Cargando…

Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study

BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bo...

Descripción completa

Detalles Bibliográficos
Autores principales: Schnetzke, Marc, Morbitzer, Christian, Aytac, Sara, Erhardt, Matthias, Frank, Christian, Muenzberg, Matthias, Studier-Fischer, Stefan, Helbig, Lars, Suda, Arnold J, Gruetzner, Paul-Alfred, Guehring, Thorsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296679/
https://www.ncbi.nlm.nih.gov/pubmed/25573541
http://dx.doi.org/10.1186/s13018-014-0143-y
_version_ 1782353026354249728
author Schnetzke, Marc
Morbitzer, Christian
Aytac, Sara
Erhardt, Matthias
Frank, Christian
Muenzberg, Matthias
Studier-Fischer, Stefan
Helbig, Lars
Suda, Arnold J
Gruetzner, Paul-Alfred
Guehring, Thorsten
author_facet Schnetzke, Marc
Morbitzer, Christian
Aytac, Sara
Erhardt, Matthias
Frank, Christian
Muenzberg, Matthias
Studier-Fischer, Stefan
Helbig, Lars
Suda, Arnold J
Gruetzner, Paul-Alfred
Guehring, Thorsten
author_sort Schnetzke, Marc
collection PubMed
description BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. METHODS: The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. RESULTS: Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = −0.31) was found. CONCLUSIONS: This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could significantly accelerate bone healing. This indicates that revision surgery of clavicle non-unions might preferably be done with additional bone graft, even if the surgeon considers that bone healing might be achieved without bone grafting.
format Online
Article
Text
id pubmed-4296679
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-42966792015-01-17 Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study Schnetzke, Marc Morbitzer, Christian Aytac, Sara Erhardt, Matthias Frank, Christian Muenzberg, Matthias Studier-Fischer, Stefan Helbig, Lars Suda, Arnold J Gruetzner, Paul-Alfred Guehring, Thorsten J Orthop Surg Res Research Article BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. METHODS: The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. RESULTS: Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = −0.31) was found. CONCLUSIONS: This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could significantly accelerate bone healing. This indicates that revision surgery of clavicle non-unions might preferably be done with additional bone graft, even if the surgeon considers that bone healing might be achieved without bone grafting. BioMed Central 2015-01-09 /pmc/articles/PMC4296679/ /pubmed/25573541 http://dx.doi.org/10.1186/s13018-014-0143-y Text en © Schnetzke et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Schnetzke, Marc
Morbitzer, Christian
Aytac, Sara
Erhardt, Matthias
Frank, Christian
Muenzberg, Matthias
Studier-Fischer, Stefan
Helbig, Lars
Suda, Arnold J
Gruetzner, Paul-Alfred
Guehring, Thorsten
Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title_full Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title_fullStr Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title_full_unstemmed Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title_short Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
title_sort additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296679/
https://www.ncbi.nlm.nih.gov/pubmed/25573541
http://dx.doi.org/10.1186/s13018-014-0143-y
work_keys_str_mv AT schnetzkemarc additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT morbitzerchristian additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT aytacsara additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT erhardtmatthias additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT frankchristian additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT muenzbergmatthias additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT studierfischerstefan additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT helbiglars additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT sudaarnoldj additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT gruetznerpaulalfred additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy
AT guehringthorsten additionalbonegraftaccelerateshealingofclaviclenonunionsandimproveslongtermresultsafter89yearsaretrospectivestudy