Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study,International Orthopaedics

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Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study
International Orthopaedics ( IF 2.0 ) Pub Date : 2022-09-01 , DOI: 10.1007/s00264-022-05564-1
Congming Zhang ₁ , Teng Ma ₁ , Ning Duan ₁ , Qiang Huang ₁ , Yao Lu ₁ , Hua Lin ₁ , Kun Zhang ₁ , Yibo Xu ₁ , Qian Wang ₁ , Hanzhong Xue ₁ , Chaofeng Wang ₁ , Zhong Li ₁

Affiliation

Purpose

To assess the efficacy of autogenous “structured” bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN).

Methods

This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed.

Results

The average time between primitive fracture and this operative treatment was 29 months (15–38 months). The average duration of surgery was 153 minutes (range, 115–230 min), and the average blood loss was 560 ml (range, 350–860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12–30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12–16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01).

Conclusions

ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.

中文翻译：

自体“结构化”植骨联合上钢板翻修治疗顽固性锁骨中轴萎缩性骨不连的临床和影像学结果：一项回顾性研究

目的

为了评估自体“结构化”骨移植 (ASBG) 的疗效，将其与上板 (SP) 翻修手术相结合，用于治疗顽固性锁骨中段无菌性骨不连 (CMAN)。

方法

这项回顾性研究包括 12 名因 CMAN 而导致自体松质骨移植 (ACBG) 和 SP 固定失败的患者。分析了 2019 年 1 月至 2020 年 12 月接受这些手术的患者在手术前和最终随访时获得的手臂、肩部和手部疼痛和残疾 (DASH) 评分的视觉模拟评分 (VAS) 数据。

结果

从原始骨折到手术治疗的平均时间为 29 个月（15-38 个月）。手术平均持续时间为 153 分钟（范围，115-230 分钟），平均失血量为 560 毫升（范围，350-860 毫升）。并发症2例（16.67%）：1例供区持续疼痛，1例小腿肌肉静脉血栓。随访期间未观察到组织感染。平均随访时间为 18 个月（范围 12-30 个月）。所有骨折均在平均 14 周（范围，12-16 周）内进展为骨愈合。平均疼痛 VAS 评分显着改善，从术前的 4.8 ± 1.7 提高到最终随访时的 1.9 ± 1.1 ( P = 0.01)。平均 DASH 评分从术前的 30.1 ± 11.2 显着提高到最终随访时的 7.8 ± 4. 2 (P < 0.01)。