novel Gene Expression in Healing Fracture Callus Tissue by DNA Microarray

et al. 2008

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“…(22) Several studies have reported their success in the treatment of aseptic humeral nonunion. (23)(24)(25)(26)(27) These studies only showed a stereotyped pattern of treatment and mostly described the results of plating with bone grafting. In contrast, we have applied an analytical approach to treatment of nonunion and based our treatment only on "what is necessary" .…”

Section: Discussionmentioning

confidence: 99%

Aseptic Humeral Nonunion: What Went Wrong? What to Do? A Retrospective Analysis of 20 Cases

Kim

Cho

et al. 2016

Journal of Trauma and Injury

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Purpose: Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion.Methods: In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing?Results: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems.Conclusion: In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting. [ J Trauma Inj 2016; 29: 129-138 ]

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“…In order to have enough stability at the non-union site, double plating, one on the lateral side and one on the posterior side is recommended [7]. Bone grafting is offered to enhance the biological environment [8].…”

Section: Discussionmentioning

confidence: 99%

Treatment with closed manipulation and functional bracing of a humeral diaphysis refracture with implant failure: A case report

Erşen¹,

Guvendiren²,

Yazıcı³

2013

IJCRI

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Introduction: Implant failures and loss of the reduction are the main complications of open reduction and internal fixation with plate and screws. If those complications occur, revision surgery is the standard treatment. We would like to present a case where implant failure and loss of reduction of humerus diaphyseal fracture is treated with close reduction and sarmiento bracing. case report: A 28-year-old male was diagnosed with closed humeral diaphysis fracture without neuromuscular injury due to traffic accident. He was treated with open reduction and internal fixation with plate and screws. After three months, he was presented to outpatient clinic with severe pain after minor trauma. Implant failure with screw breakage and loss of reduction with angulation were obvious on plane X-ray. Instead of revision surgery, it was treated with closed reduction and sarmiento bracing. conclusion: Functional bracing can be appropriate for humeral diaphysis non-unions with implant failure when the patient is not suitable for surgery.

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Plate Fixation of Ununited Humeral Shaft Fractures

Abstract: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Cited by 135 publications

References 24 publications

Identification of Novel Gene Expression in Healing Fracture Callus Tissue by DNA Microarray

Identification of Novel Gene Expression in Healing Fracture Callus Tissue by DNA Microarray

Aseptic Humeral Nonunion: What Went Wrong? What to Do? A Retrospective Analysis of 20 Cases

Treatment with closed manipulation and functional bracing of a humeral diaphysis refracture with implant failure: A case report

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