Autologous non-vascularized fibula with compression plating in the management of aseptic complex non-union of long bones.

IF 1.4 Q3 EMERGENCY MEDICINE International Journal of Burns and Trauma Pub Date : 2024-08-25 eCollection Date: 2024-01-01 DOI:10.62347/DQLS6083
Latif Zafar Jilani, Yasir Salam Siddiqui, Abdul Qayyum Khan, Mohammad Istiyak
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Abstract

Background: The surgical treatment of non-union of long bones are challenging especially when bones are osteoporotic or there is a large bone gap due to repeated surgeries and implant failures. Plate with intramedullary fibula provides a stable construct as fibula acts as a second implant with better anchorage and high pull-out strength. The aim of our study is to present our experience of treating complex non-union of long bones using compression plating (LCPs/DCPs) in combination with autologous non-vascularized fibular graft (ANVFG).

Material and methods: 10 cases of complex non-union of long bones (tibia, femur, humerus) treated with debridement, decortication followed by intramedullary fibular strut grafting and rigid osteosynthesis by LCPs/DCPs were included in this study. DASH score and LEFS score was used for upper limb and lower limb functional assessment.

Results: All patients had clinico-radiological union with a mean time of 11.4 months. Pre-operative mean DASH and LEFS score was 45.9±2.1 and 20.6±2.03 At the last follow-up, mean DASH and LEFS score was 19.8±1.1 and 60.6±2.6.

Conclusion: Compression plating with ANVFG is a viable option for treating complex non-union of long bones. Intramedullary fibula acting as a second implant provides mechanical stability and support biological healing with its osteogenic property at the non-union site.

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自体无血管腓骨加压钢板治疗无菌性复杂长骨不愈合。
背景:长骨不愈合的手术治疗具有挑战性,尤其是在骨质疏松或由于反复手术和植入物失败导致骨间隙较大的情况下。带有髓内腓骨的钢板可提供稳定的结构,因为腓骨就像第二个植入物,具有更好的固定性和较高的拔出强度。我们的研究旨在介绍我们使用加压钢板(LCPs/DCPs)结合自体无血管腓骨移植(ANVFG)治疗长骨复杂性骨不连的经验。材料和方法:本研究共纳入了 10 例长骨(胫骨、股骨、肱骨)复杂性骨不连病例,均采用清创、去骨皮质后髓内腓骨支柱移植和 LCPs/DCPs 刚性骨合成术进行治疗。上肢和下肢功能评估采用 DASH 评分和 LEFS 评分:所有患者的临床放射学结合时间平均为 11.4 个月。术前平均 DASH 和 LEFS 评分分别为(45.9±2.1)分和(20.6±2.03)分,最后一次随访时,平均 DASH 和 LEFS 评分分别为(19.8±1.1)分和(60.6±2.6)分:使用ANVFG加压钢板是治疗复杂性长骨不愈合的可行方案。髓内腓骨作为第二个植入物,可提供机械稳定性,并通过其在骨不连部位的成骨特性支持生物愈合。
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