Femoral fracture non-unions are considered to be rare, and are usually treated successfully with exchange nailing. However, recalcitrant aseptic cases often require additional bone grafting. The efficacy of BMP-7 in the treatment of recalcitrant aseptic femoral non-unions was studied. Since 2003 a multicenter registry (bmpusergroup.co.uk) was created collecting details of BMP7 application in general, between different university hospitals across Europe. Demographic data, intraoperative details, complications, clinical outcome parameters, radiological healing, VAS pain score, EuroQol-5D, and return-to-work were prospectively recorded. Radiological healing was defined as the presence of callous in two planes over 3 cortices. The minimum follow up was 12 months. Seventeen patients, who had undergone a median of 1(1 to 4) prior revision operations, over a median period from the injury of 17 months(9 to 42), were included in this observational study. In 76.4%(13/17) the BMP7 was combined with revision of the fixation. Non-union healing was verified in 14/17 cases(82.3%) in a median period of 6.5 months(3–15). Over 80% of these patients returned to their pre-injury level of activities, the median overall health state score was 82.5(35 to 100). No adverse events or complications were associated with the BMP7 application over the median follow-up of 24 months(12–68).
Although intramedullary nail fixation maybe highly indicated for comminuted and segmental humeral fractures that require operative treatment, the literature lacks reviews of this content. The aim of the present study is to prospectively evaluate the clinical and radiographic outcomes in patients with combined head and shaft fractures of the humerus who were treated by antegrade locking intramedullary nailing. During a period of four years 21 patients (9 men &
12 women) between 36 and 82 years old, with combined fractures of the humeral head and shaft, were operated by one surgeon. Three types of nail implants were used (Polarus long, Garnavos nail, True flex nail) and ante-grade technique was performed in all cases. The mean operating time was 105 min (50′–140′). The period of follow-up averaged 14.25 months (range, 9 to 18 months). Two patients were lost to follow up and one died before the callus formation procedure was accomplished. The functional assessment included determination of the Constant score and documentation of shoulder function as compared with the non injured extremity. Radiographic control was obtained during the follow-up intervals and at the final follow up. No neurovascular complications, deep wound infections or non-unions were recorded and all fractures were fully healed between 4 to 8 months post-operatively. In one case the nail was extracted before callus formation was achieved, because of acromion impingement. The results are judged as very satisfying, taking into account the comminution of the fractures. Further evaluation of the results, with comparable methods of internal fixation of such fracture patterns, is needed.
