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Clinical Cases in mineral and bone metabolism

The biomechanical potential of the bone graft in the proximal ulna non-union surgery

Mini-review, 53 - 61
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Abstract
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Introduction. Non-union after operative treatment of a displaced fracture of the olecranon or osteotomy are very uncommon and usually related to patient noncompliance and/or insufficient surgical technique with implant failure. The purpose of this study is to evaluate
the outcomes our plate-and-bone-strut-allograft technique with bone chip augmentation in the management of olecranon aseptic non-unions.
Materials and methods. We included 22 patients with distal third humeral non-unions. All non-unions were classified according to the ASAMI classification for long bones. All cases were performed through a posterior approach to the ulna, in which the non-union focus was localized, the intramedullary channel was drilled, and the non-union was stabilized by a Locking Compression
Plate combined with a strut bone allograft placed laterally to the olecranons and bone chips in the nonunion gap. Postoperative fluoroscopy was used to assess reduction as well as dynamic testing of the elbow.
To study the bone healing on radiographs, we used the Non-Union Scoring System (NUSS) retrospectively. In the follow-up of cases, we applied the duration of surgery, objective quality of life through Mayo Elbow Score system (MES), and subjective quality of life and elbow function measured by Oxford Elbow Score (OES) as criteria.
Bone alignment was examined by X-ray and bone union through the radiographic union score by Radiographic Union Score for metaepihysaris. All patients underwent the same rehabilitation protocol of 12 weeks.
Results. Full bone healing without complications was achieved in all 22 patients. The average period of union was 94.48 days. After healing the alignment was perfect in 16 cases, a valgus deformation remained in 4 cases, and a varus deformation remained in 2 cases. At twelve months after surgery, all the patients reached full recovery with the average range of flexion-extension at 111.56° (±29.33°) and of pro-supination at 162.34°(±12.8°). The objective and quality of life measured by MES 12 months after surgery were good-excellent.
Conclusion. Given the excellent postoperative results in full bone healing, the recovery of the range of motion, and the lack of major complications seen in this study, we find that LCP plating with supporting allograft is a good choice of treatment in the cases of non-union in the olecranon non-union surgical revision.

Vol. XVI (No. 1) 2019 January - April

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