gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Bone Grafting for the Correction of Nonunion or Malunion of Long Bones in the Upper Extremity: A Systematic Review

Meeting Abstract

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  • presenting/speaker T. J. France - Ohio State College of Medicine, Columbus, United States
  • Zachary Diltz - Ohio State College of Medicine, Columbus, United States
  • Sonu Jain - Ohio State College of Medicine, Columbus, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1076

doi: 10.3205/19ifssh1153, urn:nbn:de:0183-19ifssh11538

Veröffentlicht: 6. Februar 2020

© 2020 France et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: Autologous iliac crest has long been considered the best graft option as an adjuvant modality in the fixation of bone nonunions or malunions as a result of its osteoinductive, osteoconductive, and osteogenic properties. However, the clinical benefit from autologous bone graft in general and iliac crest specifically has not consistently demonstrated. Additionally, the use of iliac crest bone increases the risk of complications and leads to longer recovery and/or higher patient morbidity. The aim of this systematic review was to collect and summarize the current literature comparing different forms of bone graft used in the surgical correction of nonunions and malunions of the humerus, radius, and ulna. In this way, we sought to challenge the belief that autologous iliac crest provides superior clinical outcomes to other forms of graft.

Methods: A comprehensive systematic review was performed of PubMed, Embase, Scopus, SPORTDiscus, and the Cochrane Library for all relevant articles. A total of 4,043 publications were reviewed. Inclusion criteria:

1.
Studies comparing at least 2 different forms of bone graft or one form of bone graft versus no graft in treatment of malunions or nonunions in upper extremity long bones,
2.
Participants 18 years or older,
3.
At least 5 participants in each arm. A total of 20 articles met our inclusion criteria and were used in this review.

Results and Conclusions: Iliac crest autograft provided superior results in union rates and time to union compared to synthetic graft, such as bone metalloproteinase-7 and platelet-rich plasma. Calcium phosphate cement was an exception, demonstrating similar union rates. The combination of synthetic bone graft and autograft improved the healing rate. Allograft demonstrated comparable union rates and time to union to autograft, but had significantly shorter surgical time and hospital stay. There was a significantly shorter interval from surgery to union when allograft was combined with autologous bone marrow stem cells. Multiple articles call into question the utility of bone graft after demonstrating that surgical fixation of upper extremity nonunions and malunions without bone graft provides acceptable results. Bone graft, even autologous iliac crest bone, may not be necessary as an adjuvant in the correction of every upper extremity long bone nonunion or malunion. However when graft is used the current literature supports composite grafts over the use of autograft alone.