medigraphic.com
ISSN 1561-3100 (Print)

2020, Number 2

<< Back Next >>

Revista Cubana de Ortopedia y Traumatología 2020; 34 (2)

Diaphyseal pseudoarthrosis of the ulna and radius treated with the RALCA® model external minifixator and homologous bone graft

Tarragona RRJ, Izquierdo RF, González RJA, Chao CLA, Rodríguez AMÁ, Wu T

Language: Spanish
References: 27
Page: 1-19
PDF size: 407.11 Kb.


ABSTRACT

Introduction: Diaphyseal pseudoarthroses of the ulna and radius constitute a therapeutic challenge for the orthopedic surgeon, due to the difficulty to achieve and maintain the reduction of two parallel bones in the presence of pronator and supinator muscles that exert angular and rotational influences.
Objective: To evaluate the effectiveness of using external minifixator combined with homologous bone graft in the treatment of this condition.
Method: A longitudinal, retrospective and cross-sectional study was carried out with 74 patients operated on, from January 2000 to December 2014, for diaphyseal pseudoarthrosis of the ulna or radius at Frank País International Orthopedic Scientific Complex, cases in which RALCA® external minifixation and homologous bone graft from the ORTOP Tissue Bank were used.
Results: Pseudoarthrosis was more frequent in men (73%) and at ages 30-39 years. The most frequent location was the ulna, in its upper third (52%). Most of the patients had nonviable pseudoarthrosis (56%). The condition was consolidated in 66% of the patients within 18 weeks, and only one did not achieve consolidation. The bone that took the least time to heal was the radius. In the evaluation of the effectiveness of the surgical technique, 62% obtained good outcomes; 33%, fair outcomes; and 5%, poor outcomes.
Conclusions: The association of the RALCA® model miniexternal fixation and homologous bone graft from the Bank showed good outcomes in the treatment of ulna and radius pseudoarthrosis.


REFERENCES

  1. Sisk D. Fracturas. En: Edmonson Allen S, Grenshaw AH. Campbell Cirugía ortopédica. 6ta Ed. Editorial Panamericana. Tomo 1. Capítulo 5. Pag 691. 1981.

  2. Reis FB, Faloppa F, Fernandes HJA, Albertoni WM, Stahel PF. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann Surg Innov Res. May 2009 18;3:5. doi: https://10.1186/1750-1164-3-5.

  3. Pancorbo Sandoval EA, Delgado Quiñones A, Martín Tirado J, Hernández Hernández J, Díaz Prieto G, Quesada Pérez J. Tratamiento de la pseudoartrosis de los huesos largos mediante fijación externa. Rev Cubana Ortop Traumatol. 2010;24(2):44-56.

  4. Andrzejowski P, Giannoudis PV. The 'diamond concept' for long bone non-union management. J Orthop Traumatol. 2019;20:21 https://doi.org/10.1186/s10195-019-0528-0

  5. Liverneaux S, Facca JJHD. Non-union after fracture of the distal radius: focus nonunion after distal radius fracture: a review. Hand Surgery and Rehabilitation. 2016;35:120-5.

  6. Sanchez A, Salerni H. Retardo de consolidación de fracturas. Actual Osteol. 2015;11(1):47-56.

  7. Jacobo Núñez ME. Comportamiento de la pseudoartrosis diafisaria de huesos largos tratados con injerto óseo de banco [tesis en opción al título de especialista de primer grado en Ortopedia y Traumatología]. La Habana, ISCM-H; 2002.

  8. Davis JA, Choo A, O'Connor DP, Brinker MR. Treatment of infected forearm nonunions with large complete segmental defects using bulk allograft and intramedullary fixation. J Hand Surg Am. 2016;41(9):881-7.

  9. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-97.

  10. Hendrickx L, Virgin J, van den Bekerom MP, Doornberg JB , Kerkhoffs G, Jaarsma RL. Complications and subsequent surgery after intra-medullary nailing for tibial shaft fractures: Review of 8110 patients. Injury. 2020;51:1647-54. https://doi.org/10.1016/j.injury.2020.04.021

  11. Kim K, Ri S, Jang M, Ryang S. Treatment of Large Bone Defect of Long Bones: Comparison of Free Vascularized Fibular Graft with Compression-Distraction Technique. J Orthop Sports Med. 2019;1(3):66-77. DOI: http://10.26502/josm.5115008

  12. Arredondo E. Tratamiento de las seudoartrosis de antebrazo con injerto de cresta ilíaca y clavo Hunec. Acta Ortop Mex. 2004;18(6):245-50.

  13. Quesada Musa JV, Delgado Riffá E, Peña Pérez A, Marta Toledo I. Autoinjerto a corta distancia en la seudoartrosis del antebrazo. Rev Cubana Ortop Traumatol. 2009;3(1):4-22.

  14. Cai RB. Analysis of 81 cases of nonunion of forearm fracture. Chin Med J (Engl). 1983;1:29-32.

  15. 15 . Velázquez-Moreno JD, Casiano-Guerrero G. Algoritmo del tratamiento de la seudoartrosis diafisaria. Acta Ortopédica Mexicana. Ene.-Feb 2019;33(1):50-7. http://www.medigraphic.com/actaortopedica

  16. Álvarez Cambras R. Tratamiento de la pseudoartrosis con fijadores. Rev Cubana Ortop Traumatol. 1987;2(2):7-15.

  17. Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for treatment of segmental bone loss in the upper extremity. J Hand Surg Am. 2015;40(3):593-8.

  18. Kloen P, Wiggers JK, Buijze GA. Treatment of diaphyseal non-unions of the ulna and radius. Arch Orthop Trauma Surg. 2010;130(12):1439-45.

  19. Delgado del Caño C, García López J, Rodríguez de Oya R. Pseudoartrosis séptica. Actualización en manejo y tratamiento. Rev Esp Traum Lab. 2019;2(1):25-31. https://doi.org/10.24129/j.retla.02103.fs1901003

  20. Clembosky G, Gómez RGL, Perrone JM, Gómez DJ. Fractura de radio distal: abordaje mininvasivo con preservación del pronador cuadrado. Rev Asoc Argent Ortop Traumatol. 2015;80(3):150-7.

  21. Chloros GD, Howard A, Giordano V, Giannoudis P. Radiographic Long Bone Fracture Healing Scores: Can they predict non-union? Injury. 2020; 51(8). doi: https://doi.org/10.1016/j.injury.2020.07.024

  22. Escobedo-Troncoso VM, Cantú-Morales D. Formación de un solo hueso en antebrazo, en pseudoartrosis infectada de cúbito proximal. Acta Ortop Mex. 2015;29(2):114-7.

  23. Gupta DK, Gaurav K. Gap nonunion of forearm bones treated by modified Nicoll's technique. Indian J Orthop. 2010;44(1):84-8.

  24. Ring D, Rhim R, Carpenter C, Jupiter JB. Comminuted diaphyseal fractures of the radius and ulna: does bone grafting affect nonunion rate? J Trauma. 2005;59:438-41.

  25. Davey PA, Simonis RB. Modification of the Nicoll bone grafting technique for non union of radius and /or ulna. J Bone Joint Surg Br. 2002;84:30-3.

  26. Zaidenberg EE, Fernando ME, Pastrana MJ, Juarez CF, Olazarri F, Zaidenberg CR. Injerto óseo vascularizado pediculado del radio distal para tratar la pseudoartrosis recalcitrante del cúbito. Rev Asoc Argent Ortop Traumatol. 2018;83(1):31-7. http://orcid.org/0000-0002-1535-0586.

  27. Bornot Duránd Yandri, Ferrer Matos Gleibis, Font Ávila María E, Ferrer Matos Mariano. Pseudoartrosis no viable de tercio distal del cúbito. ccm[Internet]. Dic 2017 [citado 25 Jul 2020 ];21(4):1240-5. Disponible en: Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1560-43812017000400027&lng=es




2020     |     www.medigraphic.com