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Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study

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Abstract

Purpose

To assess the efficacy of autogenous “structured” bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN).

Methods

This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed.

Results

The average time between primitive fracture and this operative treatment was 29 months (15–38 months). The average duration of surgery was 153 minutes (range, 115–230 min), and the average blood loss was 560 ml (range, 350–860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12–30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12–16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01).

Conclusions

ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.

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Acknowledgements

I wish to thank professor Zhong Li and Chaofeng Wang for their valuable suggestion in the whole manuscript. All other authors should also be appreciated for their contributions. The successful completion of the experiment and article comes from the efforts of everyone.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Xi’an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi’an City, 710054, China

    Congming Zhang, Teng Ma, Ning Duan, Qiang Huang, Yao Lu, Hua Lin, Kun Zhang, Yibo Xu, Qian Wang, Hanzhong Xue, Chaofeng Wang & Zhong Li

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  1. Congming Zhang
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  2. Teng Ma
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  7. Kun Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by Congming Zhang, Teng Ma, and Ning Duan. The first draft of the manuscript was written by Congming Zhang, and all authors commented on previous versions of the manuscript. All operations were performed by Chaofeng Wang and Zhong Li. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chaofeng Wang or Zhong Li.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Honghui Hospital (202112003).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Fig. 3.

Competing interests

The authors declare no competing interests.

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Congming Zhang, Teng Ma, and Ning Duan are co-first authors in the making of this manuscript.

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Zhang, C., Ma, T., Duan, N. et al. Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study. International Orthopaedics (SICOT) 46, 2585–2592 (2022). https://doi.org/10.1007/s00264-022-05564-1

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