Abstract
Clinical study of a series of ten patients treated between 2004 and 2009 for non-unions of the ulna. The patients have been treated with osteosynthesis using a dynamic compression plate and biological enhancement of the consolidation using bone graft and autologous platelet injection. The follow-up consisted of clinical and radiographic assessment. Functional scores used were the Visual Analogue Scale (VAS) for pain and the Disability Assessment for the Shoulder and Hand (DASH) questionnaire. The mean time of follow-up was 21 months. Considering both clinical and radiological criteria, bony union was achieved in 9/10 cases on average time of 4 months. According to the system of Anderson, 5 patients provided an excellent result, 2 a satisfactory result, 2 an unsatisfactory result and 1 treatment resulted in failure. At follow-up, the mean VAS score for pain in the upper limb was 1 (range, 0–4) at rest and 2 (range, 0–7) during activities. The physical function and symptoms of the upper limb, evaluated with the DASH questionnaire, scored 17 points. In conclusion, at a mean 21 months follow-up, there was high success regarding both forearm alignment, clinical and functional results. The use of three combined methods provides high success regarding both radiological and clinical results, even if we have no information on the prevalent efficacy of one particular method.
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References
Richard MJ, Ruch DS, Aldridge JM III (2007) Malunions and nonunions of the forearm. Hand Clin 23:235–243
Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB (2004) Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg [Am] 86:2440–2445
Ring D, Jupiter JB, Gulotta L (2003) Atrophic nonunions of the proximal ulna. Clin Orthop Relat Res 409:268–274
Chapman MW, Gordon JE, Zissimos AG (1989) Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg [Am] 71:159–169
Wey SY, Born CT, Abene A, Ong A, Hayda R, DeLong WG Jr (1999) Diaphyseal forearm fractures treated with and without bone graft. J Trauma 6:1045–1048
Faldini C, Pagkrati S, Nanni M, Menachem S, Giannini S (2009) Aseptic forearm non-unions treated by plate and opposite fibular autograft strut. Clin Orthop Relat Res 467:2125–2134
Enneking WF, Eady JL, Burchardt H (1980) Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg [Am] 62:1039–1058
Adani R, Delcroix L, Innocenti M, Marcoccio I, Tarallo L, Celli A, Ceruso M (2004) Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft. Microsurgery 24:423–429
Adani R, Delcroix L, Tarallo L, Baccarani A, Innocenti M (2008) Reconstruction of posttraumatic bone defects of the humerus with vascularized fibular graft. J Shoulder Elbow Surg 17:578–584
Panagiotis M (2005) Classification of non-union. Injury 36:S30–S37
Lieberman JR, Daluiski A, Einhorn TA (2002) The role of growth factors in the repair of bone. Biology and clinical applications. J Bone Joint Surg [Am] 84:1032–1044
Kanthan SR, Kavitha G, Addi S, Choon DS, Kamarul T (2011) Platelet-rich plasma (PRP) enhances bone healing in non-united critical-sized defects: A preliminary study involving rabbit model. Injury 42:782–789
Calori GM, Tagliabue L, Gala L, D’Imporzano M, Peretti G, Albisetti W (2008) Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions: a prospective randomised clinical study on 120 patients. Injury 39:1391–1402
Davey PA, Simonis RB (2002) Modification of the Nicoll bone-grafting technique for non-union of the radius and/or ulna. J Bone Joint Surg [Br] 84:30–33
Anderson LD (1965) Compression plate fixation and the effect of different types of internal fixation on fracture healing. J Bone Joint Surg [Am] 47:191–208
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder, and Hand) (corrected). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608
Weber BG, Cech O (1976) In pseudoarthrosis: pathology, biomechanics, therapy, results. Hans Huber Medical Publisher, Berne, pp 13–43
Nicoll EA (1956) The treatment of the gaps in long bones by cancellous insert grafts. J Bone Joint Surg [Br] 1:70–82
Sen MK, Miclau T (2007) Autologous iliac crest bone graft: should it still be the gold standard for treating non-unions. Injury 38:S75–S80
Kloen P, Wiggers JK, Buijze GA (2010) Treatment of diaphyseal non-unions of the ulna and radius. Arch Orthop Trauma Surg 130:1439–1445
Carreon LY, Glassman SD, Anekstein Y, Puno RM (2005) Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions. Spine 30:E243–E246
Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496
Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stöckle U, Lucke M (2010) Comminuted fractures of the proximal ulna–Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 41:1306–1311
Henle P, Ortlieb K, Kuminack K, Mueller CA, Suedkamp NP (2011) Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compression plate. Arch Orthop Trauma Surg 131:85–91
Chen F, Osterman AL, Mahoney K (2001) Smoking and bony union after ulna-shortening osteotomy. Am J Orthop 30:486–489
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Tarallo, L., Mugnai, R., Adani, R. et al. Treatment of the ulna non-unions using dynamic compression plate fixation, iliac bone grafting and autologous platelet concentrate. Eur J Orthop Surg Traumatol 22, 681–687 (2012). https://doi.org/10.1007/s00590-011-0902-y
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DOI: https://doi.org/10.1007/s00590-011-0902-y