Explore the vast range of titles available.

The purpose of this study is to evaluate the efficacy of plate augmentation and hybrid bone grafting for treating atrophic nonunion of the femur with original intramedullary nail retained in situ.In this study, 36 patients with atrophic nonunion of the femur who underwent surgery using the technique of plate augmentation and a hybrid bone grafting while retaining the original intramedullary nail in situ in Xi’an Honghui Hospital from January 2019 to December 2021 were enrolled. 28 patients who met the inclusion and exclusion criteria were ultimately included in the study. These 28 patients, consisting of 20 males and 8 females with a mean age of 38 years, were evaluated based on factors such as operation time, intraoperative blood loss, the average hospitalization days. Additionally, the results and function of these patients were evaluated by union time, Wu’s scores of limb function and incidence of serious complications.All 28 patients achieved bone union at the 12 month follow-up, with an average follow-up time of 14.6 ± 4.2 months.The average operation time was 68.3 ± 11.2 min, and the average intraoperative blood loss was 140 ± 22.6 ml. Patients were hospitalized for an average of 5.8 ± 1.1 days. Full clinical and radiological bone union was achieved on average at 5.1 ± 1.9 months. The mean value of Wu's scores at the 12 month follow-up was significantly higher than before the operation. Limb function was excellent in 27 patients and good in one patient at the 12 month follow-up. However, five patients experienced the lower limb vein thrombosis, including one deep vein thrombosis and four lower limb intermuscular vein thromboses. One patient had a superficial infections of the surgical incision site, while three patients reported pain and numbness where their iliac bone graft was extracted at the 12 month follow-up. The technique of plate augmentation and hybrid bone grafting, combined with retaining the original intramedullary nail in situ has been shown to be a safe, effective, simply and standardizable practice for treating atrophic femoral nonunion with an intact original IMN fixation.

Background Although successful outcomes of platelet-rich plasma (PRP) in treating nonunion fractures have been reported, there are widespread confounding factors and biases in the studies. This study aims to assess the biological benefits of PRP-enhanced therapy while controlling for the two core factors of nonunion fractures—biomechanics and biology. Methods Retrospective analysis of medical records of patients with aseptic atrophic tibial diaphyseal fracture nonunion treated with a single locking plate in a tertiary trauma center. Patients were divided into the PRP group and the non-PRP group based on the use of PRP. The surgical procedure for the non-PRP group was a single locked plate fixation combined with autologous iliac bone grafting. For the PRP group, PRP-enhanced autologous iliac bone grafting and the creation of a bioactive chamber were added. The outcome measures included the union rate, average healing time, visual analog scale pain score, lower limb function score, and complications. Results A total of 90 patients were included, with 39 patients in the PRP group and 51 patients in the non-PRP group. The average follow-up was 16.15 ± 3.14 months in the PRP group and 15.86 ± 3.26 months in the non-PRP group. No significant differences were observed between the two groups in terms of demographic characteristics and disease parameters ( P  > 0.05). At 9 months post-revision surgery, the healing rate in the PRP group was higher than that in the non-PRP group (58.97% vs 33.33%, p  = 0.015,χ 2  = 5.885), but the final union rate did not differ significantly (92.31% vs 78.43%, p  = 0.072,χ 2  = 3.240). After excluding cases of persistent nonunion, the PRP group had a significantly shorter average healing time compared to the non-PRP group (8.88 ± 2.03 months vs 10.54 ± 2.59 months, p  = 0.002, t =  −3.103,95%CI: [ −2.74,  −0.60]) and a higher lower limb function score (67.72 ± 4.18 vs 64.55 ± 5.98, p  = 0.003, t = 2.700, 95%CI: [0.83, 5.52]). The PRP group had 4 (10.26%) complications, while the non-PRP group had 8 (15.69%) complications. Conclusion In the treatment of atrophic fracture nonunion, PRP enhanced autologous iliac bone grafting can shorten bone healing time and accelerate the healing process, thereby improving limb function more rapidly. This finding provides a superior treatment option clinically for patients in need of accelerated nonunion healing and early recovery of lower limb function.

Background Autologous bone grafting is the standard treatment for the surgical management of atrophic nonunion of long bones. Other solutions, such as bone marrow mesenchymal stem cells (BM-MSC) combined with phospho-calcium material, have also been used. Here we evaluate the safety and early efficacy of a novel procedure using autologous or allogenic adipose tissue mesenchymal stromal cells (AT-MSC) seeded in a patented tricalcium phosphate-based biomaterial for the treatment of bone regeneration in cases of atrophic nonunion. Methods This was a prospective, multicentric, open-label, phase 2 clinical trial of patients with atrophic nonunion of long bones. Biografts of autologous or allogenic AT-MSC combined with a phosphate substrate were manufactured prior to the surgical procedures. The primary efficacy was measured 6 months after surgery, but patients were followed for 12 months after surgery and a further year out of the scope of the study. All adverse events were recorded. This cohort was compared with a historical cohort of 14 cases treated by the same research team with autologous BM-MSC. Results A total of 12 patients with atrophic nonunion of long bones were included. The mean (SD) age was 41.2 (12.1) years and 66.7% were men. Bone healing was achieved in 10 of the 12 cases (83%) treated with the AT-MSC biografts, a percentage of healing similar (11 of the 14 cases, 79%) to that achieved in patients treated with autologous BM-MSC. Overall, two adverse events, in the same patient, were considered related to the procedure. Conclusions The results of this study suggest that AT-MSC biografts are safe for the treatment of bone regeneration in cases of atrophic nonunion and reach high healing rates. Trial registration Study registered with EUDRA-CT (2013-000930-37) and ClinicalTrials.gov (NCT02483364).

Introduction Intramedullary (IM) nailing is the treatment of choice for femoral shaft fractures, but nonunion rates have been reported to be as high as 12%. Surgical interventions for nonunion involve exchange nailing or plate augmentation. Recently, a combined treatment of exchange nailing and plate augmentation has demonstrated good results, but its comparative effectiveness remains unclear. This study aimed to compare the clinical and radiographic outcomes of three different surgical interventions for atrophic femoral shaft nonunion, and investigate the factors that affect bone healing after reoperation. Materials and methods A retrospective study was conducted at five university hospitals involving 149 patients with aseptic atrophic nonunion after IM nailing. These patients underwent reoperation with plate augmentation, exchange nailing, or combined treatment. Clinical and radiographic outcomes were assessed and compared according to reoperation procedure. Logistic regression analysis was performed to identify factors affecting persistent nonunion after reoperation. Results Of the cohort, 57 patients underwent plate augmentation, 64 underwent exchange nailing, and 28 received combined treatment. There were no significant differences in patient demographics among the groups. Exchange nailing produced a significantly lower union rate than did the combined treatment (82.8% vs. 100%, p = 0.016), whereas no significant difference was observed in the union rate and time to the union between plate augmentation and the combined treatment. Combined treatment showed the longest operative time and the greatest transfusion requirements. The risk factors for persistent nonunion included age, absence of autogenous bone grafts, and use of an exchange nailing technique. Conclusions Exchange nailing as a treatment for atrophic femoral shaft nonunion after IM nailing resulted in a lower union rate. The efficacy of the combined treatment requires further study, and persistent nonunion may be influenced by age, bone grafting, and surgical techniques. A comprehensive approach targeting both biological environment and mechanical stability is crucial in the treatment of atrophic femoral shaft nonunion.

Purpose This retrospective study aimed to compare the efficacy of augmented plate fixation with autogenous hybrid bone grafting (Group A) and vertical double-plate fixation with autogenous bone grafting through channels after removal of the original intramedullary nail (IMN) (Group B) for the treatment of atrophic nonunion of femoral shaft after IMN. Methods In the retrospective study, 56 patients who were diagnosed atrophic femoral nonunion after IMN fixation were enrolled and evaluated from January 2019 to July 2024 in Xi’an Honghui Hospital. All cases were fixed with either group A ( n  = 29) or group B ( n  = 27). Operation time, total blood loss, visual analog scale (VAS) scores, time to union, union rate, and the surgical complications were compared between the two groups. Results The results showed that Group A had a shorter operation time (96.2 ± 22.9 min vs. 122.4 ± 30.6 min;  p  < 0.001), less total blood loss (320.5 ± 98.7 m vs. 645.8 ± 142.3 mLL;  p  < 0.001), lower VAS scores at postoperative day 3 (5.0 ± 1.0 vs. 6.9 ± 1.1, p  < 0.05), and significantly shorter radiographic union time (5.0 ± 1.4 vs.6.6 ± 1.6 months, p  < 0.05). There was no significant difference in the surgical complications between the two groups. Conclusion The method of retaining the original intramedullary nail using hybrid bone grafting combined with local augmented plate fixation had a shorter operation time, less total blood loss, lower VAS scores, and shorter union time compared to the method of removing the original intramedullary nail, performing channel bone grafting, and using vertical double-plate fixation. In clinical practice, the treatment method of retaining the original intramedullary nail using hybrid bone grafting combined with local augmented plate fixation may be a more preferable treatment option for atrophic nonunion of femoral shaft after intramedullary nailing.

Purpose This study was conducted to assess a stepwise surgical procedure applied to treat a continuous series of patients with aseptic atrophic nonunion of long bones. Methods A retrospective review was performed of the medical files of patients treated by the senior author between January 2014 and January 2021 for aseptic atrophic nonunion of long bones using a standard stepwise surgical procedure consisting of four successive surgical steps: bridge locked plating, aggressive osteoperiosteal decortication, copious autologous iliac bone grafting, and tight closure without drainage. Patients were clinically and radiographically evaluated until bone healing, then at final follow-up for the purpose of the study. The primary objective of the study was to assess completion of bone healing; secondary objectives were the time required reaching bone union, the occurrence of complications at the iliac bone graft donor site, and the achievement of bone consolidation after a second attempt of treatment when indicated following failure of the index procedure. Results There were a total of 55 patients. One patient died from myocardial infarction before reaching bone healing and another one lost from early follow-up. There were remaining 53 patients with 37 years of mean age. The affected bone was the clavicle in five patients, humerus in 14, ulna in four, radius in one, femur in 13, and tibia in 16. The mean follow-up period was 3.4 years. A total of 52 patients (98.1%) achieved bone healing at a mean of 14.8 weeks from the index procedure. The only patient who did not reach bone healing after the index procedure was successfully revised using decortication-bone graft and new fixation with intra-medullary femoral nailing. Four patients (7.5%) developed local complications at the site of iliac bone harvesting. Conclusion Our stepwise surgical procedure was very effective treating aseptic atrophic nonunion of long bones. However, as this study is a retrospective review of a limited series of one surgeon’s experience, prospective comparative studies with large number of patients are suitable to define the advantages and indications of the procedure herein described.

Purpose To assess the efficacy of autogenous “structured” bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). Methods This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. Results The average time between primitive fracture and this operative treatment was 29 months (15–38 months). The average duration of surgery was 153 minutes (range, 115–230 min), and the average blood loss was 560 ml (range, 350–860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12–30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12–16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up ( P  = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up ( P  < 0.01). Conclusions ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.

Background Open reduction, superior plate (SP) fixation, and autologous cancellous granular bone grafting (ACGBG) are common strategies for treating clavicular midshaft atrophic nonunion (CMAN). We aimed to compare the radiological findings and clinical effects of two autologous cancellous bone grafts (ACBGs) and those of single SP fixation, to treat CMAN. Methods This retrospective study comprised 62 patients admitted to our hospital with CMAN (ACGBG with single SP fixation between March 2012 and October 2017, 32 patients; autologous cancellous structured bone grafting [ACSBG] with single SP fixation between November 2017 and May 2021, 30 patients). Patient visual analog scale (VAS) scores for pain and disability of the arm, shoulder, and hand (DASH) scores, obtained preoperatively and at final follow-up, were recorded and analyzed. Statistical differences between the ACGBG and ACSBG groups were assessed using Fisher’s exact and two-sample independent t tests. Results No statistically significant differences were observed between the two groups in terms of patient demographics or the incidence of complications. VAS and DASH scores decreased significantly from the preoperative day to 9 months postoperatively in both groups, but this difference was not statistically significant at final follow-up. However, at 3 and 6 months postoperatively, compared with mean VAS and DASH scores in the ACGBG group, the ACSBG group showed lower pain and dysfunction scores ( p  < 0.05). The mean fracture healing times were 15.2 (range, 12–20) and 18.6 (range, 12–32) weeks in the ACSBG and ACGBG groups, respectively ( p  = 0.01). One case of plate breakage occurred in the ACGBG group at 5 months postoperatively, with recovery following ACSBG revision with single SP fixation. Conclusions ACSBG combined with single SP fixation is a promising and effective alternative technique for promoting bone union and postoperative early functional rehabilitation in treating CMAN. Level of evidence Level 3.

To investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates. This retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients. The study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8-28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients. Structural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.

Background Atrophic nonunion may frequently be seen after clavicular midshaft fractures. Despite a variety of surgical options, clavicular nonunion cases are associated with impaired bone healing. The aim of current study was to evaluate efficacy of perioperatively administered hyaluronic acid (HA)-based mesh in patients with atrophic midshaft clavicular nonunion managed with iliac wing autograft and plate fixation. Materials and Methods This retrospective clinical study investigated 44 patients with atrophic midclavicular nonunion who underwent open reduction plate fixation with iliac wing autografts. Patients were divided into two groups as those managed with iliac wing autograft and anatomical locking plate (ALP) fixation alone and those managed with addon perioperative HA-based mesh, i.e., Group 1 ( n = 24) and Group 2 ( n = 20), respectively. Age, duration till to surgery, fracture healing time, length of gap, and length of injured and contralateral clavicle were also invastigated. The 2-year Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores were evaluated. Kolmogorov–Smirnov test, Mann–Whitney U-test, and Spearman’s correlation test were used to assess variables. Results Patients’ age, followup time, and duration till surgery were similar between two groups. The study groups did not significantly differ in terms of postoperative clavicular length, as measured relative to unaffected side. Mean duration of the fracture healing was significantly shorter in Group 2 compared to that in Group 1. Mean postoperative 2-year Constant score was statistically higher in Group 2 compared to that of Group 1. In addition, Group 2 had also significantly higher DASH score than that of Group 1. Conclusions HA-based mesh application added on the iliac wing autografting with ALP fixation may be an efficacious alternative for atrophic nonunion of clavicular midshaft.