A Modification of Internal Bone Transport Method for Reconstruction of Nonunion of Forearm
| Autor: | Merter Yalcinkaya, Osman Lapcin, Kubilay Beng, Yavuz Arikan, Bilal Demir, Barış Özkul |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Nonunion Bone healing Bone grafting 03 medical and health sciences 0302 clinical medicine Forearm lcsh:Orthopedic surgery modified internal bone transport medicine Internal fixation Orthopedics and Sports Medicine Surgical Technique ulna 030222 orthopedics business.industry Ulna Soft tissue 030229 sport sciences medicine.disease Surgery lcsh:RD701-811 medicine.anatomical_structure Orthopedic surgery business Bone defects radius |
| Zdroj: | Indian Journal of Orthopaedics Indian Journal of Orthopaedics, Vol 53, Iss 1, Pp 196-203 (2019) |
| ISSN: | 0019-5413 |
| Popis: | Background: Defects of bone and soft tissue occur frequently after high-energy trauma, infections, and tumor resection. Treatment options are limited and outcomes are controversial in nonunion. Classical reconstruction methods are challenging. We describe a method of internal bone transport for treatment of complicated nonunion of the forearm. This method permits axial and internal bone transport without harming the distorted and complex neurovascular anatomy or soft-tissue envelope. Materials and Methods: Five patients (mean age, 27 years) with defect nonunion (3 ulna, 2 radius) were treated. Mean preoperative defect size was 36 mm, mean shortening was 14 (0–30) mm, and the extent of surgical resection was 24 (20–40) mm. Total bone loss due to defect, resection, or shortening was 74 mm. According to Paley classification, two of the patients had B1, and three had B3 defect nonunion. This study treats defect nonunion of the forearm using an internal bone-transport method. Our method involved cannulated screws, a cerclage wire, and a circular fixator being used in combination. When transportation was completed, internal fixation of the docking site with a plate and screws was done, with bone grafting after fixator removal. Bone healing and functional outcomes were assessed with radiographs and disabilities of the arm, shoulder, and hand (DASH) scores, respectively. Results: Mean followup was 67.6 months. Solid osseous union and functional improvement were achieved in all cases. Mean bone loss was 66 mm, mean fixator time was 131.8 days, the lengthening index was 1.3 days/mm, and the fixator index was 2.1 days/mm. DASH score was 82.2 before treatment and 15.36 after treatment. Conclusions: Using our method, internal bone transport and progressive axial docking of defects can be done with minimal effects on surrounding neurovascular arrangements and soft tissues. Size of fixators can be decreased and formation of painful scar tissue can be avoided. |
| Databáze: | OpenAIRE |
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