Use of intramedullary fibular strut graft

A novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion

S. Vidyadhara, K. Vamsi, Sharath K. Rao, James J. Gnanadoss, S. Pandian

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

Original languageEnglish
Pages (from-to)1009-1014
Number of pages6
JournalInternational Orthopaedics
Volume33
Issue number4
DOIs
Publication statusPublished - 08-2009

Fingerprint

Transplants
Humeral Fractures
Fibula
Bone Transplantation
Humerus
Therapeutics
Osteoporosis
Joints
Morbidity
Bone and Bones
Orthopedic Surgeons
Conservative Treatment

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

@article{d29f236610db49d2a472ff539d58ede0,
title = "Use of intramedullary fibular strut graft: A novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion",
abstract = "Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.",
author = "S. Vidyadhara and K. Vamsi and Rao, {Sharath K.} and Gnanadoss, {James J.} and S. Pandian",
year = "2009",
month = "8",
doi = "10.1007/s00264-008-0596-x",
language = "English",
volume = "33",
pages = "1009--1014",
journal = "International Orthopaedics",
issn = "0341-2695",
publisher = "Springer Verlag",
number = "4",

}

Use of intramedullary fibular strut graft : A novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion. / Vidyadhara, S.; Vamsi, K.; Rao, Sharath K.; Gnanadoss, James J.; Pandian, S.

In: International Orthopaedics, Vol. 33, No. 4, 08.2009, p. 1009-1014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Use of intramedullary fibular strut graft

T2 - A novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion

AU - Vidyadhara, S.

AU - Vamsi, K.

AU - Rao, Sharath K.

AU - Gnanadoss, James J.

AU - Pandian, S.

PY - 2009/8

Y1 - 2009/8

N2 - Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

AB - Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

UR - http://www.scopus.com/inward/record.url?scp=68349113830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68349113830&partnerID=8YFLogxK

U2 - 10.1007/s00264-008-0596-x

DO - 10.1007/s00264-008-0596-x

M3 - Article

VL - 33

SP - 1009

EP - 1014

JO - International Orthopaedics

JF - International Orthopaedics

SN - 0341-2695

IS - 4

ER -