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Minimally invasive plate augmentation in the treatment of long-bone non-unions

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants.

Materials and methods

Seventeen patients with hypertrophic non-union of the long bones between 2010 and 2014 on radiography who previously underwent intramedullary (IM) nailing or plate osteosynthesis for long-bone fractures were included. A locking compression plate was inserted with at least three mono- or bicortical screws at each proximal and distal segment. Broken or loosened interlocking screws of IM nail were simultaneously re-fixed. Fracture site exposure, pre-fixed implant removal, and bone grafting were not performed. We investigated whether union occurred and analyzed functional outcomes and complications.

Results

Eleven femoral and six tibial non-unions were prospectively included. In the pre-existing implants, 13 nails and 4 plates were found. All cases achieved union at a mean 22.7 weeks. One case of superficial infection was managed with oral antibiotics. Deep infection or implant failure did not occur.

Conclusions

Minimally invasive plate augmentation can achieve additional stability and promote healing of hypertrophic non-union of the long bones. When indicated, this technique is the least invasive alternative to exchange nailing and reduces surgical risks in the treatment of diaphyseal non-union.

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References

  1. Hakeos WM, Richards JE, Obremskey WT (2011) Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting. J Orthop Trauma 25(2):84–89

    Article  PubMed  Google Scholar 

  2. Hak DJ, Lee SS, Goulet JA (2000) Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma 14(3):178–182

    Article  CAS  PubMed  Google Scholar 

  3. Litrenta J, Tornetta P 3rd, Vallier H, Firoozabadi R, Leighton R, Egol K et al (2015) Dynamizations and exchanges: success rates and indications. J Orthop Trauma 29(12):569–573

    Article  PubMed  Google Scholar 

  4. Gardner MJ, Toro-Arbelaez JB, Harrison M, Hierholzer C, Lorich DG, Helfet DL (2008) Open reduction and internal fixation of distal femoral nonunions: long-term functional outcomes following a treatment protocol. J Trauma 64(2):434–438

    Article  PubMed  Google Scholar 

  5. Menon DK, Dougall TW, Pool RD, Simonis RB (2002) Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma 16(7):491–497

    Article  PubMed  Google Scholar 

  6. Yang KH, Kim JR, Park J (2012) Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure. J Trauma Acute Care Surg 72(2):E60–E64

    Article  PubMed  Google Scholar 

  7. Park J, Yang KH (2013) Indications and outcomes of augmentation plating with decortication and autogenous bone grafting for femoral shaft nonunions. Injury 44(12):1820–1825

    Article  PubMed  Google Scholar 

  8. Ye J, Zheng Q (2012) Augmentative locking compression plate fixation for the management of long bone nonunion after intramedullary nailing. Arch Orthop Trauma Surg 132(7):937–940

    Article  PubMed  Google Scholar 

  9. Nadkarni B, Srivastav S, Mittal V, Agarwal S (2008) Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486

    Article  PubMed  Google Scholar 

  10. Choi YS, Kim KS (2005) Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop 29(5):287–290

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N (2003) Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury 34(5):349–356

    Article  PubMed  Google Scholar 

  12. Swanson EA, Garrard EC, Bernstein DT, O’Connor DP, Brinker MR (2015) Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma 29(1):21–27

    Article  PubMed  Google Scholar 

  13. Swanson EA, Garrard EC, O’Connor DP, Brinker MR (2015) Results of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunions. J Orthop Trauma 29(1):28–35

    Article  PubMed  Google Scholar 

  14. Ueng SW, Chao EK, Lee SS, Shih CH (1997) Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 43(4):640–644

    Article  CAS  PubMed  Google Scholar 

  15. Park J, Kim SG, Yoon HK, Yang KH (2010) The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma 24(2):89–94

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea

    Ki-Chul Park

  2. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea

    Chang-Wug Oh, Joon-Woo Kim, Kyeong-Hyeon Park, Il-Hyung Park, Hee-Soo Kyung & Jeong Heo

  3. Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea

    Jong-Keon Oh

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  1. Ki-Chul Park
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  2. Chang-Wug Oh
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  4. Kyeong-Hyeon Park
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Correspondence to Chang-Wug Oh.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Park, KC., Oh, CW., Kim, JW. et al. Minimally invasive plate augmentation in the treatment of long-bone non-unions. Arch Orthop Trauma Surg 137, 1523–1528 (2017). https://doi.org/10.1007/s00402-017-2773-0

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  • DOI: https://doi.org/10.1007/s00402-017-2773-0

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