Julien Gaillard1, Alain-Charles Masquelet2, Pierre Boutroux2, Adeline Cambon-Binder2. 1. Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Orthopedic surgery department, American Hospital of Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France. Electronic address: julien_gaillard94@hotmail.com. 2. Service de Chirurgie Orthopédique et Traumatologique-SOS Main, Chirurgie Réparatrice de l'Appareil Locomoteur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
Abstract
INTRODUCTION: Treatment of humeral non-union with or without bone defect is complex, with non-negligible rates of complication and failure. Few reports focused on management of treatment failure. OBJECTIVE: The study hypothesis was that the induced-membrane technique associated in a 2-stage strategy to internal fixation provides systematic bone healing in refractory humeral non-union. MATERIAL AND METHODS: The study included 15 patients, with a median age of 46.6 years, with humeral non-union of a mean 24 months' progression and mean history of 3 attempted revision surgeries. Seven patients showed bone defect, exceeding 5cm in 2 cases. Six had history of radial palsy. RESULTS: Consolidation was achieved in all cases, at a mean 4.6 months. Ten patients underwent radial nerve transposition, 6 of whom had shown radial motor nerve palsy; all recovered within 2 to 5 months. There was 1 case of superficial infection, and 1 of seroma. DISCUSSION: The induced-membrane technique ensures bone healing due to the biological properties of the membrane; the main drawback is the need for 2-stage surgery. When bone defect exceeds 5cm, a multi-perforated fibula segment can be placed inside the membrane to increase primary stability and enhance bone integration. CONCLUSION: The induced-membrane technique is suited to humeral non-union, with or without bone defect. The 2-stage strategy is mandatory in case of suspected latent infection. In the 2-stage procedure, anteromedial radial nerve transposition facilitates the bone-graft stage. LEVEL OF EVIDENCE: IV, retrospective study.
INTRODUCTION: Treatment of humeral non-union with or without bone defect is complex, with non-negligible rates of complication and failure. Few reports focused on management of treatment failure. OBJECTIVE: The study hypothesis was that the induced-membrane technique associated in a 2-stage strategy to internal fixation provides systematic bone healing in refractory humeral non-union. MATERIAL AND METHODS: The study included 15 patients, with a median age of 46.6 years, with humeral non-union of a mean 24 months' progression and mean history of 3 attempted revision surgeries. Seven patients showed bone defect, exceeding 5cm in 2 cases. Six had history of radial palsy. RESULTS: Consolidation was achieved in all cases, at a mean 4.6 months. Ten patients underwent radial nerve transposition, 6 of whom had shown radial motor nerve palsy; all recovered within 2 to 5 months. There was 1 case of superficial infection, and 1 of seroma. DISCUSSION: The induced-membrane technique ensures bone healing due to the biological properties of the membrane; the main drawback is the need for 2-stage surgery. When bone defect exceeds 5cm, a multi-perforated fibula segment can be placed inside the membrane to increase primary stability and enhance bone integration. CONCLUSION: The induced-membrane technique is suited to humeral non-union, with or without bone defect. The 2-stage strategy is mandatory in case of suspected latent infection. In the 2-stage procedure, anteromedial radial nerve transposition facilitates the bone-graft stage. LEVEL OF EVIDENCE: IV, retrospective study.
Authors: Ali Hassan Chamseddine; Mark E Mouchantaf; Kinan F Freiha; Ali H Asfour; Abbas A Dib; Hassan M Wardani; Ali M Bazzal; Georgio E Nahed Journal: Int Orthop Date: 2022-03-20 Impact factor: 3.479
Authors: Laurent Mathieu; Romain Mourtialon; Marjorie Durand; Arnaud de Rousiers; Nicolas de l'Escalopier; Jean-Marc Collombet Journal: Mil Med Res Date: 2022-09-02