Is Bone Graft Possible without Limit in Length for Nonunion of Ulna Alone?
Abstract
Background: When either the radius or ulna is united, and the other fails to heal, bone graft and bridge plating can be a choice to treat nonunion of the radius or ulna alone. The length of the bone used to fill the bony defect, however, has not yet been found in terms of biomechanics or biology for healing. The purpose of this study was to find the length of bone grafts possible for operative treatment of bridge plating in nonunion of ulna alone by 3D-finite element method. Method: Using 3D-finite element models based on CT scans of ulna, iliac bone graft and 3.5-locking compression plate(LCP) and screws(10-holes), biomechanical values were obtained to compare them according to 5 to 20mm of lengths of the bone grafts when applied anterior-posterior bending, axial compression and torsion loads. Results: With 5, 10 and 15mm in bone graft lengths, the bending and axial compression forces produced less than 2mm of displacement values of the bone graft. In terms of stiffness, maximum values in the ulna bone under the bending force were greater than those during the testing under axial compression and torsion regardless of lengths of the bone grafts. Conclusion: For stability in nonunions of ulna alone, the recommended length of iliac bone graft associated with bridge plating which can maintain stability is less than 20mm, and it must be paid attention to bending force for postoperative rehabilitation.
References
Singer BR, et al. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br. 1998;80(2):243–248.
Matthew I. Rudloff. Diaphyseal Fractures of the Radius and Ulna. In Eds.: Charles M. Court-Brown, et al. Rockwood and Green’s Fractures in Adults. (8th Edn). Wolters kluwer, China, 2015; 1123, 1170, 1171.
John T Capo. Forearm, shaft. In Eds.: Richard E Buckley, et al. AO Principles of Fracture Management. (3rd Edn.). 2017: 170, 657.
Chapman M, Gordon JE, Zissimos AG. Compression-plate Fixation of Acute Fractures of the Diaphyses of the Radius and Ulna. J Bone Joint Surg 1989;71A:159.
Pollock F, Parkovich AM, Prieto JJ, Lorenz M. The Isolated Fracture of the Ulnar Shaft. J Bone Joint Surg1983;65-A:339.
Stern PJ, Drury WJ. Complications of Plate Fixation of Forearm Fractures. Clin Orthop 1983;175:25.
Street DM. Intramedullary Forearm Nailing. Clin Orthop 1986;212:219.
Teipner W, Mast J. Internal Fixation of Forearm Diaphyseal Fractures. Orthop Clin North Am 1980;11:387.
Kurt P. Droll, Philip Perna, Jeff Potter, Elaine Harniman, Emil H. Schemitsch and Michael D. McKee. Outcomes following plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 2007;89:2619-2624.
John C. Weinlein. Delayed Union and Nonunion of Fractures. In Eds.: Charles M. Court-Brown, et al. Campbell’s Operative Orthopedics. (3rd Edn.).2017: 3112.
Anderson LD, et al. Compression-plate fixation in acute diaphyseal fractures of the
radius and ulna. J Bone Joint Surg Am. 1975;57(3):287–297.
Heim U, Zehnder R. [Analysis of failures following osteosynthesis of forearm shaft fractures.] Hefte Unfallheilkunde.1989;201:243–258. German.
Grace TG, Eversmann WW Jr. Forearm fractures: treatment by rigid fixation with early motion. J Bone Joint Surg Am. 1980;62(3):433–438.
Downloads
Additional Files
Published
Issue
Section
License
Declaration and Copyright Transfer Form
(to be completed by authors)
I/ We, the undersigned author(s) of the submitted manuscript, hereby declare, that the above manuscript which is submitted for publication in the STM Journals(s), is not published already in part or whole (except in the form of abstract) in any journal or magazine for private or public circulation, and, is not under consideration of publication elsewhere.
- I/We will not withdraw the manuscript after 1 week of submission as I have read the Author Guidelines and will adhere to the guidelines.
- I/We Author(s ) have niether given nor will give this manuscript elsewhere for publishing after submitting in STM Journal(s).
- I/ We have read the original version of the manuscript and am/ are responsible for the thought contents embodied in it. The work dealt in the manuscript is my/ our own, and my/ our individual contribution to this work is significant enough to qualify for authorship.
- I/We also agree to the authorship of the article in the following order:
Author’s name
1. ________________
2. ________________
3. ________________
4. ________________
| We Author(s) tick this box and would request you to consider it as our signature as we agree to the terms of this Copyright Notice, which will apply to this submission if and when it is published by this journal. |