New technology for humerus reconstruction with a free fibular autologous graft in hypotrophic pseudarthrosis

Abstract

Introduction Modern technologies for treating patients with fractures of the humerus using metal structures (various options for free and non-free bone autoplasty, dynamic plates DCP, LCP, intramedullary locked osteosynthesis, external fixation devices) do not always guarantee restoration of the integrity of the segment. Patient's fibula as an autologous osteoplastic material assists in achieving adequate contact of the ends of the fragments, prevents secondary displacement, and creates conditions for bone formation. Material and methods We retrospectively evaluated the results of restorative treatment in four patients of the same sex, with the same etiology of pseudoarthrosis, and failure of previous operations in whom a free fibular autograft was used for humerus reconstruction at one medical institution. A new method of humerus reconstruction in hypotrophic pseudoarthrosis patented in the Russian Federation is described in detail. Results and discussion Capabilities of any dynamic internal system are limited in time and effects. The external fixation device allows for controlled fixation of the fragments of the humerus and maintains it in the required mode until the consolidation of the fragments. The fibular graft, implanted into the bone marrow cavity in the area of the junction of fragments, plays the role of an interface and additionally reinforces the humerus, preventing secondary displacement that may be caused by compression forces created with the fixator. The autogenous osteoplastic substance formed in interfragmental gap and along the periphery is a substrate for local osteoplastic intervention that stimulates osteogenesis. Conclusion A free bone autograft shaped as a cylindrical fibular fragment s implanted into the zone of active angio- and osteogenesis. The coaptation zone of fragments of the humerus is reinforced with an implant intraosseously along its length to eliminate the risk of secondary displacement of the fragments by creating compression with an external fixator. The use of an external fixation device provides contact in the area of the bone wound and maintains compression between the ends of the humerus fragments until bony fusion.

Keywords

• humerus
• hypotrophic pseudoarthrosis
• free bone grafting
• autograft
• ilizarov apparatus