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

Göğüş, Abdullah; Öztürk, Çağatay; Tezer, Mehmet; Camurdan, Koray; Hamzaoğlu, Azmi

doi:10.1007/s00264-006-0134-7

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…Post-operatively, these investigations may be helpful in confirming the degree of union both for the fracture itself and between allograft and the host bone when it has been required. 21 In our study, the pre-operative diagnosis determined by the classification of the radiographs, rarely changed at the time of surgery. This may be a reflection of our clinical practice in which all the peri-prosthetic fractures within our hospital are managed by the hip revision unit and both the bone stock and stability are assessed stringently during surgery.…”

Section: Discussionmentioning

confidence: 61%

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

Rayan

Dodd

Haddad

2008

The Journal of Bone and Joint Surgery. British volume

112

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The Vancouver classification has been shown by its developers to be a valid and reliable method for categorising the configuration of periprosthetic proximal femoral fractures and for planning their management. We have re-validated this classification system independently using the radiographs of 30 patients with periprosthetic fractures. These were reviewed by six experienced consultant orthopaedic surgeons, six trainee surgeons and six medical students in order to assess intra- and interobserver reliability and reproducibility. Each observer read the radiographs on two separate occasions. The results were subjected to weighted kappa statistical analysis. The respective kappa values for interobserver agreement were 0.72 and 0.74 for consultants, 0.68 and 0.70 for trainees on the first and second readings of the radiographs and 0.61 for medical students. The intra-observer agreement for the consultants was 0.64 and 0.67, for the trainees 0.61 and 0.64, and for the medical students 0.59 and 0.60 for the first and second readings, respectively. The validity of the classification was studied by comparing the pre-operative radiological findings within B subgroups with the operative findings. This revealed agreement for 77% of these type-B fractures, with a kappa value of 0.67. Our data confirm the reliability and reproducibility of this classification system in a European setting and for inexperienced staff. This is a reliable system which can be used by non-experts, between centres and across continents.

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Section: Discussionmentioning

confidence: 61%

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

Rayan

Dodd

Haddad

2008

The Journal of Bone and Joint Surgery. British volume

112

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“…The papers included in the review are reported by category in Table 2. (15)(16)(17)25,26,(29)(30)(31)(32)(33) 205 Bone substitutes (41,42,45,46,48) 331 Growth factors (53,(55)(56)(57)(58) 615 Cell therapies (66,69,73) 69 Pharmacological therapy (97)** (98)(99)(100)(101)(102)(103)(104)(105)(107)(108)(109)(110)(111)(112)(113)(114) 110 ** Systematic review including case series and case reports.…”

Section: Resultsmentioning

confidence: 99%

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

et al. 2020

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Background: The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures. Methods: A systematic review was conducted by using Pubmed/MEDLINE; Embase and Ovid databases. The combination of the search terms “long-bones; diaphyseal fracture; bone healing; growth factors; cell therapies; scaffolds; graft; bone substitutes; orthobiologics; teriparatide”. Results: The initial search resulted in 4156 articles of which 37 papers fulfilled the inclusion criteria and were the subject of this review. The studies included 1350 patients (837 males and 513 females) with a mean age of 65.3 years old. Conclusions: General lack of high-quality studies exists on the use of adjuvant strategies for bone healing enhancement in acute shaft fractures. Strong evidence supports the use of bone grafts, while only moderate evidence demineralized bone matrix and synthetic ceramics. Conflicting results partially supported the use of growth factors and cell therapies in acute fractures. Teriparatide showed promising results, particularly for atypical femoral fractures and periprosthetic femoral fractures.

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Section: Patient 10mentioning

confidence: 99%

“…This technique was successful in treating osteoporotic femoral and humeral fractures, although it was not used for nonunions 8 . The sandwich technique we have described in the current report has notable differences compared with the technique described by Gogus et al 8 . We used wider allograft struts that serve to cradle, if not almost fully encircle, the nonunion, and this provided greater rotational stability and increased circumferential bone mass.…”

Section: Patient 10mentioning

confidence: 99%

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Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta

Puvanesarajah

Shapiro

Sponseller

2015

The Journal of Bone and Joint Surgery

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Background: Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. Methods: From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years).Results: All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function.Conclusions: Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the allograft to the native diaphysis.

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

Cited by 17 publications

References 22 publications

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

European validation of the Vancouver classification of periprosthetic proximal femoral fractures

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta

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