Validation of the Non-Union Scoring System in 300 long bone non-unions

Calori, G.M.; Colombo, M.; Mazza, Emílio; Mazzola, S.; Malagoli, E.; Marelli, N.; Corradi, A

doi:10.1016/j.injury.2014.10.030

Cited by 110 publications

(86 citation statements)

References 38 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The average age of the study population was 42.3 (range ; the sex ratio was 1.84 in favor of males ( Table 1). Retrospectively, the Non-Union Scoring System (NUSS) (8) was used to understand and study the type of nonunion. To assess the NUSS, information from the medical case history was used.…”

Section: Methodsmentioning

confidence: 99%

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

Rollo¹

2017

ccmbm

View full text Add to dashboard Cite

SummaryIntroduction. The nonunion rate has been reported between 0.1% and 15%. There are also several predisposing factors for the onset of complications: general factors connected with the patient and specific factors related to the fracture site. The purpose of our study is to review the etiology of nonunion of the clavicle in its atrophic form and investigate the outcomes of the revision treatment in a single step. Materials and methods. Retrospective study on 71 patients suffering from nonunions due to the following treatments: conservative in 13 patients; plate fixation in 12; closed reduction and fixation with K-wire in 24; open reduction and fixation with K-wire. All patients were operated on in beach chair position and classic approach to the clavicle by incising the previous surgical scar. The clinical and radiographic criteria for evaluating the outcomes were: the Short Form (12) Health Survey (SF-12), the Constant Shoulder Score (CSS) and the Disability Disabilities of the Arm, Shoulder and Score (DASH) and radiographic Union Score (RUS) for bone healing. The evaluation endpoint was set at 12 months. Results. Blood and culture tests showed 22 infected nonunions and 49 atrophic or oligoatrophic. In only 10 cases, before surgery, the inflammatory markers were positive. The isolated microorganisms were resistant to common antibiotics. In 70 out of 71 cases, plates and screws on the upper side and fibula allogenic splints at the bottom, associated with cancellous bone grafts taken from the patients' iliac crests, were implanted. In one case, however, it was decided to implant the plate on the front edge of the clavicle and the fibula allogeneic splint on the posterior margin, also associated with a cancellous bone graft taken from the patient's iliac crest. The radiographic bone healing was observed in 107.8 (range 82-160) days for the aseptic nonunions, while in 118.4 (range 82-203) days for the septic ones. The non-healing case was a serious failure that led to asubtotal excision of the clavicle. Conclusions. The importance of classification and study of nonunions are essential to achieve positive outcomes. The guiding principle of our work is that aseptic nonunions heal in the operating room, while infected nonunions can be challenged and defeated on the operating table. Restoring the correct length of the clavicle interconnection between the sternum and the shoulder cingulum is indispensable to avoid functional deficits of the upper limb. The fibula splint and the tricorticale bone graft have both mechanical and strong biological values to quickly heal the nonunion.The return to pre-injury quality of life has to be our main goal.

show abstract

Section: Methodsmentioning

confidence: 99%

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

Rollo¹

2017

ccmbm

View full text Add to dashboard Cite

show abstract

“…All patients had a shoulder and humeral CT scan before surgery. To understand and study the type of nonunion, we used the Non-Union Scoring System (NUSS) (6). The score averaged 61.7 (range 35-74) ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…The score averaged 61.7 (range 35-74) ( Table 1). We used the NUSS also to choose the type of surgery to be performed (6). All patients were informed in a clear and comprehensive way of the type of treatment and other possible surgical and conservative alternatives.…”

Section: Methodsmentioning

confidence: 99%

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Rollo

Rotini

Pichierri

et al. 2017

ccmbm

View full text Add to dashboard Cite

SummaryBackground. Fractures of the proximal part of the humerus represent almost 4-5% of all fractures. The rate of non union is estimated to be 1.1 to 10%. Non union, displacement, and fixation failure can be hazardous complications for these injuries. The purpose of our study was to evaluate the outcomes of plate and bone strut allograft with bone chips grafting augmentation in the management of proximal humeral aseptic non union. Methods. We treated 16 aseptic non union proximal humeral fractures by the medial humeral shaft bone strut allograft and lateral plate and screws with bone chips grafting. The patients' ages were between 55 and 70 years. The chosen criteria to evaluate the group during the clinical and radiological follow-up were the quality of life measured by The Short Form (12) Health Survey (SF-12), shoulder function and related quality of life measured by the Constant Shoulder Score (CSS) compared with healthy side, bone healing measured by X-rays, and postoperative complications. The follow-up was perfor med with clinical and radiographic controls at 1, 3, 6 and 12 months. Surgical time and international units of red blood cells transfused were also calculated. The evaluation endpoint was set at 12 months. Results. The X-rays bone healing occurred in our group on average of 126.4 days after surgery. The surgical time and blood loss were consistent with standard surgical procedures. The quality of life and functional recovery were excellent after plate and bone strut allograft. Conclusions. Surgical techniques that increase mecha nical stability, while incorporating bone biology, are effective aids for treating problematic fractural patterns.KEY WORDS: aseptic non union; proximal humeral fracture outcome; bone strut allograft; plate; osteosynthesis; complications.

show abstract

“…smoking) into a score (27). From this NUSS-score, there are therapy considerations that can be adapted to the patient (28)(29)(30). The higher the score, the more specialized and custom the therapy concept must be to offer the possibility of consolidation ( Table 2).…”

Section: Classificationmentioning

confidence: 99%

Non-Union Current Treatment Concept

2016

View full text Add to dashboard Cite

Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of nonunions according to the principles of 'diamond concept' and aspects that have to be attended. Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept. Results: If an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required. Conclusions: By using the 'diamond concept' as a complex concept, non-unions can be treated in different stages in a targeted manner.

show abstract

Validation of the Non-Union Scoring System in 300 long bone non-unions

Cited by 110 publications

References 38 publications

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Non-Union Current Treatment Concept

Contact Info

Product

Resources

About