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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 |

REPOSITORIES: biostudies-literature

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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.

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

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