Comparative analysis of surgical treatments of non-union in forearm fractures
https://doi.org/10.18019/1028-4427-2021-27-2-199-208
Abstract
Objective. To compare outcomes of non-union in forearm fractures treated with the use of a comprehensive surgical approach considering the injury pattern and localization.
Material and methods. Based on treatment approaches the cases were categorized into 3 groups with proximal forearm fractures (group I, n = 28; 33.8 %), mid-shaft and distal forearm fractures (group II, n = 32; 38.5 %), and controls (group III, n = 23; 27.7 %). Group I included patients with hypertrophic nonunion (HTNU) of the forearm bones treated with bone graft and plating. Group II consisted of atrophic nonunion, HTNU of the forearm bones repaired with the Ilizarov external fixation. A single 3 mL local injection of autologous bone marrow and a kukumazim solution of 50 PU were used to induce bone fusion in the patients of the two groups. The control group included non-unions with no considerations to the fracture pattern and localization. All patients underwent physical, radiological examinations and laboratory tests.
Results. The control group showed 8.7 % poor and 69.5 % good outcomes at a long term, whereas 3.6 % results were rated as poor and 82.1 % as good in group I, with 3.1 % poor and 87.6 % good outcomes in group II. The ratings can be associated with a differentiated surgical approach considering the injury pattern and localization, the use of kukumazim proteolytic enzymes and autologous bone marrow injection.
Conclusion. Optimization of surgical treatments and considerations for injury pattern and localization allowed for a 2.8-time (3.1 %) decrease in poor outcomes and a 30 % reduction in the limb immobilization period.
About the Authors
I. Yu. Khodjanov
Republican Specialized Scientific-practical Medial Centre of Traumatology and Orthopaedics
Uzbekistan
Uzbekistan
Iskandar Yu. Khodjanov, M.D., Ph.D., Professor,
Tashkent
A. M. Rakhimov
Republican Specialized Scientific-practical Medial Centre of Traumatology and Orthopaedics
Uzbekistan
Uzbekistan
Anvar M. Rakhimov, M.D., Ph.D.,
Tashkent
A. A. Kosimov
Tashkent Medical Academy;
Tashkent state dental medical Institute
Uzbekistan
Uzbekistan
Azam A. Kosimov, M.D., Ph.D.,
Tashkent
References
1. Barabash A.P., Barabash Iu.A. Intramedulliarnaia sistema fiksatsii Fixion v lechenii perelomov, lozhnykh sustavov dlinnykh kostei [Fixion intramedullary fixation system in treatment of fractures, pseudoarthroses of long bones]. Genij Ortopedii, 2010, no. 2, pp. 44-49. (in Russian)
2. Dmitriev A.E., Ivannikov S.V., Ianovskaia E.M. Otsenka rezultatov lecheniia lozhnykh sustavov kostei predplechia, osnovannaia na analize dannykh radionuklidnykh issledovanii [The evaluation of the results of treatment of pseudoarthroses of the forearm bones based on the analysis of radionuclide study data]. Khirurgiia, 1991, no. 12, pp. 48-50. (in Russian)
3. Badawi I. Combined intramedullary and extramedullary fixation with autogenous bone grafting for the treatment of forearm nonunions with severe bone loss. The Egyptian Orthopaedic Journal, 2017, vol. 52, no. 4, pp. 251. DOI: 10.4103/eoj.eoj_69_17
4. Kenan M.A., Habib H.R. Diaphyseal Fracture-Nonunion of Forearm Bone Treated by Compression Plating Aided with Autologous Bone Grafting – A Study Outcome. J. Orthop. Clin. Stu. Adv. Res., 2018, vol. 2, no. 1. DOI: 10.16966/2576-6449.106
5. Tauber C., Pritsch M. Non-union of forearm fractures with reference to plate osteosynthesis. Orthop. Rev., 1980, vol. 9, pp. 80-91.
6. Ibragimov S.Kh. Kriterii otsenki anatomo-funktsionalnogo sostoianiia verkhnei konechnosti u bolnykh i invalidov s posledstviiami perelomov kostei predplechia. Diss. … kand. med. nauk [The criteria of evaluation of anatomic-and-functional condition of the upper limb in patients and disabled persons with the consequences of the forearm bone fractures. Cand. med. sci. diss.]. Tashkent, 2000, 123 p. (in Russian)
7. Sokolova M.N. Lechenie bolnykh s defektami i lozhnymi sustavami kostei predplechia metodom chreskostnogo osteosinteza. Avtoref. diss. … kand. med. nauk [Treatment of patients with defects and pseudoarthroses of the forearm bones by the method of transosseous osteosynthesis. Cand. med. sci. diss. abstr.]. Kurgan, 2011, 24 p. (in Russian)
8. Tsuman V.G., Mashkov A.E. Autotransplantatsiia kostnogo mozga pri lechenii lozhnykh sustavov i obshirnykh defektov trubchatykh kostei [Bone marrow autografting in treatment of pseudoarthroses and extensive defects of long bones]. Detskaia Khirurgiia, 2006, no. 2, pp. 14-17. (in Russian)
9. Borzunov D.Y. Nesvobodnaia kostnaia plastika po G.A. Ilizarovu v probleme reabilitatsii bolnykh s defektami i lozhnymi sustavami dlinnykh kostei [Non-free bone grafting according to G.A. Ilizarov in the problem of rehabilitation of patients with long bone defects and pseudoarthroses]. Genij Ortopedii, 2011, no. 2, pp. 21-26. (in Russian)
10. Goldman B.M., Litvinova N.A. Osteosintez kompressiruiushchimi metallicheskimi plastinami pri svezhikh i nesrosshikhsia perelomakh, lozhnykh sustavakh i defektakh kostei predplechia [Osteosynthesis with compressing metal plates for fresh and nonunited fractures, pseudoarthroses and defects of the forearm bones]. Vestnik Khirurgii, 1981, no. 5, pp. 113-117. (in Russian)
11. Gubochkin N.G., Mikitiuk S.I., Ivanov V.S. Peresadka krovosnabzhaemykh kostnykh transplantatov dlia lecheniia lozhnykh sustavov i defektov kostei [Transplantation of vascularized bone grafts for treatment of bone pseudoarthroses and defects]. Genij Ortopedii, 2014, no. 4, pp. 5-10. (in Russian)
12. Dazhin A.Iu., Minasov B.Sh., Valeev M.M., Chistichenko S.A., Biktasheva E.M. Svobodnaia kostnaia plastika vaskuliarizirovannym fragmentom malobertsovoi kosti pri lechenii bolnykh s obshirnymi segmentarnymi defektami kostei predplechia [Free osteoplastee osteoplasty using a vascularized fibular fragment for treatment of patients with extensive segmental defects of forearm bones]. Geniij Ortopedii, 2013, no. 2, pp. 58-61. (in Russian)
13. Zaks Kh.O., Avanesov R.R. Osteosintez plastinami diafizarnykh nesrosshikhsia perelomov i lozhnykh sustavov kostei predplechia [Osteosynthesis of shaft non-united fractures and pseudoarthroses of the forearm bones using plates]. Resp. sb. nauch. trudov “Aktualnye voprosy lecheniia povrezhdenii i zabolevanii oporno-dvigatelnoi sistemy” [Republican Proceedings “Relevant Problems of the Treatment of Injuries and Diseases of the Locomotor System”]. Vladimirskii MONIKI, Moscow, 1990, pp. 89-91. (in Russian)
14. Krylov A.A. Lechenie lozhnykh sustavov kostei predplechia s primeneniem ekstraossalnogo fiksatora [Treatment of pseudoathroses of the forearm bones using an extra-osseous fixator]. Ortopediia, Travmatologiia i Protezirovanie, 1977, no. 5, pp. 81-83. (in Russian)
15. Makazhanov O.Kh. Autoplasticheskii sposob operativnogo lecheniia lozhnykh sustavov diafizov dlinnykh trubchatykh kostei. Avtoref. diss. … kand. med. nauk [Autoplastic variant of surgical treatment of pseudoarthroses of long tubular bone shafts. Cand. med. sci. diss. abstr.]. Karaganda,1974, 23 p. (in Russian)
16. Faldini C., Pagkrati S., Nanni M., Menachem S., Giannini S. Aseptic forearm nonunions treated by plate and opposite fibula autograft strut. Clin. Orthop. Relat. Res., 2009, vol. 467, no. 8, pp. 2125-2134. DOI: 10.1007/s11999-009-0827-5
17. Dos Reis F.B., Faloppa F., Fernandes H.J., Albertoni W.M., Stahel P.F. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann. Surg. Innov. Res., 2009, vol. 3, pp. 5. DOI: 10.1186/1750-1164-3-5
18. Hong G., Cong-Feng L., Hui-Peng S., Cun-Yi F., Bing-Fang Z. Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails. Clin. Orthop. Relat. Res., 2006, vol. 450, pp. 186-192. DOI: 10.1097/01.blo.0000214444.87645.75
19. Ling H.T., Kwan M.K., Chua Y.P., Deepak A.S., Ahmad T.S. Locking compression plate: a treatment option for diaphyseal nonunion of radius or ulna. Med. J. Malaysia, 2006, vol. 61, no. Suppl. B, pp. 8-12.
20. Popkov A.V., Popkov D.A., Grebeniuk E.B., Muradisinov S.O. Udlinenie predplechia s napriazhennym intramedulliarnym armirovaniem [Forearm lengthening with stressed intramedullary reinforcement]. Genij Ortopedii, 2007, no. 1, pp. 85-89. (in Russian)
21. Gupta D.K., Kumar G. Gap nonunion of forearm bones treated by modified Nicoll's technique. Indian J. Orthop., 2010, vol. 44, no. 1, pp. 84-88. DOI: 10.4103/0019-5413.58611
22. Kamrani R.S., Mehrpour S.R., Sorbi R., Aghamirsalim M., Farhadi L. Treatment of nonunion of the forearm bones with posterior interosseous bone flap. J. Orthop. Sci., 2013, vol. 18, no. 4, pp. 563-568. DOI: 10.1007/s00776-013-0395-0
23. Chantelot C., Feugas C., Schoofs M., Leps P., Fontaine C. Massive bone loss of the forearm skeleton in trauma victims: six reconstructions with a free fibular transfer. Orthopaedic Proceedings, 2018, vol. 86-B, no. Suppl. 1. Société Française de Chirurgie Orthopédique et Traumatologie.
24. Crow S.A., Chen L., Lee J.H., Rosenwasser M.P. Vascularized bone grafting from the base of the second metacarpal for persistent distal radius nonunion: a case report. J. Orthop. Trauma, 2005, vol. 19, no. 7, pp. 483-486. DOI: 10.1097/01.bot.0000145970.56642.5b
25. Gupta S., Malhotra A., Mittal N., Garg S.K., Jindal R., Kansay R. The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate. Bone Joint J., 2018, vol. 100-B, no. 8, pp. 1094-1099. DOI: 10.1302/0301-620X.100B8.BJJ-2017-1442.R1
26. Kloen P., Buijze G.A., Ring D. Management of forearm nonunions: current concepts. Strategies Trauma Limb Reconstr., 2012, vol. 7, no. 1, pp. 1-11. DOI: 10.1007/s11751-011-0125-0
27. Tarallo L., Mugnai R., Adani R., Catani F. Treatment of the ulna non-unions using dynamic compression plate fixation, iliac bone grafting and autologous platelet concentrate. Eur. J. Orthop. Surg. Traumatol., 2012, vol. 22, no. 8, pp. 681-687. DOI: 10.1007/s00590-011-0902-y
28. Lyzhin A.V. Khirurgicheskoe lechenie psevdoartrozov kostei predplechia. Avtoref. diss. … kand. med. nauk [Surgical treatment of pseudoarthroses of the forearm bones. Cand. med. sci. diss. abstr.]. Cheliabinsk, 1971, 18 p. (in Russian)
29. Shodiev B.U. Lechenie nesrosshikhsia perelomov i lozhnykh sustavov kostei predplechia [Treatment of non-united fractures and pseudoarthroses of the forearm bones]. Materialy mezhdunar. nauch.-prakt. konf. “Sovremennye Problemy v Travmatologii i Ortopedii” [Proceedings of the International Scientific-Practical Conference “Present Problems in Traumatology and Orthopaedics”]. Travmatologiia zhene Ortopediia, 2008, no. 2 (14), pp. 216. (in Russian)
30. Kuftyrev L.M., Borodin V.V. Rezultaty lecheniia psevdoartrozov kostei predplechia po Ilizarovu [Results of the treatment of pseudoarthroses of the forearm bones according to Ilizarov]. Sbornik nauchnykh trudov “Chreskostnyi kompressionno-distraktsionnyi osteosintez po Ilizarovu v travmatologii i ortopedii” [Proceedings of the Conference “Transosseous Compression-Distraction Osteosynthesis in Traumatology and Orthopaedics”]. Kurgan, 1985, issue 10, pp. 30-33. (in Russian)
31. Zedgenidze I.V. Matematicheskoe modelirovanie komponovok sterzhnevykh apparatov vneshnei fiksatsii [The mathematical modeling of the configurations of rod external fixators]. Genij Ortopedii, 2008, no. 4, pp. 114-117. (in Russian)
32. Tkachenko S.S., Taidukov V.M. Kompressionnyi osteosintez pri lechenii lozhnykh sustavov kostei predplechia [Compression osteosynthesis in the treatment of pseudoarthroses of the forearm bones]. Ortopediia, Travmatologiia i Protezirovanie, 1984, no. 2, pp. 16-20. (in Russian)
33. Kim A.P. Khirurgicheskoe lechenie nesrosshikhsia perelomov i lozhnykh sustavov proksimalnykh otdelov kostei predplechia. Diss. … kand. med. nauk [Surgical treatment of non-united fractures and pseudoarthroses of the proximal forearm bones. Cand. med. sci. diss.]. Tashkent, 1993, 160 p. (in Russian)
34. Puseva M.E., Mikhailov I.N., Sidorova G.V. Chreskostnyi osteosintez povrezhdenii Montedzhia [Transosseous osteosynthesis of Monteggia injuries]. Genij Ortopedii, 2009, no. 4, pp. 99-103. (in Russian)
35. Miliukov V.E., Zharikova T.S. Kriterii formirovaniia vozrastnykh grupp patsientov v meditsinskikh issledovaniiakh [Criteria for formation of age-related groups of patients in medical studies]. Klinicheskaia Meditsina, 2015, no. 11, pp. 5-11. (in Russian)
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For citations:
Khodjanov I.Yu., Rakhimov A.M., Kosimov A.A. Comparative analysis of surgical treatments of non-union in forearm fractures. Genij Ortopedii. 2021;27(2):199-208. https://doi.org/10.18019/1028-4427-2021-27-2-199-208
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