Symptomatic Radial Neck Nonunion Following Traumatic Impacted Radial Neck Fracture

Golinvaux, Nicholas S.; Labrum, Joseph T.; Lee, Donald H.; Desai, Mihir J.

doi:10.1016/j.jhsa.2019.10.012

Cited by 6 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fracture nonunion and delayed healing are difficulties faced by many trauma and orthopedic surgeons, irrespective of experience and expertise. 34,35 Current strategies for treating fracture nonunion require reoperation, which is disadvantageous for the patient, both in terms of health and recovery, as well as economically, as it incurs a high economic burden. Even after secondary surgery, the success rate of fracture healing cannot be guaranteed.…”

Section: Discussionmentioning

confidence: 99%

miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition

Liu

Xue

et al. 2021

Molecular Therapy - Nucleic Acids

View full text Add to dashboard Cite

Patients who sustain concomitant fractures and traumatic brain injury (TBI) are known to have significantly quicker fracture-healing rates than patients with isolated fractures. The mechanisms underlying this phenomenon have yet to be identified. In the present study, we found that the upregulation of microRNA-92a-3p (miRNA-92a-3p) induced by TBI correlated with a decrease in integrin binding sialoprotein (IBSP) expression in callus formation. In vitro, overexpressing miRNA-92a-3p inhibited IBSP expression and accelerated osteoblast differentiation, whereas silencing of miRNA-92a-3p inhibited osteoblast activity. A decrease in IBSP facilitated osteoblast differentiation via the Phosphatidylinositol 3-kinase/threonine kinase 1 (PI3K/AKT) signaling pathway. Through luciferase assays, we found evidence that IBSP is a miRNA-92a-3p target gene that negatively regulates osteoblast differentiation. Moreover, the present study confirmed that pre-injection of agomiR-92a-3p leads to increased bone formation. Collectively, these results indicate that miRNA-92a-3p overexpression may be a key factor underlying the improved fracture healing observed in TBI patients. Upregulation of miRNA-92a-3p may therefore be a promising therapeutic strategy for promoting fracture healing and preventing nonunion.

show abstract

Section: Discussionmentioning

confidence: 99%

miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition

Liu

Xue

et al. 2021

Molecular Therapy - Nucleic Acids

View full text Add to dashboard Cite

show abstract

“…The first well-documented case was by Middleton at Royal North Shore Hospital in Sydney, Australia, in 1976, where a 29-year-old, very active farmer experienced bilateral non-unions at 5 and 8 months, respectively, both managed successfully with bone grafting [ 22 ]. In Golinvaux et al contemporary cohort of 472 consecutive minimally displaced radial head fractures treated non-surgically over 15 years, only 8 non-unions were found (1.7%) [ 20 ]. They commented that their retrospective study design introduced selection bias which may under-report the pathology's true incidence.…”

Section: Reviewmentioning

confidence: 99%

Non-union of Conservatively Managed Radial Neck Fractures in Adults: A Systematic Review

Wilton¹,

Pananwala²

2022

Cureus

View full text Add to dashboard Cite

Non-union of radial neck fractures in adults is rare. This review aims to identify factors contributing to the non-union of undisplaced radial neck fractures and assess treatment options and outcomes. Systematic searches of English articles in PubMed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were undertaken in September 2021 according to the PRISMA guidelines. The search terms were (fracture) AND (radial neck) AND (non-union OR non-union). Eligible studies reported adults who experienced undisplaced radial neck fractures that went on to non-union without prior surgical intervention. Fifteen case reports/series were included involving 29 non-unions in 27 patients. The largest study included eight patients. There were 11 males (38%) and 18 females (62%). The average age at the time of the presentation was 55 (range: 29-73). In 13 cases, comorbidities were commented on, including association with smoking in 4 (30%), diabetes in 3 (23%), and excessive alcohol in 5 (38%). The average time from injury to a diagnosis of non-union was 6.7 (range: 2-24) months. The average time of follow-up was 28.6 (range:6-84) months. Eight minimally symptomatic or asymptomatic non-unions were managed conservatively without complication. Seventeen symptomatic non-unions were managed operatively. Treatments included open fixation (1), open fixation with bone grafting (1), bone grafting alone (2), arthroplasty (2), radial head resection (2), and unknown surgery (7). Patients managed operatively achieved full or near-full, asymptomatic range of motion at an average of 5.4 (3-12) months postoperatively. Non-union is a rare complication of an adult radial neck fracture, and risk factors may include female gender, smoking, diabetes, and chronic alcohol. Persistence with non-operative management is encouraged as it can resolve symptoms with or without a radiographic union. Operative options range from bone grafting +/- fixation to arthroplasty. On average, the time from injury to the decision made to operate is 6.5 (3-12) months. A comfortable, functional range of motion is possible with all treatment strategies.

show abstract

“…That was my bias approaching the data of Golinvaux and colleagues. 4 I have several questions for the authors. For many surgeons, non-or minimally displaced radial head fractures are never reimaged because radiographs will not influence treatment.…”

Section: To the Editormentioning

confidence: 99%

Nonunion of Nonsurgically Treated Nondisplaced Fracture of the Radial Neck

Ring

2020

The Journal of Hand Surgery

View full text Add to dashboard Cite

Symptomatic Radial Neck Nonunion Following Traumatic Impacted Radial Neck Fracture

Cited by 6 publications

References 13 publications

miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition

miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition

Non-union of Conservatively Managed Radial Neck Fractures in Adults: A Systematic Review

Nonunion of Nonsurgically Treated Nondisplaced Fracture of the Radial Neck

Contact Info

Product

Resources

About