Femoral shaft healing disorder − biomechanics and biology − case report
Authors:
P. Kmeť 1; L. Kopp 1,2
Authors‘ workplace:
Klinika úrazové chirurgie Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské, zdravotní a. s. – Masarykovy nemocnice v Ústí nad Labem
1; Ústav anatomie, 2. lékařská fakulta Univerzity Karlovy, Praha
2
Published in:
Rozhl. Chir., 2021, roč. 100, č. 8, s. 409-416.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.8.409–416
Overview
Nonunion is one of the common fracture healing complications. Its diagnosis is based on clinical and X-ray/CT findings. Nonunions can be classified, according to Weber and Cech, as vital and nonvital. Low mechanical stability is the main underlying factor in the development of vital nonunions and therefore, the treatment should be focused on increasing their stability. Absence of biological activity is the causal factor in the development of nonvital nonunions; thus the therapy must be bolstered by bone grafting and decortication. Treatment of nonunions is time consuming and costly and the frequency of their incidence is not decreasing. However, significant progress has been made in the treatment of patients with this bone healing defect over the last decades owing to improved understanding of its genesis and the development of osteosynthetic materials. The presented case of nonunion after periprosthetic fracture includes a detailed description of the therapeutic considerations and techniques used in subsequent phases of treatment, accompanied by radiologic and pictorial documentation. Six months after application of a wave plate, the nonunion was successfully healed. The wave plate is a rarely used implant in our countries; however, its specific biomechanical and biological characteristics significantly support healing of indicated diaphyseal nonunions.
Keywords:
nonunion − stable fixation − wave plate − femur
Sources
1. Šmejkal K, Lochman P, Trlica J, et al. Poruchy hojení po operační léčbě zlomenin stehenní kosti. Acta Chir Orthop Traumatol Cech. 2015;82:358−363. ISSN: 0001-5415.
2. Čech O, Douša P, Krbec M, et al. Traumatologie pohybového aparátu, pánve, páteře a paklouby. Praha, Galén 2016:575−588. ISBN 978-80-7492-266-4.
3. Wendsche P, Veselý R, et al. Traumatologie. Praha, Galén 2015:232−238,299−303. ISBN 978-80-7492-211-4.
4. Wendsche P, Veselý R, et al. Úskalí a komplikace při léčení zlomenin. Praha, Galén 2018:32−40,177–182. ISBN 978-80-7492- 393-7.
5. Čech O. Paklouby dlouhých kostí. Praha, Avicenum 1976. ISBN 08-036-76.
6. Mills LA, Aitken SA, Hamish A, et al. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop. 2017;88(4):434−439. doi:10.1080/174536 74.2017.1321351.
7. Rupp M, Biehl C, Budak M, et al. Diaphyseal long bone nonunions – types, aetiology, economics and treatment recommendations. Int Orthop. 2018;42(2):247−258. doi:10.1007/s00264-017-3734-5.
8. Blatter G, Weber BG. Wave plate osteosynthesis as a salvage procedure. Arch Orthop Trauma Surg. 1990;109:330−333. doi:10.1007/BF00636171.
9. Jorge SRN, Cocco LF, Kawano C, et al. The wave plate method in non union femoral shaft fractures treatment. Acta Ortop Bras. 2006;14(1):17−21. doi:10.1590/ S1413-78522006000100003.
10. Mariolani JRL, Belangero WD. Comparing the in vitro stiffness of straight-DCP, wave-DCP, and LCP bone plates for femoral osteosynthesis. Int Sch Res Notices 2013:308753. doi:10.1155/2013/308753. eCollection 2013.
11. Karnezis IA. Biomechanical considerations in “biological” femoral osteosynthesis: an experimental study of the ”bridging” and “wave” plating techniques. Arch Orthop Trauma Surg. 2000;120(5−6):272–275. doi:10.1007/ s004020050463.
12. Angelini AJ, B. Livani, M. A. Flierl, et al. Less invasive percutaneous wave plating of simple femur shaft fractures: a prospective series. Injury 2010;41(6):624– 628. doi:10.1016/j.injury.2010.01.101.
13. Ring D, Jupiter JB, Sanders RA, et al. Complex nonunion of fractures of the femoral shaft treated by wave-plate osteosynthesis. Bone Joint Surg Br. 1997;79(2):289−294. doi:10.1302/0301- 620x.79b2.6886.
14. Schulz AP, Faschingbauer M, Seide K, et al. Is the wave plate still a salvage procedure for femoral non-union? Results of 75 cases treated with a locked wave plate. Trauma Emerg Surg. 2009;35(2):127−131. doi:10.1007/ s00068-008-8009-9.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 8
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