J Korean Fract Soc.  2011 Apr;24(2):163-168. 10.12671/jkfs.2011.24.2.163.

Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture

• Kim JY
• Lee YK
• An KC
• Sung TW

• KMID: 2183859
• DOI: http://doi.org/10.12671/jkfs.2011.24.2.163

Abstract

PURPOSE
To evaluate autogenous iliac bone graft for nonunion after hand fracture.
MATERIALS AND METHODS
From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment.
RESULTS
Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases.
CONCLUSION
Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.

Keyword

Hand fracture; Nonunion; Autogenous iliac bone graft

MeSH Terms

Bone Transplantation
Follow-Up Studies
Fractures, Open
Hand
Humans
Joints
Range of Motion, Articular
Retrospective Studies
Time-to-Treatment
Transplants

Figure

• 

  Fig. 1 A 28-year-old man sustained middle phalanx fracture of right index finger by belt injury. (A) The anteroposterior view of the preoperative X-ray shows bony gap of the fracture site at 3 months after initial operation. (B) Immediate postoperative X-ray shows autogenous iliac bone graft and K-wire fixation. (C) At eight weeks after autogenous iliac bone graft, the X-ray shows the medullary bridge of the fracture site. (D) The anteroposterior view of the X-ray after K-wire removal shows the filling of the bony gap. (E) Finger extension and (F) Flexion at final evaluation. He ultimately recovered 70% of his finger motion, had no pain, and used his finger in pinching and griping activities.

• 

  Fig. 2 A 22-year-old man sustained distal phalanx open fracture of left index finger. The osteomyelitis was developed after K-wires fixation at local clinic. (A) The anteroposterior view of the preoperative X-ray shows osteolytic lesion of distal phalanx. (B) Antibiotics mixed cement was inserted after debridement and curettage. (C) At four weeks after antibiotics mixed cement insertion, autogenous iliac bone graft and K-wire fixation was done. (D) The X-ray after K-wire removal shows the bony union. (E) Finger extension and (F) Flexion at final evaluation. He ultimately recovered nearly complete of his finger function.

• 

  Fig. 3 A 52-year-old woman sustained middle phalanx open fracture of left index finger. (A) The anteroposterior view of the X-ray shows after initial opertaion. (B) Preoperative X-ray shows bony gap of the fracture site at 3 months after initial operation. (C) Immediate postoperative X-ray shows autogenous iliac bone graft and K-wire fixation. (D) The X-ray after K-wire removal shows the bony union. (E) Finger extension, 0° and (F) Flexion, 70° at final evaluation.

• 

  Fig. 4 A 39-year-old woman sustained multiple open fracture and dislocation of left hand by machine injury. Multiple fractures were fixed mulitple K-wires at the time of injury. (A) Preoperative view shows non-union of 5th metacarpla fracture site at 3 months after initial operation. (B) Immediate postoperative X-ray shows autogenous iliac bone graft and miniplate fixation. (C) At 10 weeks after autogenous iliac bone graft, the anteroposterior view of the X-ray shows cortical continuity of the fracture site. (D) The anteroposterior view of the X-ray after miniplate removal shows the filling of the bony gap.

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