PATIENTS TREATED FOR NONUNIONS WITH PLATE AND SCREW FIXATION AND ADJUNCTIVE LOCKING NUTS

Locking nuts were used as an adjunct to plate fixation in 48 procedure s in 44 patients, All the procedures were done by one surgeon during a 4-year period, The patients in this study were treated for nonunion o r malunion and thus had difficult technical problems, such as cortical defects or holes left from previous hardware, The use of standard imp lants were generally unreliable for additional fixation. The locking n uts were used as a cortical substitute in 26 instances, to create a fi xed angle relationship between the plate and the screw in 14 instances , to elevate the plate off the bone to help increase vascularity in fi ve instances, and to increase purchase in severely osteoporotic bone i n three instances, Complete followup was obtained on 43 of the 44 pati ents, Forty of the 43 patients achieved complete union after their rec onstructive procedure, Three patients had continued nonunions with eve ntual hardware failure and required reoperation, The use of the lockin g nuts enabled the surgeons to obtain stable fixation at the time of r eoperation with eventual union of all of the ununited bones, The succe ss of the use of this implant is best gauged by the fact that the surg eon could place screws effectively where cortical defects existed, all ow improved purchase in osteoporotic bone, and create a fixed angle pl ate screw relationship that would have been difficult to do without th e locking nuts.