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Published on: November 13, 2016
[Therapeutic efficacy of augmentative plate fixation in long-bone hypertrophic nonunion subsequent to intramedullary
Jian-zheng Zhang1, Tian-sheng Sun, Zhi Liu
1Department of Orthopedics, General Hospital of Beijing Military Command, Beijing 100700, China.
Objective:
To determine the therapeutic efficacy of augmentation plate fixation in nonunion of long-bone fracture after interlocking intramedullary nailing.
Methods:
From April 1998 to April 2009, 14 patients with long-bone hypertrophic nonunion after intramedullary nail internal fixation were treated with augmentative plate. There were nine patients with nonunion of femur, three of humerus and two of tibia. After implanting the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of bone shaft. In all patients, the rotational instability of fracture site was verified intra-operatively in all cases. However, motion disappeared after plate augmentation.
Results:
All patients achieved radiological solid union at an average of 8 months (range: 6 - 11). Hardware was removed in six cases at 6-11 months post-operation. No infection, hardware loosening or rupture was found.
Conclusion:
The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. Augmentation plate fixation is indicated for femoral and tibial nonunion of proximal or distal metaphyseal-diaphyseal junctional areas, primary comminuted fracture and humeral nonunion after intramedullary nailing.
