OBJECTIVE: To explore the anatomic feature and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. METHODS: The anatomic features and distribution of upper muscular branches of lateral femoral muscle were observed in the lower extremities of 40 adult cadavers. From February 1989 to February 1999, 7 cases with bone defect or nonunion of upper part of femur were treated with transfer of bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. RESULTS: The upper muscular branches of lateral femoral muscle originated from the transversal branch of lateral circumflex femoral artery. The musculoperiosteal branch and periosteal branch were originated at 16.8 +/- 3.0 cm below the greater trochanter. The diameter and length of musculoperiosteal branch were 1.4 to 1.7 mm and 2.7 to 5.6 cm, those of the periosteal branch were 0.4 to 0.6 mm and 1.2 to 1.5 cm respectively. Bone union achieved in 10 to 18 weeks after operation in all 7 cases after 18 to 42 months follow-up. The motion of hip joint reached 180 degrees in 4 cases, 120 degrees in 2 cases and 65 degrees in 1 case. The donor area recovered well. CONCLUSION: The bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle is an effective alternative for repairing the bone defect or nonunion of the upper or middle part of femur.
ObjectiveTo summarize the effectiveness of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion.MethodsBetween January 2010 and December 2014, 23 patients with infected tibial nonunion were treated with bone transport with unilateral external fixator combined with locked plate internal fixation. There were 19 males and 4 females with an average age of 37.8 years (range, 19-54 years). The mean length of the bone defect was 6.5 cm (range, 5.2-8.1 cm). The number of previous operations ranged from 2 to 4 times, with an average of 2.5 times. The time from injury to this treatment was 7-23 months, with an average of 11.8 months. The time of bone transport, time of the external fixation, fracture healing time, external fixation index, healing index, and complication were recorded; and the Association for the Study and Application of the Methods of Ilizarov (ASAMI) bone healing and function scores were used to evaluate the effectiveness.ResultsAll patients were followed up 3-6 years with an average of 4.8 years. Wounds and bone defects healed in all patients. No complication such as infection recurrence, nonunion, re-fracture, malunion, iatrogenic nerve paralysis, or stiffness of knee and ankle joints occurred. Five patients had needle infections which were treated by local care and no deep infection occurred. The time of bone transport was 65-120 days (mean, 75.6 days); the time of the external fixation was 75-145 days (mean, 97.8 days); the fracture healing time was 4-17 months (mean, 8.7 months); the external fixation index was 18-28 days/cm (mean, 22.4 days/cm); and the healing index was 31-52 days/cm (mean, 40.2 days/cm). At last follow-up, according to ASAMI criteria, the result of bone healing was excellent in 15 cases and good in 8 cases, and the result of function was excellent in 18 cases and good in 5 cases, all with the excellent and good rate of 100%.ConclusionFor infected tibial nonunion, bone transport with unilateral external fixator combined with locked plate internal fixation can reduce the time of external fixation and related complications, with a satisfactory effectiveness.
OBJECTIVE To observe the osteogenesis of percutaneous autogenous bone marrow grafting in cicatricial bone defect, to seek a good method for treating fracture nonunion. METHODS Eighteen rabbits were adopted in this study. 1 cm bone defect model was made in each side of radius, 6 weeks later, 2 ml autogenous bone marrow was injected in the right radial bone defect as experimental group, 2 ml autogenous peripheral blood in the left side as control group. X-ray features, histologic changes, Ca and P content in the site of bone defect were studied in various times. Also 15 patients were treated clinically for the nonunion fracture, the average time from nonunion to bone marrow grafting was 13 months. RESULTS In experimental group, the increasing new bone tissue were observed in X-ray and histologic examination. While in control group, no osteogenesis was observed. Ca and P content of experimental group was higher than that of control group. For the 15 patients, 13 cases healed in 5-9 months, 2 cases failed. CONCLUSION Percutaneous autogenous bone marrow grafting is capable of osteogenesis in the cicatricial bone defects. It can be used in nonunion cases which are not fit for operation of bone grafting because of poor condition of the skin.
【Abstract】 Objective To discuss the strategy of condylar reconstruction in the treatment of refractory condylarnonunion and defect of humerus. Methods From September 1998 to September 2005, 18 patients with refractory condylarnonunion concomitant with defect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. Accordingto AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1, 4 cases of type C2and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defectivebone mass was 1-4 cm2. The mean extension and flexion of elbow joint was 21.5°(5-65°) and 95.8°(85.0-123.5°) respectively. Accordingto Cassebaum scoring system, the excellent and good rate was 27.8% (excellent in 1 case and good in 4 cases). Time frominjury to operation averaged 22.8 months(7-52 months). All patients were operated with approach of olecranon osteotomy.Bone defect was reconstructed with il iac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, anatomicplates and reconstruction plates were used to fix. Results Eighteen patients were followed up 12-86 months (mean27.6 months). All the incisions healed by first intention. No bone block displacement, loosening or breakage of internal fixationoccurred. The time of bone union averaged 5.7 months(4-8 months). The mean extension and flexion of elbow joint were 11.4°(0-44.5°) and 128.6°(105.5-144.5°) 1 year after operation. Ectopic ossification formed in 1 case at anterior part of elbow 4 monthsafter operation. According to Cassebaum scoring system, the results were excellent in 8 cases, good in 6 cases, fair in 3 cases andpoor in 1 case. The excellent and good rate was 77.8%. Conclusion The shape of humeral condyle can be reconstructed withil iac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internalfixation and early function exercise can improve the function of elbow joint evidently.
OBJECTIVE: To introduce the operation method of treatment of nonunion of scaphoid bone by transfer of pedicled radial periosteal bone flap. METHODS: From Match 1986, 26 cases with old nonunion of scaphoid bone were treated by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery, the size of bone flap was 1.0 cm x 0.4 cm x 0.5 cm. RESULTS: All patients with old nonunion of scaphoid bone were healed by first intention, bone union was occurred after 2 to 3 months of operation, and wrist joint almost recovered normal function. CONCLUSION: It is an effective operation method to treat nonunion of scaphoid bone.
OBJECTIVE To investigate the effect of allogeneic decalcified bone graft in the treatment of nonunion in children. METHODS From April 1990 to September 1997, 17 children with nonunion were adopted in this study. Among them, there were 10 boys and 7 girls, the age ranged from 2 to 13 years. The allogeneic decalcified bone graft taken from fresh corpse by aseptic manipulation were used to repair 3 cases of congenital nonunion and 14 cases of acquired nonunion. RESULTS All cases were followed up 2 to 9 years after operation, 9 cases were cured successfully and 7 cases were cured after twice operations. One case of congenital pseudoarthrosis of the tibia was operated twice and there were callus grown half years after the second operation, but reoccurred after one year. Although there were 1.5 cm to 3 cm shortening deformity of extremity including another 2 cases of congenital pseudoarthrosis of the tibia and 5 cases of nonunion caused by chronic osteomyelitis, the function of joint was normal. CONCLUSION Treatment of nonunion in children by allogeneic decalcified bone graft is a valuable technique in clinical practice. It is characterised by high capacity of osteoinduction, low antigenicity, rapid bony union, plentiful source of bone graft and convenient utilization.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
OBJECTIVE To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.
【Abstract】 Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperativenonunion of fracture of lower limb. Methods Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nail ing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nail ing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. Results The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospital ization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.