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Treatment of diaphyseal non-unions of the ulna and radius

INTRODUCTION: Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. METHOD: We...

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Autores principales: Kloen, Peter, Wiggers, Jim K., Buijze, Geert A.
Formato: Texto
Lenguaje:English
Publicado: Springer-Verlag 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991229/
https://www.ncbi.nlm.nih.gov/pubmed/20217106
http://dx.doi.org/10.1007/s00402-010-1071-x
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author Kloen, Peter
Wiggers, Jim K.
Buijze, Geert A.
author_facet Kloen, Peter
Wiggers, Jim K.
Buijze, Geert A.
author_sort Kloen, Peter
collection PubMed
description INTRODUCTION: Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. METHOD: We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975–2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. PATIENTS: The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. RESULTS: Average follow-up time was 75 months (range 12–315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). CONCLUSION: Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.
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spelling pubmed-29912292010-12-15 Treatment of diaphyseal non-unions of the ulna and radius Kloen, Peter Wiggers, Jim K. Buijze, Geert A. Arch Orthop Trauma Surg Orthopaedic Surgery INTRODUCTION: Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. METHOD: We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975–2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. PATIENTS: The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. RESULTS: Average follow-up time was 75 months (range 12–315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). CONCLUSION: Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome. Springer-Verlag 2010-03-09 2010 /pmc/articles/PMC2991229/ /pubmed/20217106 http://dx.doi.org/10.1007/s00402-010-1071-x Text en © The Author(s) 2010 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Orthopaedic Surgery
Kloen, Peter
Wiggers, Jim K.
Buijze, Geert A.
Treatment of diaphyseal non-unions of the ulna and radius
title Treatment of diaphyseal non-unions of the ulna and radius
title_full Treatment of diaphyseal non-unions of the ulna and radius
title_fullStr Treatment of diaphyseal non-unions of the ulna and radius
title_full_unstemmed Treatment of diaphyseal non-unions of the ulna and radius
title_short Treatment of diaphyseal non-unions of the ulna and radius
title_sort treatment of diaphyseal non-unions of the ulna and radius
topic Orthopaedic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991229/
https://www.ncbi.nlm.nih.gov/pubmed/20217106
http://dx.doi.org/10.1007/s00402-010-1071-x
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