OBJECTIVE: To present a surgical choice for nonunion and bone defect. METHODS: From November 1994 to October 1997, 17 cases of nonunion of fracture and massive bone defect were treated by autogenous iliac bone and fibular bone with vascular anastomosis. Of 17 cases, there were 10 cases of nonunion of bone fracture, 7 cases of bone defect following tumor resection (4 cases of benign and 3 cases of malignant). Autogenous fibular bone grafting with vascular anastomosis, ranging from 12 cm to 29 cm in length, were employed in 12 cases; autogenous iliac bone grafting, ranging from 7 cm x 3 cm to 9 cm x 5 cm in size, were utilized in the other 5 cases. All of 17 cases were followed up for 10 months to 5 years, 3 years and 7 months in average, and were evaluated from clinical manifestation. RESULTS: Bone union was achieved in 10 cases of nonunion of fracture after bone grafting, bony refilling of the bone defect was observed in 4 cases due to benign tumor and 1 case due to malignant tumor. The other 2 cases of malignant tumor died from lung metastasis of the tumor 10 months and 12 months after bone grafting, respectively. CONCLUSION: Bone grafting is an effective surgical option in treatment of nonunion of fracture and bone defect.
Objective To review the progress of treatments for old calcaneal fractures. Methods The related literature of treatments for old calcaneal fractures were reviewed and analyzed from the aspects such as the pathoanatomy, classifications, and surgical treatments. Results Old calcaneal fractures are common in clinical, the anatomical changes are very complicated. In addition to classical open reduction and internal fixation, arthrodesis, and osteotomy, techniques of minimally invasive operation, external fixator, and three-dimensional printing are more and more widely applied, treatments for old calcaneal fractures nonunion have also received increasing attention. Conclusion Although the perfect strategy for treating old calcaneal fractures has not yet been developed, great progress has been achieved recently, the personalized therapy need to be further studied, and therapies for the early stage old calcaneal fractures and old calcaneal fractures nonunion need to be further explored.
Objective To explore an ideal operative treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients. Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free il iac grafts and fixed by dynamic hi p screws (DHS) and/or canulated screws. Multi ple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 onaverage) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average). Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the heal ing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture heal ing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.
Objective To review the research progress of P75 neurotrophin receptor (P75NTR) so as to clarify its mechanism, and to explore its relationship with nonunion so as to provide a new idea for the treatment of nonunion. Methods The related domestic and foreign literature of P75NTR in recent years was extensively reviewed, summarized, and analyzed to find out the mechanism of action of P75NTR and the pathological factors of nonunion formation. Results P75NTR can express in nonunion tissues and lead to defect of fibrin degradation and inhibition of angiogenesis, which play an important role in the pathogenesis of nonunion. Conclusion It needs to be confirmed by further study whether the purpose of treating nonunion can be achieved by blocking the effects described above of P75NTR.
Objective To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion. Methods From March 2000 to June 2005,the procedure was done in 18 patients with scaphoid nonunion, a small bone flap(1.5 cm×3.5 cm×0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients,among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degereration at fracture end and obviously widening fracture line. Results The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day. Conclusion Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.