Keywords
Traumatology
Graft
Consolidation
Pseudoarthrosis
Fibula
How to Cite
Abstract
Background: Diaphyseal fractures of the radius (DFR) are injuries that affect the middle portion of this bone and can occur alone or in association with fractures of the ulna, resulting in complications such as bone deviation and functional impairment of the joints. With a bimodal epidemiology, these fractures are prevalent in young adults, often associated with high-energy trauma, and in the elderly, with a higher incidence in women due to osteoporosis and low-energy falls. When bone healing does not occur properly, it can result in pseudoarthrosis, a failure of the fracture to unite. Treatment of pseudoarthrosis involves surgical techniques to restore stability and promote bone healing, with the use of bone grafts, such as the non-vascularized fibula graft (NVFG), which is an effective technique for cases of failed healing. EFNV offers mechanical support and promotes bone regeneration. It is an advantageous option because it is low-cost, less invasive and has less morbidity, as long as the fracture site has a low load demand.
Aim: To report on the use of EFNV in the treatment of a pseudoarthrosis in a FDR treated at our department. Methodology: This is a case report of a patient treated at the Orthopedics and Traumatology Department of the Hospital Universitário São Francisco na Providência de Deus - HUSF, located in the city of Bragança Paulista – SP, Brazil.
Case report: A 27-year-old female patient with FDR in his left limb after falling from his own height underwent surgical treatment with dorsal placement of a plate. After surgery, the patient developed pseudoarthrosis, which was confirmed by persistent pain and bone diastasis on imaging tests. As a result, a new surgery was performed using an autologous bone graft from a non-vascularized fibula, as well as a new internal fixation. The patient is currently asymptomatic and is being followed up clinically and radiologically, without complete bone healing.
Conclusion: EFNV represented an effective and viable alternative in the treatment of pseudoarthrosis of the radius, especially in cases of failed bone healing after osteosynthesis.
References
AGRAWAL, Udit; TIWARI, Vivek. Congenital Tibial Pseudarthrosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.
BENZON, Honorio et al. Practical Management of Pain E-Book. Elsevier Health Sciences, 2022.
BUIJZE, Geert Alexander; JUPITER, Jesse; CHAMMAS, Michel. Distal Radius Fractures: Evidence-Based Management. Elsevier Health Sciences, 2021.
CUGOLA, Landino. Long-term follow-up of non-vascularized fibular autograft for diaphyseal radial reconstruction: case report and literature overview. Rivista Italiana di Chirurgia della Mano, 2023.
EKINCI, Yakup; GÜRBÜZ, Kaan. Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of the Upper Extremity Pseudarthrosis? Journal of Clinical Practice and Research, v. 42, n. 2, p. 167, 2020.
FACTOR, Shai et al. Predictive Factors for Union Time in Adult Diaphyseal Forearm Fractures. Surgical Techniques Development, v. 12, n. 3, p. 135–144, set. 2023.
HO, Christine A. Radius Shaft Fractures—What Alignment is Acceptable at What Age? Plates or Flexible Nails? Journal of Pediatric Orthopaedics, v. 41, p. S14, jul. 2021.
JEROME, Terrence Jose; THIRUMAGAL, SK. A Rare Presentation of an Isolated Radius Shaft Fracture in a Two-Month-Old Child: Dilemmas and Management. Cureus, v. 12, n. 12, p. e11947, 2020.
KHATIB, Mohamad; HASANI, Ibrahim W. Distal Radius Reconstruction Using Proximal Non-vascularized Fibula Graft in a Patient During the Syrian Conflict: A Case Study of Treatment Outcomes. Cureus, v. 16, n. 3, p. e55821, mar. 2024.
KOULALI IDRISSI, K.; GALIUA, F. Greffon non vascularisé de péroné (fibula) comme technique de sauvetage pour reconstruction d’un avant-bras. Chirurgie de la Main, v. 29, n. 2, p. 118–120, 1 abr. 2010.
LEVEN, Dante; CHO, Samuel K. Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management. Asian Spine Journal, v. 10, n. 4, p. 776–786, ago. 2016.
LYNCH, Thomas B. et al. Complex Fractures of the Radial and Ulnar Shaft. Journal of Orthopaedic Trauma, v. 38, n. 9S, p. S21, set. 2024.
ROYEN, Kjell Van; GOORENSA, Chul Ki; GOUBAU, Jean. Radius and Ulna Shaft Fractures. Turkiye Klinikleri Orthopaedics and Traumatology - Special Topics, v. 16, n. 2, p. 66–72, 2023.
SHARMA, Tarun Kumar et al. Non-vascularised fibula as an adjuvant in the management of diaphyseal humerus non-union- A meta-analysis and systematic review. Journal of Orthopaedics, v. 58, p. 140–145, dez. 2024.
SMALL, Roy F.; TAQI, Muhammad; YAISH, Amjad M. Radius and Ulnar Shaft Fractures. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.
SYED, Muhammad Khalid et al. GAP Non Union Managed in Radius and Ulna by Non–Vascularized Fibula Graft in Adults. Pakistan Journal of Medical & Health Sciences, v. 16, n. 09, p. 201–201, 2022.
TOMAR, L.; GOVIL, G.; DHAWAN, P. Infected Diaphyseal Non-union of Radius Managed with Fibular Graft and Intramedullary Fixation: Case Report on Simple Technique for Complex Case. Journal of Case Reports, v. 10, n. 4, p. 261–265, 9 fev. 2021.
VAN DER WATER, Lisa et al. Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled. Children (Basel, Switzerland), v. 9, n. 1, p. 49, 3 jan. 2022.
VASARA, Henri et al. Adverse Events After Surgical Treatment of Adult Diaphyseal Forearm Fractures: a Retrospective Analysis of 470 Patients. JBJS Open Access, v. 8, n. 3, p. e22.00115, set. 2023.
ZUCKERMAN, Scott L.; DEVIN, Clinton J. Pseudarthrosis of the Cervical Spine. Clinical Spine Surgery, v. 35, n. 3, p. 97–106, 1 abr. 2022.
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