扩髓交锁髓内钉治疗胫骨萎缩性骨不连

[目的] 探讨胫骨萎缩性骨不连的原因及扩髓交锁髓内钉治疗胫骨萎缩性骨不连的效果。[方法] 对26例胫骨萎缩性骨不连的病例采用扩大髓腔的交锁髓内钉内固定。[结果] 经6个月～2年的随访，骨折全部愈合，关节功能明显改善。[结论] 扩大 髓腔的交锁髓内钉内固定是治疗胫骨萎缩性骨不连的理想方法。     

Characteristics,Treatments, and Outcomes of Tibial Plateau Nonunions: A Systematic Review

BackgroundDue to the rare incidence of tibial plateau nonunions, current studies are limited to small sample sizes and patient demographics. The aim of this systematic review is to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes of tibial plateau nonunions.MethodsPubMed, Clinical Key, and MEDLINE were searched for articles published prior to August 2020 in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The authors used varying combinations of the following terms to identify relevant articles: “tibial,” “plateau,” “nonunion,” “non-union.” Studies were assessed for patient demographics, pre-revision nonunion characteristics, treatment, and post-revision outcomes.ResultsEight studies were included, yielding 31 tibial plateau nonunions (21 males, 10 females). The majority of nonunions were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). Schatzker class I and II nonunions were not attributed to neglect, contradicting previous suggestions. Time to union was 4.0 months, the most common treatments being autologous bone grafting (76.7%) and revision plating (63.3%).ConclusionThis study demonstrates the effectiveness of autologous bone grafts and revision plating for tibial plateau nonunions. Physicians may use these findings to guide decision making in the event of high energy plateau nonunions. Lastly, various limitations exist within the current literature, emphasizing the need for standardized reporting measures.     

交锁髓内钉治疗股骨胫骨骨折骨不连原因探讨

目的探讨股骨、胫骨骨折交锁髓内钉内固定后发生骨不连的原因及防治方法。方法对235例使用交锁髓内钉的股骨胫骨骨折病例进行回顾性分析,手术采用闭合、小切口或有限切开复位,用三维瞄准器锁定骨折远近端。结果235例随访189例196肢,平均随访15.2个月,股骨87例发生骨不连5例;胫骨109例发生骨不连8例。骨不连与骨折部位、手术方式、解锁时间有明显关系。结论应力遮挡和局部血供障碍是静力型交锁髓内钉所致骨不连的主要原因,术中尽量闭合复位和有限切开复位内固定及适时解锁可降低骨不连的发生。     

应用可吸收螺钉内固定治疗陈旧性腕舟状骨骨折骨不连

腕舟状骨骨折是常见的腕部骨折之一，不稳定腕舟骨骨折治疗后发生骨不连者高达46％～55％。应用可吸收螺钉内固定治疗腕舟骨骨折骨不连报道不多。1998年1月～2003年7月，我们应用可吸收螺钉治疗陈旧性腕舟状骨骨折骨不连13例，疗效满意。     

Pseudarthrose ancienne avec grande perte de substance osseuse du radius traitée par la technique de Watson-Jones. À propos d’une observation

Large bone defects in the forearm pose a challenging reconstruction problem, especially when the condition has become chronic. The Watson-Jones technique is a relatively simple procedure that sacrifices pronation-supination, but allows the forearm to be used in everyday life. Here, we describe a unique case of one-bone forearm reconstruction for a patient who had been suffering from radius non-union for several years. This reconstruction technique provided the patient with acceptable function and appearance of the arm.     

Complications of the Latarjet procedure

The Latarjet procedure is an operation performed either arthroscopically or open for recurrent anterior shoulder instability, in the setting of glenoid bone loss; with good to excellent functional results. Despite excellent clinical results, the complication rates are reported between 15 and 30 %. Intraoperative complications such as graft malpositioning, neurovascular injury, and graft fracture can all be mitigated with meticulous surgical technique and understanding of the local anatomy. Nonunion and screw breakage are intermediate-term complications that occur in less than 5 % of patients. The long-term complications such as graft osteolysis are still an unsolved problem, and future research is required to understand the etiology and best treatment option. Recurrent instability after the Latarjet procedure can be managed with iliac crest bone graft reconstruction of the anterior glenoid. Shoulder arthritis is another complication reported after the Latarjet procedure, which poses additional challenges to both the surgeon and patient.     

Compression screw fixation without bone grafting for scaphoid fibrous nonunion

Purpose

Bone graft is often recommended as an adjuvant for treatment of scaphoid nonunions. However, recent literature has suggested that fibrous nonunion may be suited to treatment with rigid fixation without bone grafting. This work reported on outcomes of compression screw fixation for established scaphoid fibrous nonunions without bone graft.

Methods

Fourteen patients underwent surgical compression screw fixation without bone grafting of scaphoid fibrous nonunion between January 1, 2000, and December 31, 2012, with minimum follow-up until the time of clinical and radiographic healing. Fibrous nonunion of the scaphoid was defined as a scaphoid fracture with all of the following features: (1) persistent tenderness, (2) incomplete trabecular bridging on three X-ray views, (3) injury that had occurred at a minimum of 6 months prior to surgery, and (4) identification of fibrous union at the time of surgery. Outcomes were assessed with range of motion assessment, Disability of the Arm, Shoulder and Hand (DASH) scores, and plain radiographs.

Results

Twelve of the 14 patients healed successfully, while two patients required secondary vascularized bone grafting. Both unhealed patients sustained proximal pole fractures and had a duration of ≥1 year from injury to surgery. Average time to healing was 4.4 ± 2.0 months. Average flexion was 73 ± 22° and average extension was 66 ± 22° postoperatively. Average grip strength was 90 ± 25 lbs on the operative side. Mean postoperative pain score was 1.4 (range, 0 to 7). Mean postoperative DASH score was 10.2 (range, 0 to 52). Increasing age and an interval from injury to surgery of >1 year correlated with worse DASH and pain scores.

Conclusions

Patients with fibrous scaphoid nonunion demonstrated good results with rigid fixation without bone grafting. Increasing age and >1-year interval between injury and surgery resulted in lower self-assessed outcomes.

Level of Evidence

Therapeutic Level IV, retrospective case series