Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 3 ( September-December, 2021 ) > List of Articles

ORIGINAL RESEARCH

Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results

Giuseppe Rollo, Giovanni Vicenti, Roberto Rotini, Ante Prkic, Denise Eygendaal, Luigi Meccariello

Keywords : Artificial bone grafting, Aseptic non-union, Distal humerus, Patient-reported outcomes, Reconstruction, Revision surgery

Citation Information : Rollo G, Vicenti G, Rotini R, Prkic A, Eygendaal D, Meccariello L. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. 2021; 16 (3):144-151.

DOI: 10.5005/jp-journals-10080-1533

License: CC BY-NC-SA 4.0

Published Online: 15-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim: Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. Materials and methods: A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18–84 years) and mean total follow-up was 43 months (range, 24–62 months). Results: All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. Conclusion: The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. Clinical significance: The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications.


PDF Share
  1. Allende C, Allende BT. Post-traumatic distal humerus non-union: open reduction and internal fixation: long-term results. Int Orthop 2009;33(5):1289–1294. DOI: 10.1007/s00264-008-0650-8.
  2. Donders JCE, Lorich DG, Helfet DL, et al. Surgical technique: treatment of distal humerus nonunions. HSS J 2017;13(3):282–291. DOI: 10.1007/s11420-017-9551-y.
  3. Helfet DL, Kloen P, Anand N, et al. Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Jt Surg – Ser A 2003;85(1):33–40. DOI: 10.2106/00004623-200301000-00006.
  4. Bégué T. Articular fractures of the distal humerus. Orthop Traumatol Surg Res 2014;100(1 Suppl.). DOI: 10.1016/j.otsr.2013.11.002.
  5. Rollo G, Rotini R, Eygendaal D, et al. Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures. J Shoulder Elb Surg 2018;27(7): 1326–1332. DOI: 10.1016/j.jse.2018.02.073.
  6. Simonis RB, Nuñez VA, Khaleel A. Use of the coventry infant hip screw in the treatment of nonunion of fractures of the distal humerus. J Bone Jt Surg - Ser B 2003;85(1):74–77. DOI: 10.1302/0301-620X.85B1.12953.
  7. Pogliacomi F, Aliani D, Cavaciocchi M, et al. Total elbow arthroplasty in distal humeral nonunion: Clinical and radiographic evaluation after a minimum follow-up of three years. J Shoulder Elb Surg 2015;24(12):1998–2007. DOI: 10.1016/j.jse.2015.08.010.
  8. Rollo G, Pichierri P, Marsilio A, et al. The challenge of nonunion after osteosynthesis of the clavicle: Is it a biomechanical or infection problem? Clin Cases Miner Bone Metab 2017;14(3):372–378. DOI: 10.11138/ccmbm/2017.14.3.372.
  9. Rollo G, Rotini R, Pichierri P, et al. Grafting and fixation of proximal humeral aseptic non union: a prospective case series. Clin Cases Miner Bone Metab 2017;14(3):298–304. DOI: 10.11138/ccmbm/2017.14.3.298.
  10. Rollo G, Prkić A, Pichierri P, et al. Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: a consecutive case series. J Clin Orthop Trauma 2019;10:S127–S132. DOI: 10.1016/j.jcot.2019.05.004.
  11. Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 1989;(241):146–165. PMID: 2924458.
  12. Yin P, Zhang L, Li T, et al. Infected nonunion of tibia and femur treated by bone transport. J Orthop Surg Res 2015;10(1):49. DOI: 10.1186/s13018-015-0189-5.
  13. Morrey BF, Sanchez-Sotelo J. Approaches for elbow arthroplasty: how to handle the triceps. J Shoulder Elbow Surg 2011;20(2 Suppl.): S90–S96. DOI: 10.1016/j.jse.2010.12.004.
  14. Calori GM, Colombo M, Mazza EL, et al. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury 2014;45(S6): S93–S97. DOI: 10.1016/j.injury.2014.10.030.
  15. Maiettini D, Bisaccia M, Caraffa A, et al. Feasibility and value of Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Acta Inform Med 2016;24(6):394–396. DOI: 10.5455/aim.2016.24.394-396.
  16. Rollo G, Prkic A, Bisaccia M, et al. Grafting and fixation after aseptic non-union of the humeral shaft: a case series. J Clin Orthop Trauma 2020;11:S51–S55. DOI: 10.1016/j.jcot.2019.08.020.
  17. Bose S, Roy M, Bandyopadhyay A. Recent advances in bone tissue engineering scaffolds. Trends Biotechnol 2012;30(10):546–554. DOI: 10.1016/j.tibtech.2012.07.005.
  18. Mariani E, Lisignoli G, Borzì RM, et al. Biomaterials: foreign bodies or tuners for the immune response? Int J Mol Sci 2019;20(3):636. DOI: 10.3390/ijms20030636.
  19. Murgatroyd DF, Harris IA, Tran Y, et al. Predictors of return to work following motor vehicle related orthopaedic trauma. BMC Musculoskelet Disord 2016;17(1):171. DOI: 10.1186/s12891-016- 1019-6.
  20. Macken AA, Prkic A, Kodde IF, et al. Global trends in indications for total elbow arthroplasty: a systematic review of national registries. EFORT Open Rev 2020;5(4):215–220. DOI: 10.1302/2058-5241.5.190036.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.