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      Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

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          Abstract

          Objective

          To investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates.

          Methods

          This retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients.

          Results

          The study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8–28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients.

          Conclusion

          Structural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.

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          Most cited references 30

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          The biology of fracture healing in long bones.

           B McKibbin (1978)
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            Internal plate fixation of fractures: short history and recent developments

            Metal plates for internal fixation of fractures have been used for more than 100 years. Although initial shortcomings such as corrosion and insufficient strength have been overcome, more recent designs have not solved all problems. Further research is needed to develop a plate that accelerates fracture healing while not interfering with bone physiology. The introduction of rigid plates had by far the greatest impact on plate fixation of fractures. However, it led to cortical porosis, delayed bridging, and refractures after plate removal. These unwarranted effects were said to be caused by bone–plate contact interfering with cortical perfusion. Consequently, further plate modifications aimed to reduce this contact area to minimize necrosis and subsequent porosis. The advocates of limited-contact plates have not published measurements of the contact area or proof of the temporary nature of the porosis. Moreover, clinical studies of newer plate types have failed to show a superior outcome. Histomor-phometric measurements of the cortex showed no difference in the extent of necrosis under plates having different contact areas. Necrosis was predominant in the periosteal cortical half, whereas porosis occurred mostly in the endosteal cortical half. No positive correlation was found between either. The scientific evidence to date strongly suggests that bone loss is caused by stress shielding and not interference with cortical perfusion secondary to bone–plate contact. Consequently, an axially compressible plate (ACP) incorporating polylactide (PLA) inserts press-fit around screw holes was designed. The bioresorbable inserts should allow for (1) increased micromotion in the axial plane to promote healing during the union phase and (2) gradual degradation over time to decrease stress shielding during the remodeling phase. Results of ongoing experimental results are encouraging. Only plates allowing dynamic compression in the axial plane can lead to a revolution in fracture fixation.
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              Effects of construct stiffness on healing of fractures stabilized with locking plates.

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                Author and article information

                Journal
                J Int Med Res
                J. Int. Med. Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                17 March 2019
                May 2019
                : 47
                : 5
                : 1998-2010
                Affiliations
                Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
                Author notes
                Liang Sun, Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 76 Nanguo Road, Beilin District, Xi'an 710054, Shaanxi Province, China. Email: zxc186@ 123456tom.com
                Article
                10.1177_0300060518814607
                10.1177/0300060518814607
                6567751
                30880524
                © The Author(s) 2019

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Categories
                Clinical Research Reports

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