Dataset Information

Arthroscopic-Assisted Bone Graft Harvest From the Proximal Humerus for Distal Third Clavicle Fracture Nonunion.

ABSTRACT: Clavicle fracture nonunion can lead to persistent pain and loss of shoulder function. Distal clavicle fractures have the greatest risk of nonunion and are often treated surgically. Bone grafting plays a vital role in the treatment of distal clavicle nonunion. Although multiple options for bone graft exist, the iliac crest has long been considered the gold standard for harvest. Despite its extensive use, multiple complications have been associated with iliac crest bone graft harvest. We advocate a surgical technique for arthroscopic bone graft harvest from the proximal humerus with open reduction and internal fixation of an ipsilateral distal clavicle nonunion.

SUBMITTER: Tenpenny W

PROVIDER: S-EPMC7768109 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Arthroscopic-Assisted Bone Graft Harvest From the Proximal Humerus for Distal Third Clavicle Fracture Nonunion.

Tenpenny William W Caldwell Paul E PE Rivera-Rosado Emanuel E Pearson Sara E SE

Arthroscopy techniques 20201116 12

Clavicle fracture nonunion can lead to persistent pain and loss of shoulder function. Distal clavicle fractures have the greatest risk of nonunion and are often treated surgically. Bone grafting plays a vital role in the treatment of distal clavicle nonunion. Although multiple options for bone graft exist, the iliac crest has long been considered the gold standard for harvest. Despite its extensive use, multiple complications have been associated with iliac crest bone graft harvest. We advocate ...[more]

PMID: 33381403

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Project description:Recent systematic reviews have shown anterior cruciate ligament reconstruction using quadriceps tendon (QT) grafts to have superior clinical outcomes compared with traditional bone–patella tendon–bone and hamstring tendons grafts. Using minimally invasive techniques to harvest the QT graft can reduce postoperative pain and intraoperative surgical time. This technique is usually performed with a distal-to-proximal approach but often has issues of inadvertently harvesting a graft short of the desired length or causing a hematoma. As an alternative, we introduce a minimally invasive approach with a proximal-to-distal harvest technique that results in better visualization of tissue planes, more consistent graft sizes, lower risk of inadvertent arthrotomy, and reduced risk of hematoma. The minimally invasive QT graft harvest with a proximal-to-distal approach can offer unique advantages over the current standard distal-to-proximal approach. Technique Video Video 1 In this video, we demonstrate a novel technique for harvesting the quadriceps tendon (QT) for anterior cruciate ligament reconstruction. The patient is supine on the operating table with the leg flexed over the side of the bed for dissection and harvest. The harvest can be adequately done with a 2-cm horizontal incision approximately 8 to 9 cm proximal to the patella. Before the incision the vastus medialis obliquus, rectus femoris (RF), and patella are outlined. The Arthrex QuadPro can be used as a ruler as seen here. Through a 2-cm horizontal incision, subcutaneous fat is dissected to reveal the facial envelope of the RF and QT. A split is made in the fascia, which usually reveals a small amount of fat overlying the tendon. Pretendinous fat and adhesions are removed to expose the RF tendon. The next step is to feather off the musculotendinous junction. At this proximal level, the muscle of the quadriceps begins to envelope the tendon making the tendon width appear smaller than it actually is. This can be done with a scalpel, key elevator, knife, Cobb, or any other sharp instrument. Adequate feathering of the muscle bellies will show a wide tendon adequate for harvest. A rectangular-shaped tenotomy consistent with the harvester diameter or slightly larger is performed in the RF tendon. Below, the VI will come into view. This is a proximal to distal view of the plane between the RF and VI. The RF is then quickly whip stitched. Blunt dissection is performed above and below the RF tendon to allow easier passage of the harvester. The graft is loaded into the harvester. We know from anatomical studies that the tendon 2-cm distal to our tenotomy should begin to splay out and widen. Furthermore, the central aspect of the RF tendon is not in the center of the patella but about 10% lateral due to the Q angle of the tendon. Therefore, direct visualization of the harvest path 2-cm distal and aiming at the proximal pole of the patella just off center laterally should minimize the risk of poor trajectory leading to short graft harvest. The desired length is seen on the harvester and the graft is amputated. A 9-mm harvester was used in this example, which yields a graft that will easily pass through the corresponding tunnel or will be a snug fit slightly smaller as seen. There are various graft fixation methods. A reliable and reproducible fixation method is the Arthrex FiberTag.

Project description:The optimal surgical approach and placement of plates for the treatment of distal third diaphyseal fracture of the humerus are the subjects of debate. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of modified medial minimally invasive plate osteosynthesis (MIPO) techniques using a double technique for the treatment of distal third diaphyseal fracture of the humerus. A total of 30 patients with a distal third diaphyseal fracture of the humerus were selected from our hospital. Patients were seen between January 2017 and October 2022. They were treated with a modified medial approach combined with MIPO using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complications, the mean fracture length (FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow was evaluated using Neer's assessment of the shoulder and Mayo's assessment of the elbow. The FL was 56.1 ± 7.2 mm and the DCL was 38.3 ± 5.3 mm. The mean operative time was 84.8 ± 13.4 min (range 60-110 min). The mean blood loss during surgical treatment was 46.5 ± 10.2 ml (range 30-60 ml). Bone healing was observed in all patients from 10 to 16 weeks (average 12.1 ± 1.7) postoperatively, and one case with poor surgical wound healing was recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.1 ± 4.8°), with a maximum flexibility straightness ranging from 0° to 5° (average 2.2 ± 1.3°). The Mayo elbow joint function score was 80-100 (average 91.4 ± 5.0). The Neer shoulder joint function score ranged from 85 to 100 (average 92.5 ± 3.9). The modified medial approach was beneficial it did not cause any iatrogenic radial nerve or ulnar nerve injuries. The anterior and the medial side plates are fixed perpendicular to the distal humerus and provide excellent stability at the same time producing better shoulder and elbow joint function.

Dataset Information

Arthroscopic-Assisted Bone Graft Harvest From the Proximal Humerus for Distal Third Clavicle Fracture Nonunion.

Publications

Arthroscopic-Assisted Bone Graft Harvest From the Proximal Humerus for Distal Third Clavicle Fracture Nonunion.

Similar Datasets

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