OBJECTIVE To investigate the effect of allogeneic decalcified bone graft in the treatment of nonunion in children. METHODS From April 1990 to September 1997, 17 children with nonunion were adopted in this study. Among them, there were 10 boys and 7 girls, the age ranged from 2 to 13 years. The allogeneic decalcified bone graft taken from fresh corpse by aseptic manipulation were used to repair 3 cases of congenital nonunion and 14 cases of acquired nonunion. RESULTS All cases were followed up 2 to 9 years after operation, 9 cases were cured successfully and 7 cases were cured after twice operations. One case of congenital pseudoarthrosis of the tibia was operated twice and there were callus grown half years after the second operation, but reoccurred after one year. Although there were 1.5 cm to 3 cm shortening deformity of extremity including another 2 cases of congenital pseudoarthrosis of the tibia and 5 cases of nonunion caused by chronic osteomyelitis, the function of joint was normal. CONCLUSION Treatment of nonunion in children by allogeneic decalcified bone graft is a valuable technique in clinical practice. It is characterised by high capacity of osteoinduction, low antigenicity, rapid bony union, plentiful source of bone graft and convenient utilization.
Thirteen patients with intractable nonunions of fractures of long bones were sucessfully treated by a combination of internal fixation and implantation of bBMP. There was an average of 1.5 operative procedures per patient in an attempting to establish reunion prior to bBMP implantation. Union was obtained in 12 of the 13 patients exapt in one who gained success from establish the second attempt. The average time requited to union was 4.7 months. No complication was seen.
Objective To observe the effect of vascular endothelial growth factor (VEGF) in fracture healing and to investigate the influence of VEGF and VEGF antibody in fracture healing. Methods One hundred and five rabbits were used tomake fracture model in the left radius and randomly divided into control group,VEGF group and VEGF antibody group. VEGF and VEGF antibody were used in the VEGF group and VEGF antibody group respectively, then the blood flow of the fracture ends was measured by single photon emission computed tomography (SPECT) 8,24 , 72 hours, 1, 3, 5 and 8 weeks after fracture, the X-ray films of the fracture sites were taken after 1, 3, 5 and 8 weeks to observe the fracture healing. Results The blood flow of the fracture ends in the VEGF groupincreased during aperiod from 8h to 3wk after fraction when compared with that of the control group, and no obvious difference was seen on the X-ray films between the two groups. In the VEGF antibody group, the blood flow of the fracture ends decreased obviously when compared with that of the control group. The fracture healing processwas interfered seriously and nonunion change was seen in the fracture site. Conclusion The lack of VEGF will interfere with the fracture healing process and result in nonunion in the fracture site. Administration of ectogenous VEGF may promote fracture healing by increasing the blood flow of the fracture ends.
Objective To explore an ideal operative treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients. Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free il iac grafts and fixed by dynamic hi p screws (DHS) and/or canulated screws. Multi ple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 onaverage) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average). Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the heal ing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture heal ing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.
OBJECTIVE To investigate a new operative method for repairing nonunion and defect of tibia. METHODS First, observe the relation between the joint branches of descending genicular artery and the saphenous branch of descending genicular artery in 10 cadevers. Then the medial femoral condylar bone flap pedicled with the saphenous vessels was prepared in 4 cadavers for simulated purpose. Clinically, two patients with tibial nonunion were treated by transplantation of this pedicled bone flap. RESULTS: In the 4 simulated operations, the ink which was injected into the femoral artery could be released from the joint branches. And in the clinical operation, the area of the pedicled bone flaps were 5.0 cm x 2.0 cm x 1.5 cm and 4.5 cm x 1.5 cm x 1.5 cm respectively. Followed up for 8 to 12 weeks, the fracture unioned well. CONCLUSION: This operation is simple and reliable, it is characterised by 1. unnecessary to anastomosis the vessels 2. reliable blood supply 3. high quality of bone flap 4. either bone flap or bone-skin flap can be chosen 5. long vessel pedicle.
Objective To study the surgical procedures and results for treating the nonunion of lateral humeral condyle fracture combined with cubitus valgus in adolescents. Methods From June 2004 to October 2006, 5 patients with nonunion of lateral humeral condyle fracture and cubitus valgus were treated, including 3 males and 2 females aged 8-17 yearsold. Three cases received external fixation for 2-3 weeks in other hospital, while 2 cases were misdiagnosed as soft tissue injury. The patients were hospital ized after they were diagnosed with nonunion of lateral humeral condyle fracture and cubitus valgus 4-12 years after injury. Preoperatively, the angle of cubitus valgus deformity was 25-55° (average 44.8°), and the elbow motion range of flexion and extension was 135-140° (average 139°) and 0-20° (average 7°), respectively. One case with the symptoms of ulnar neuritis was diagnosed as incomplete injury of ulnar nerve. The time between admission to hospital and operation was 3-7 days. All the patients were treated with wedge shaped supracondylar osteotomy of the distal aspect of humerus and humerus lateral column reconstruction. Regular follow-up was conducted after operation and the elbow function was evaluated according to the scale system of Jupiter et al. Results All incisions healed by first intention and all the cases were followed up for 14-28 months (average 20 months). X-ray films revealed that bone union was attained in all the 5 cases, among which the bone union at the supracondylar osteotomy site was reached 5-8 weeks after operation (average 6 weeeks) and the bone union at the lateral column reconstruction site was reached 3-6 months after operation. The deformity of cubitus valgus was corrected in all thecases. At latest follow-up, the flexion motion of the elbow was 100-135° (average 121°), and the extension range was 0-30° (average 13°), the angle of postoperative cubitus valgus deformity was — 5-10° (average 2°). According to the system of Jupiter et al, 2 cases were excellent, 2 cases were good and 1 case was fair. One patient and symptoms of radial nerve traction injury after operation and achieved complete recovery 3 months later; and 1 case suffering from ulnar neuritis before operation recovered 6 months after operation. No other compl ications occurred. Conclusion It is effective to use wedge-shaped supracondylar osteotomy of the distal aspect of the humerus and lateral colum reconstruction through internal fixation to treat the nonunion of the lateral humeral condyle fracture combined with cubitus valgus.
【Abstract】 Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperativenonunion of fracture of lower limb. Methods Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nail ing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nail ing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. Results The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospital ization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.
ObjectiveTo investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. MethodsBetween March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years (range, 22-46 years). Nonunion was found at 10-29 months (mean, 16 months) after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/hyperplastic type, and 4 cases of unstable/atrophic type. ResultsAll incision healed at first stage. Twenty-six patients were followed up 10-28 months (mean, 14 months). A total of 16 (61.5%) fractures healed at 4-11 months after deferred dynamization (7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type); the other 10 fractures failed to heal. The healing rate was 100% (7/7) in patients with stable/hyperplastic type nonunion, 75% (9/12) in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. ConclusionDeferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.
Objective To compare the results of plate and Kirschner wire fixation in treatment of nonunion of clavicular fracture. Methods From September 1991 to January 2002, 19 patients (9 with plate and 10 with Kirschner wire) were treated. The results were evaluated by reduction, bone union time, recovery of joint function, pain, and correction of deformation. Results The follow-up time was 6-23 months with an average of 11 months. Bone union -occurred after a mean time of 11 weeks. In plate group, 7 patients gained excellent results, 1 good and1 fair. In Kirschner wire group, 3 patients gained excellent results, 3 good, 3 fair and 1 poor. The result of plate is significantly better than that of Kirschner wire fixation(Plt;0.05). Conclusion Plate fixation is a good simple method for treatment of nonunion of clavicular fracture.
【Abstract】 Objective To discuss the strategy of condylar reconstruction in the treatment of refractory condylarnonunion and defect of humerus. Methods From September 1998 to September 2005, 18 patients with refractory condylarnonunion concomitant with defect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. Accordingto AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1, 4 cases of type C2and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defectivebone mass was 1-4 cm2. The mean extension and flexion of elbow joint was 21.5°(5-65°) and 95.8°(85.0-123.5°) respectively. Accordingto Cassebaum scoring system, the excellent and good rate was 27.8% (excellent in 1 case and good in 4 cases). Time frominjury to operation averaged 22.8 months(7-52 months). All patients were operated with approach of olecranon osteotomy.Bone defect was reconstructed with il iac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, anatomicplates and reconstruction plates were used to fix. Results Eighteen patients were followed up 12-86 months (mean27.6 months). All the incisions healed by first intention. No bone block displacement, loosening or breakage of internal fixationoccurred. The time of bone union averaged 5.7 months(4-8 months). The mean extension and flexion of elbow joint were 11.4°(0-44.5°) and 128.6°(105.5-144.5°) 1 year after operation. Ectopic ossification formed in 1 case at anterior part of elbow 4 monthsafter operation. According to Cassebaum scoring system, the results were excellent in 8 cases, good in 6 cases, fair in 3 cases andpoor in 1 case. The excellent and good rate was 77.8%. Conclusion The shape of humeral condyle can be reconstructed withil iac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internalfixation and early function exercise can improve the function of elbow joint evidently.