Supplemental graft fixation for distal radius vascularized bone graft

Vascularized bone grafts from the distal radius have been used successfully for the treatment of scaphoid nonunions. Typically, the harvested graft is secured into the scaphoid with a press-fit technique. This type of fixation may lead to graft extrusion in the early postoperative period, and thus to treatment failure. In this technical note, we describe the use of micro bone suture anchors for supplemental fixation of the vascularized bone graft into the scaphoid. It is a simple and quick technique and provides an enhanced fixation of the vascularized bone graft, which is beneficial during the early critical period of bone healing.     

Management of scaphoid nonunion

The primary risk factor for nonunion of the scaphoid is displacement/instability, but delayed or missed diagnosis, inadequate treatment, fracture location, and blood supply are also risk factors. Untreated nonunion leads to degenerative wrist arthritis-the so-called scaphoid nonunion advanced collapse wrist. However, the correlation of symptoms and disease is poor; the true "natural history" is debatable because we evaluate only symptomatic patients presenting for treatment. It is not clear that surgery can change the natural history, even if union is attained. The diagnosis of nonunion is made on radiographs, but computed tomography or magnetic resonance imaging scans can be useful to assess deformity and blood supply. Treatment options vary from percutaneous fixation to open reduction and internal fixation with vascularized or nonvascularized bone grafting to salvage procedures involving excision and/or arthrodesis of carpals.     

旋转加压式外固定架的研制和临床应用

目的：通过旋转加压式外固定架生物力学的研究及其临床应用，评价其应用价值，方法：用尸体胫腓骨４对，造成中段斜形骨折模型，随机用外固定架和６孔加压钢板固定，在ＷＪ－１０Ａ型试验机上测试。同时用外固定架治疗胫腓骨骨折患者３６例，随访时间最长２年半，最短１年，平均１８月，其中２９例得到随访。结果：生物力学测试外固定架组承受的平均最大破坏载荷（ＭＬＦ）为２１３０Ｎ，而加压钢板组为１９７０Ｎ，两者差异显著（Ｐ     

A new animal model for bone atrophic nonunion: Fixation by external fixator

A new small animal model of bone atrophic nonunion was established for investigating the process of bone regeneration by performing cauterization of the periosteum, removal of the local bone marrow, and stabilization with external fixation. The model allows the creation of an atrophic nonunion without the need for a critical size defect. Furthermore, it provides reproducible, well‐defined mechanical conditions and minimized physical interference of the implant with the biological processes in the healing zone. Eighty adult Sprague‐Dawley rats received an osteotomy of the left femur, stabilized with an external fixator. In half of the animals, the periosteum proximal and distal to the osteotomy was destroyed by cauterization and the adjacent bone marrow was removed (nonunion group). At 2 and 8 weeks after surgery, radiological, biomechanical, histological, and histomorphometrical analyses showed a typical physiological healing in the control group, while the nonunion group was characterized by resorption of the bone ends with some callus formation distant to the osteotomy. At both time points, the callus was composed of significantly less bone and significantly more connective tissue (p < 0.001). In addition, the torsional strength of the osteotomized femur was significantly less in the nonunion group than in the control group, which was comparable to that of the intact femur (p < 0.001). In conclusion, the present model allows the induction of an atrophic nonunion without the need of a critical size defect. It is reproducible, provides standardized biomechanical conditions, and allows minimized interaction of the implant with the healing zone. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res     

The total scaphoid titanium arthroplasty: A 15-year experience

Scaphoid nonunion followed by necrosis of bone segments is a common pathologic condition for the hand surgeon, and the difficulty of its management is well known. The total titanium scaphoid replacement, although not well-described in the literature, in our experience represents a reasonable choice in the treatment of this condition. Strict patient selection is necessary to achieve good clinical results. The titanium avoids the silicone synovitis, a well-described complication of silastic implants. Furthermore, this technique permits other surgical steps in case of failure.     

Scaphoid nonunion and flexor pollicis longus tendon rupture

Four patients presented with a rupture of the flexor pollicis longus tendon that was associated with a longstanding scaphoid nonunion. A radiocarpal arthrosis was present in 3 of the 4 patients and a dorsiflexed intercalated segment instability deformity was also seen in 3 of the 4 patients. Three patients underwent surgery consisting of an osteosynthesis with an iliac bone graft for the scaphoid nonunion and a palmaris longus tendon graft for the ruptured flexor pollicis longus tendon. An osseous union of the scaphoid and a functional active range of motion of the thumb interphalangeal joint (33 degrees on average) was attained in all 3 of the patients treated surgically. Preoperative radiologic examinations and intraoperative findings suggest that the volarly protruding distal scaphoid segment is the cause of the rupture.     

Fixation of mandibular osteotomies: comparison of locking and nonlocking hardware

BACKGROUND.: The outcome of patients undergoing rigid plate fixation of symphyseal mandibular osteotomies for exposure, resection, and reconstruction of tumors in the oral cavity or oropharynx was analyzed to determine the impact of hardware selection on complications. METHODS.: Forty-five patients underwent titanium plate rigid internal fixation of mandibular osteotomies during cancer resection and free flap reconstruction at an academic medical center. The incidence of hardware-related complications and mandibular nonunion was compared in patients receiving either locking hardware or nonlocking hardware. RESULTS.: The incidence of osteotomy-related complications in patients with an inferior border nonlocking mandibular fracture plate was 21%. In the patients with locking hardware or an inferior border nonlocking mandibular fracture plate combined with a tension band, there were no hardware-related complications and no mandibular nonunions. This difference was statistically significant (chi(2) = 6.01, p < .05). CONCLUSIONS.: Locking mandibular reconstruction plates are associated with fewer complications than inferior border nonlocking mandibular fracture plates for rigid fixation of mandibular osteotomies in patients undergoing resection of head and neck cancer.     

高能冲击波对骨组织代谢及愈合影响的实验及临床研究

目的了解高能冲击波对骨组织ＤＮＡ的影响，以及其治疗骨折延期愈合、骨折不连接的疗效。方法通过新西兰种兔肢体实施体外高能冲击波治疗，取骨膜组织进行体外培养Ｈ３—ＴｄＲ掺入放射性自显影研究。临床应用其治疗骨不连接１８例，骨折延迟愈合２０例。结果证实冲击后１～２周实验侧骨膜组织Ｈ３ＴｄＲ标记率明显高于对照侧（Ｐ＜０．０５），表明实验侧骨膜成骨细胞有丝分裂明显增强，骨膜成骨作用增强。临床冲击治疗后１６周，２０例骨折延迟愈合均愈合；冲击后１６周，１８例骨不连接，１５例愈合。结论该法可促进骨膜形成、骨细胞ＤＮＡ代谢，是治疗骨折延迟愈合、骨不连接的有效方法，其作用机理仍有待于进一步研究。     

四肢骨折术后延迟愈合及不愈合相关因素及预防对策

目的:分析引起四肢骨折术后延迟愈合及不愈合危险因素,探讨相关预防对策。方法:52例四肢骨折术后延迟愈合及不愈合患者作为观察组,按照1:1比例选择52例同期正常愈合的四肢骨折手术患者作为对照组,比较年龄、性别、骨折部位、骨折类型、感染、功能锻炼、外固定管理等相关因素在两组之间的差异。结果:观察组年龄、粉碎性骨折、合并感染、功能锻炼不规范、外固定不妥当,高于对照组(P<0.05),是影响四肢骨折延迟愈合及不愈合的因素,两组患者性别构成、骨折部位比较无差异(P>0.05)。结论:影响四肢骨折术后存在延迟愈合及不愈合因素较多,应采取针对性措施避免或减少其发生。