Routine use of autograft is not necessary for treatment of humeral shaft nonunions and anticipated nonunions after failed nonoperative treatment.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Erika Roddy, Jonah Hebert Davis, Reza Firoozabadi, David Barei
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引用次数: 0

Abstract

Objectives: To determine if the use of autogenous bone graft is necessary for the treatment of humeral shaft nonunions after initial nonoperative management.

Design: Retrospective.

Setting: Level 1 academic trauma center.

Patient selection criteria: All skeletally mature patients undergoing nonunion repair of a humeral shaft fracture (AO/OTA 12A, 12B, 12C) after initial nonoperative management of the acute fracture.

Outcome measures and comparisons: The primary outcome was osseous union. Failure of nonunion repair was defined by lack of osseous union within 365 days from surgery and/or return to the operating room for additional attempts to promote union. Secondary outcomes included complications including infection, radial nerve palsy, and donor site morbidity.

Results: Seventy-two patients were included in the final cohort. Thirty-eight patients (53%) were female, and the average age was 51 (SD 18, range 17, 83). Two patients (3%) developed a recalcitrant nonunion, both of which healed after a second procedure consisting of revision compression plating. The use of bone autograft was uncommon overall in this cohort (4 patients, 6%). Bone morphogenic protein, bone allograft, or demineralized bone matrix was used in 12 patients (17%). The remaining 56 patients (78%) were treated with compression plating alone. Compression was generated through multiple techniques including use of the articulated tensioning device, a pull screw with a verbrugge clamp, lag screw application, and compression generated via eccentric drilling through the plate. There were no differences in terms of patient demographics, fracture or injury characteristics between the groups that received autograft and those who did not (p>0.05). Use of autograft or other biologic supplementation was not associated with a statistically significant increase in union rate, 100% versus 97% (p=1.00). In the four patients who underwent autogenous bone grafting, there were no reported donor site complications.

Conclusions: For humeral shaft fractures initially treated nonoperatively that went on to nonunion or anticipated nonunion, the union rate for compression plating alone was comparable to the union rate noted in the literature after treatment with bone autograft and compression plating. These results suggest that routine use of bone autograft may be unnecessary in the treatment of humeral shaft nonunions.

常规使用自体移植物对于治疗肱骨不连和非手术治疗失败后预期的不连是不必要的。
目的:确定在初始非手术治疗后,自体骨移植是否有必要治疗肱骨不连。设计:回顾性。单位:一级学术创伤中心。患者选择标准:所有在急性骨折初始非手术治疗后接受肱骨骨干骨折不愈合修复(AO/OTA 12A, 12B, 12C)的骨骼成熟患者。结果测量和比较:主要结果为骨愈合。骨不连修复失败的定义是手术后365天内骨不愈合和/或返回手术室进行额外的促进骨不连的尝试。次要结果包括并发症,包括感染、桡神经麻痹和供体部位发病率。结果:72例患者被纳入最终队列。女性38例(53%),平均年龄51岁(SD 18,范围17,83)。2例患者(3%)出现顽固性骨不连,均在第二次翻修加压钢板手术后愈合。在这个队列中,自体骨移植的使用总体上是罕见的(4例,6%)。12例(17%)患者使用骨形态发生蛋白、骨同种异体移植物或脱矿骨基质。其余56例(78%)患者单独接受加压钢板治疗。压缩是通过多种技术产生的,包括使用铰接张紧装置、带verbrugge钳的拉力螺钉、拉力螺钉应用以及通过偏心钻穿钢板产生的压缩。自体移植物组和非自体移植物组在患者人口统计学、骨折或损伤特征方面没有差异(p < 0.05)。自体移植物或其他生物补充的使用与愈合率的增加没有统计学意义,100%对97% (p=1.00)。在接受自体骨移植的4例患者中,没有报告供体部位并发症。结论:对于最初非手术治疗的肱骨干骨折,如果不愈合或预期不愈合,单独加压钢板的愈合率与文献中报道的自体骨移植和加压钢板治疗后的愈合率相当。这些结果表明,常规使用自体骨移植物可能是不必要的治疗肱骨不连。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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