Locking screw augmentation in hypertrophic nonunion of tibia: a novel surgical technique

Locking screw augmentation in hypertrophic nonunion of tibia: a novel surgical technique

Authors

  • Andrea Gatti Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy;
  • Umberto Tarantino Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy;
  • Monica Gasparini Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy
  • Marco Cateni Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy
  • Eleonora Piccirilli 1Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy
  • Chiara Greggi a:1:{s:5:"en_US";s:30:"University of Rome Tor Vergata";}
  • Elena Gasbarra Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy

Keywords:

Nonunion, Hypertrophic nonunion, Surgical technique, Augmentation

Abstract

Background and aim: Nonunion is a common complication in long bone diaphyseal fracture. Hypertrophic nonunion is commonly caused by mechanical instability due to high strain at the fracture site whereas atrophic nonunion is mainly caused by biological impairment. Multiple surgical techniques have been reported to treat hypertrophic nonunion of long bones but there is no consensus about what is the best choice. We present our surgical option in hypertrophic nonunion of lower limb.

Methods: We performed a locking cortical screw augmentation technique in fractures previously fixed with plate and screws in order to increase plate stability and to enhance fracture healing process.

Results: Radiographic evaluations carried out three months after surgery showed that the fracture line is radiographically filled by bone callus. No pain, no limp, no signs of infection or implant failure were reported.

Conclusions: Locking cortical screw augmentation could represent a valid technique to reduce micromovements and to increase the stability at the fracture site with the possibility of early weight bearing and good clinical outcome.

References

Cunningham BP, Brazina S, Morshed S, Miclau T. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury 2017; 48: S69–75.

Özkan S, Nolte PA, van den Bekerom MPJ, Bloemers FW. Diagnosis and management of long-bone nonunions: a nationwide survey. Eur J Trauma Emerg Surg 2019; 45(1): 3–11.

Mills LA, Aitken SA, Simpson AHRW. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop 2017; 88(4): 434–9.

Moghaddam A, Zimmermann G, Hammer K, Bruckner T, Grützner PA, Von Recum J. Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures. Injury 2011; 42(12): 1435–42.

Shibuya N, Humphers JM, Fluhman BL, Jupiter DC. Factors Associated with Nonunion, Delayed Union, and Malunion in Foot and Ankle Surgery in Diabetic Patients. J Foot Ankle Surg 2013; 52(2): 207–11.

Tanner M, Vlachopoulos W, Findeisen S, Miska M, Ober J, Hagelskamp S, et al. Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis. J Clin Med 2019; 8(9): 1276.

Tian R, Zheng F, Zhao W, Zhang Y, Yuan J, Zhang B, et al. Prevalence and influencing factors of nonunion in patients with tibial fracture: Systematic review and meta-analysis. J Orthop Surg Res 2020; 15(1): 1–16.

Hofmann A, Ritz U, Hessmann MH, Schmid C, Tresch A, Rompe JD, et al. Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions. Bone 2008; 42(5): 894–906.

Minkwitz S, Faßbender M, Kronbach Z, Wildemann B. Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats. PLoS One 2015; 10(4): 1–23.

Perren SM. Evolution of the internal fixation of long bone fractures. J Bone Jt Surg - Ser B 2002; 84(8): 1093–110.

Salih S, Blakey C, Chan D, McGregor-Riley JC, Royston SL, Gowlett S, et al. The callus fracture sign: a radiological predictor of progression to hypertrophic non-union in diaphyseal tibial fractures. Strateg Trauma Limb Reconstr 2015; 10(3): 149–53.

Bhattacharyya T, Bouchard KA, Phadke A, Meigs JB, Kassarjian A, Salamipour H. The accuracy of computed tomography for the diagnosis of tibial nonunion. J Bone Jt Surg - Ser A 2006; 88(4): 692–7.

Jäger M, Wassenaar D, Busch A, Haversath M. Pseudarthroses. Orthopade 2020; 49(6): 547–60.

Reahl GB, Gerstenfeld L, Kain M. Epidemiology, Clinical Assessments, and Current Treatments of Nonunions. Curr Osteoporos Rep 2020; 18(3): 157–68.

Feng W, Fu L, Liu J, Qi X, Li D, Yang C. Biomechanical evaluation of various fixation methods for proximal extra-articular tibial fractures. J Surg Res 2012; 178(2): 722–7.

Wu CC, Chen W. A revised protocol for more clearly classifying a nonunion. J Orthop Surg 2000; 8(1): 45–52.

Lam SW, Teraa M, Leenen LPH, Van Der Heijden GJMG. Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures. Injury 2010; 41(7): 671–5.

Bhan K, Tyagi A, Kainth T, Gupta A, Umar M. Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence. Cureus 2020; 12(7).

Park KC, Oh CW, Kim JW, Park KH, Oh JK, Park IH, et al. Minimally invasive plate augmentation in the treatment of long-bone non-unions. Arch Orthop Trauma Surg 2017; 137(11): 1523–8.

Lai PJ, Hsu YH, Chou YC, Yeh WL, Ueng SWN, Yu YH. Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - Retrospective cohort study. BMC Musculoskelet Disord 2019; 20(1): 1–7.

Eom TW, Kim JJ, Oh HK, Kim JW. Challenge to treat hypertrophic nonunion of the femoral shaft: the Poller screw augmentation technique. Eur J Orthop Surg Traumatol 2016; 26(6): 559–63.

Ferreira N, Marais LC. Management of tibial non-unions according to a novel treatment algorithm. Injury 2015; 46(12): 2422–7.

Leighton R, Watson JT, Giannoudis P, Papakostidis C, Harrison A, Steen RG. Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis. Injury 2017; 48(7): 1339–47.

Malhotra R, Kumar V, Garg B, Singh R, Jain V, Coshic P, et al. Role of autologous platelet-rich plasma in treatment of long-bone nonunions: a prospective study. Musculoskelet Surg 2015; 99(3): 243–8.

Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, et al. Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 2001; 83 A Suppl 1(Pt 2): S151.

Griffin XL, Costa ML, Parsons N, Smith N. Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults. Cochrane Database Syst Rev 2011; (4).

Ruedi T, Buckley R, Moran C. AO principles of fracture management, Books and DVD; 2007.

Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P. Rockwood and Green’s fractures in adults. 7th 2nd vo. Limppincott Williams and Wilkins; 2010.

Hak DJ. Management of aseptic tibial nonunion. J Am Acad Orthop Surg 2011; 19(9): 563–73.

Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M. Causative factors of fracture nonunion: The proportions of mechanical, biological, patient-dependent, and patient-independent factors. J Orthop Sci 2014; 19(1): 120–4.

Hasenboehler E, Rikli D, Babst R. Locking Compression Plate with Minimally Invasive Plate Osteosynthesis in diaphyseal and distal tibial fracture: A retrospective study of 32 patients. Injury 2007; 38(3): 365–70.

Downloads

Published

06-10-2021

How to Cite

1.
Gatti A, Tarantino U, Gasparini M, Cateni M, Piccirilli E, Greggi C, et al. Locking screw augmentation in hypertrophic nonunion of tibia: a novel surgical technique . Acta Biomed [Internet]. 2021 Oct. 6 [cited 2024 Jul. 20];92(S1):e2021434. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/11993