Revista de la Asociación Argentina de Ortopedia y Traumatología
versión On-line ISSN 1852-7434
ALLENDE, Christian. No consolidaciones postraumáticas en los huesos largos del miembro superior: Actividad biológica en el foco y resultados funcionales prospectivosPosttraumatic nonunion in long bones of the Upper extremity: Biological activity at the gap And prospective functional results. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2010, vol.75, n.1, pp. 34-47. ISSN 1852-7434.
Background: Little is known about the biological activity present at the gap in non-unions of the upper extremity, and no precise information exists concerning the real impairment that results from them. The goal was to evaluate the correlation between radiology, histology and immunohistochemistry; and prospectively evaluate the results achieved in nonunions of the upper extremity treated surgically. Methods: Forty-one patients with post-traumatic nonunions affecting the long bones of the upper extremity and treated surgically between 2004 and 2007 were prospectively evaluated. Patient's age averaged 41.6 years. Time between initial trauma and definitive surgery averaged 12.45 months. Thirty-five patients had had previous surgical treatment. Results: Follow-up averaged 16.8 months. Time until bony union averaged 4.63 months. Constants score averaged 84.96 points; DASH score averaged 12.79 points. There was no concordance between radiology and IHQ, neither between radiology and histology, or between IHQ and histology. DASH score, Constant's score and the analog scale of pain showed significant improvement. There were no statistically significant differences between vital and non-vital nonunions, and between smokers and non smokers. Patients with previous surgeries presented a preoperative subjective evaluation significantly worse than patients without previous interventions. Patients younger than 50 years achieved a Constant score significantly higher than older patients. Conclusions: This series of patients showed lack of concordance between radiographic, histological and IHQ evaluations. In general, good percentage of blood vessels was detected in all types of nonunions, but vascular endothelial growth factor was scarce. Union was obtained in forty cases. Statistically significant subjective and objective improvement was achieved in all cases.
Palabras clave : Nonunion; Upper extremity; Histology; Inmunohistochemistrum; Vascular endothelial growth factor.