Pronator quadratus pedicled bone graft for scaphoid non-unions

Scaphoid fractures frequently present with nonunion and proximal pole necrosis, the treatment of which is bone grafting. Pronator quadratus pedicled vascularized bone graft is an option especially in the setting of proximal pole necrosis. We describe our experience of managing such scaphoid non-unions using pronator quadratus pedicled vascularized bone graft. Six patients were managed using pronator quadratus pedicled vascularized bone graft following scaphoid fracture nonunion with proximal pole necrosis. All patients had good fracture healing and symptom resolution. Mild deficit in wrist extension was noted in all patients. Pronator quadratus pedicled vascularized bone graft is an attractive option for managing scaphoid nonunion. Lying adjacent to the fracture site, bone can be harvested and transferred without making any other incisions. This procedure introduces another source of blood supply to the fracture site and hence improves fracture healing.

Treatment of Wide Gap Non-Unions in Lower Extremities

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.

Treatment of Wide Gap Non-Unions in Lower Extremities

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.

Recombinant Human Bone Morphogenic Protein-2 (BMP-2): A Newer & Novel Osteoinductive Treatment Modality for Non-union of Bones.

Background: The non-union of bones is a multifactorial phenomenon. In this study, it was emphasized to evaluate the efficacy and safety of bone morphogenetic protein-2 (BMP-2) as a bone-stimulating agent in the treatment of non-unions. Methods: Fifteen patients [5 males, mean age 51.06 years (range: 21—75)] with sixteen non-unions were treated with BMP-2. There were eleven femoral non-union, three humerus, one ulna, one distal fibula non-union. The mean follow-up was 22.06 months. Results: Both clinical and radiological union occurred in 15 (93.75%) non unions cases. Radiological union achieved within a mean time of 15.75 weeks. The remaining one show incomplete union with recalcitrant formation was asymptomatic and having good pain free range of movement, declines further intervention. No complications or adverse effects from the use of BMP-2 were encountered. Conclusion: In this study, it was observed that BMP-2 is a powerful adjunct and one of the safe armamentarium for the surgeon to handle difficult and challenging clinical conditions.

Proximal Humerus Nonunion: Operated with Fibular Strut Allograft and Locking Plate.

Proximal humerus fracture is one of the common fractures seen in practice. Being metaphyseal region, it is less prone for nonunion. Although more than 80% of these heal with no surgical intervention, displaced unimpacted surgical neck fractures are associated with a higher incidence of nonunion with rates varying from less than 1% to as high as 23%. We report a case of 35-year-old male with nonunion following fracture of left proximal humerus.

Surgical Excision of Symptomatic Nonunion of Fifth Metatarsal Base Avulsion Fracture in Athletes / 대한스포츠의학회지

The purpose of this study was to evaluate the clinical results of surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes. From February 2008 to December 2009, six athletic patients who had a symptomatic nonunion of fifth metatarsal base avulsion fracture underwent surgical excision of ununited bony fragment and they were followed for more than 12 months. The mean age was 18.5 years and the mean follow-up period was 13 months. The clinical results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) scoring system and statistically analyzed (SPSS ver. 18.0). The AOFAS and VAS score was improved in all patients. The mean AOFAS forefoot score was improved from 58.6+/-5.7 preoperatively to 95+/-5.4 postoperatively, which indicated significant difference (p=0.024). The mean preoperative VAS score was 8.0+/-0.6 and the mean postoperative VAS score was 1.6+/-0.5 cm, which indicated significant difference (p=0.023). There were no postoperative problems and functional loss on the operation lesions. The surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes was found to be one of the ideal treatment option for early return to full activity and relief of pain.

Autologous bone marrow transfusion to treat the tibia diaphyseal nonunions

Background: Bone marrow stem cells with their plasticity can be used to replace and repair the other damaged organs and tissues, so they can also be used to obtain bone healing of nonunions. Objective: to evaluate the results of percutaneous autologous bone marrow grafting to treat the tibia diaphyseal nonunions. Subjects and methods: 12 patients with noninfected nonunion of the tibia were diagnosed and treated in Viet Duc Hospital. About 250mL of marrow was aspirated, then separated and concentrated by density gradient centrifugation. The final mononuclear cell mass containing stem cells and progenitors was washed in 30ml of 0.9% NaCL and then injected into the damaged sites. Patients were evaluated by clinical and X-rays examinations with at least 6 months follow-up. Results: None of the patients had post - op complications. Bone union was obtained in eleven of the twelve patients (91,7%) at an average of 15,3 weeks (range, 9 - 30 weeks), the bone marrow grafts used for these patients who had bone union contained a mean of 5,65 \xb1 3,74 x 106 (0,95 - 11,73 x 106) CD34(+) stem cells in total. Conclusions: Percutaneous autologous bone - marrow grafting is a minimally invasive alternative and a simple, effective, safe method for the treatment of the tibia diaphyseal nonunions with the comparative bone healing rate. \r\n', u'\r\n', u'

The role of fibroblasts in bone healing with extracorporeal shock wave treatment / 中华物理医学与康复杂志

Objective To investigate the role of fibroblasts in nonunion fracture healing using extracorporeal shock wave(ESW) treatment. Methods Thirty healthy rabbits were selected to make the models of non-union fractures of the right tibias, which were then held apart by external fixation. 12 weeks after the operation, hypertrophic non-unions were confirmed in 27 of the rabbits by radiography. These 27 were divided randomly into a treatment group and a control group. The test animals were treated with ESW under general anaesthesia. The two ends of the nonunion fracture were shocked 1 000 times at 0.54 mJ/mm2 and a frequency of 60 times/minute. The nonunions of the control group were treated with external fixations only. Histological examination and transmission electron microscopy(TEM) were conducted after 2 and 6 weeks. Standardized radiographs were taken after 12 weeks of the shock wave treatment. Results ESW induced microfractures, which initiated the healing process of the nonunionfractures. X-rays showed that 8 of the 9 fractures of the treatment group had healed after 12 weeks of EWS treatment, but only 3 of the 9 in the control group had healed. Statistical analysis showed that this difference was significant at the 5% level. After 2 weeks of ESW treatment, TEM showed many collagen fibers around the fibroblasts in the treatment group, with characteristic and periodic transverse lines. This indicated that the fibroblasts had been secreting collagen fibers as osteoblasts. Six weeks later, osteoblasts and fibroblasts had formed bone lacunes, and they had become osteocytes. However osteogenetic activates were not found in the control group. Conclusions Fibroblasts are activated by ESW to better form bone tissue. This process plays an important role in rebuilding broken bones.

Effects of low-intensity pulsed ultrasound on fracture healing / 第二军医大学学报

Many basic and clinical studies have showed that through a variety of biological and biophysical mechanisms, low-intensity pulsed ultrasound improves the fracture healing and provides an ideal repairing environment.Thus,it can not only accelerate the healing of fractures,but also enhance the healing rates;not only accelerate the healing of fresh fractures, but also the healing of delayed unions and nonunions.This review elaborates on the effects of low-intensity pulsed ultrasound on the healing of fractures,its mechanisms and its prospective applications. [