Salvage of Humeral Nonunions With Onlay Bone Plate Allograft Augmentation

Hornicek, Francis J.; Zych, Gregory A.; Hutson, James J.; Malinin, Theodore I.

doi:10.1097/00003086-200105000-00026

Cited by 68 publications

(61 citation statements)

References 9 publications

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“…22,23 Plate fixation requires a wide dissection that carries a high risk of damage to the radial nerve; such palsies are usually transient and their incidence is around 5%. 11,[13][14][15][16]18 Sufficient screw purchase for stable fixation may be difficult to obtain in patients with osteoporosis secondary to ageing, disuse or previous surgery. Methods to enhance fixation stability in cases of osteopenia include the use of a long plate, a blade plate, 2 plates, reinforcing screw fixation with polymethylmethacrylate, replacing the 4.5-mm cortical screws with 6.5-mm cancellous screws, adding an allograft strut on the medial surface of the humerus, and attaching washers and nuts to the plate and screws.…”

Section: Discussionmentioning

confidence: 99%

“…Ilizarov external fixation has yielded a union rate of 94%, 7,8 but requires long fixation time and risks pin-tract infection and patient discomfort because of the large size of the frame. Plate fixation with bone grafting achieves a union rate of >90%, [9][10][11][12][13][14][15][16][17][18][19][20] but requires a wide dissection which entails a high risk of damage to the radial nerve (around 5%). 11,[13][14][15][16]18 Poor bone quality or a deficient plate technique may lead to non-union.…”

Section: Introductionmentioning

confidence: 99%

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Two-Plate Fixation for Humeral Shaft Nonunions

Martı́nez¹,

Cuenca²,

Herrera

2009

J Orthop Surg (Hong Kong)

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Purpose.To review 22 patients who underwent 2-plate fixation for non-union of the humeral shaft. Methods. 13 women and 9 men aged 32 to 76 (mean, 48) years underwent fixation for non-union of the humeral shaft, using a 2-plate construct, together with decortication, debridement, and bone grafting. The two 3.5-mm reconstruction plates were parallel and lying at 90º to each other and fixed with screws purchasing into at least 6 cortices of each fragment for both plates. Fractures were located in the upper third (n=8) or middle third (n=14) of the humerus. Initial treatments included casting (n=9), coaptation splinting (n=8), multiple retrograde pinning (n=4), and Marchetti-Vicenzi nailing (n=1). 18 non-unions were atrophic and 4 were hypertrophic. Shoulder and elbow range of motion as well as functional results were evaluated. iatrogenic radial nerve palsy that recovered within 3 months. Conclusion. Two-plate fixation achieves good results for humeral shaft non-unions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Two-Plate Fixation for Humeral Shaft Nonunions

Martı́nez¹,

Cuenca²,

Herrera

2009

J Orthop Surg (Hong Kong)

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“…In the distal-third of the humerus, "90-90" degree dual plating with a malleable lateral reduction plate and a more stout posterolateral extraarticular plate has been shown to lead to good alignment and union [31]. When plating fractures with far cortex bone loss or severe osteopenia, placement of a cortical strut allograft can be considered to augment the far cortex and provide purchase for the screws at that level [32].…”

Section: Operative Management Of Humeral Shaft Fracturesmentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

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“…There are some examples using a similar technique in nonunions [15,21]. Hornicek et al [15] treated ten established humeral shaft non-unions with a similar surgical technique and achieved excellent results with a union rate of 100%. We also have experience with 24 patients (15 femur, 8 humerus) with non-union treated by the same surgical technique and a similar rate of union.…”

Section: Discussionmentioning

confidence: 99%

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

Göğüş

Öztürk

Tezer

et al. 2006

International Orthopaedics (SICO

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In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called "sandwich technique." A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3-6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/ osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.

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Salvage of Humeral Nonunions With Onlay Bone Plate Allograft Augmentation

Cited by 68 publications

References 9 publications

Two-Plate Fixation for Humeral Shaft Nonunions

Two-Plate Fixation for Humeral Shaft Nonunions

Humeral shaft fractures

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

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