{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:44:41Z","timestamp":1760060681161,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Successful non-union therapy consists of a combination of optimizing mechanical stability and activating biological factors. The conventional method for treating non-union is debridement and stabilization with metal hardware. The human allogeneic cortical bone screw (Shark Screw\u00ae) merges human cortical bone properties with screw stability, addressing non-union surgery principles by integrating mechanical and biological aspects. The objective of this retrospective study was to compare the clinical and radiological outcomes of the conventional method with those of the new method using the Shark Screw\u00ae. This retrospective, multicentre, level III study included 41 patients with non-unions in upper extremities, 11 treated with the conventional method (metal hardware \u00b1 graft), and 30 patients with the Shark Screw\u00ae (\u00b1graft). Patient demographics, non-union location, autograft and\/or allograft use, follow-up time, complications, union rate, time to union, and time to return to work were recorded. Follow-up was 18 months in the conventional group and 10 months in the Shark Screw\u00ae group. The union rate was 72.7% in the conventional group and 96.7% in the Shark Screw\u00ae group. Time to union was significantly shorter in the Shark Screw\u00ae group. In the conventional group, the complication rate was 36%, and it was 3.4% in the Shark Screw\u00ae group. Hardware removal in the conventional group was 64%, and it was 0% in the Shark Screw\u00ae group. The Shark Screw\u00ae presents a reliable option for treating non-unions in the shoulder, forearm, hand, and fingers.<\/jats:p>","DOI":"10.3390\/life15091421","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:27:12Z","timestamp":1757500032000},"page":"1421","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-Union Treatment in the Shoulder, Arm, Wrist, and Fingers: A Multicentre Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw\u00ae)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9156-6479","authenticated-orcid":false,"given":"Elisabeth","family":"Huber","sequence":"first","affiliation":[{"name":"DOKH Friesach, St Veit Str. 12, A-9360 Friesach, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd","family":"Jakob","sequence":"additional","affiliation":[{"name":"Landeskrankenhaus Villach, Nikolaigasse 43, A-9500 Villach, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Palle","sequence":"additional","affiliation":[{"name":"DOKH Friesach, St Veit Str. 12, A-9360 Friesach, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-4352","authenticated-orcid":false,"given":"Gudrun H.","family":"Borchert","sequence":"additional","affiliation":[{"name":"Dr. Borchert Medical Information Management, Egelsbacher Str. 39e, D-63225 Langen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Pastl","sequence":"additional","affiliation":[{"name":"Klinik Diakonissen Linz, Wei\u00dfenwolffstra\u00dfe 13, A-4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"ref_1","first-page":"518","article-title":"Results of nonunion treatment with bone morphogenetic protein 7 (BMP-7)","volume":"115","author":"Zimmermann","year":"2012","journal-title":"Unfallchirurg"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1055\/a-0899-5345","article-title":"M\u00f6glichkeiten der vaskularisierten Knochentransplantationen bei Defektpseudarthrosen an ausgew\u00e4hlten Beispielen der oberen Extremit\u00e4t","volume":"35","author":"Evers","year":"2019","journal-title":"OP-Journal"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/15589447231219523","article-title":"Risk Factors for the Development of Persistent Scaphoid Non-Union After Surgery for an Established Non-Union","volume":"20","author":"Patterson","year":"2025","journal-title":"Hand"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"103896","DOI":"10.1016\/j.otsr.2024.103896","article-title":"A systematic scoping review of the latest data on orthobiologics in the surgical treatment of non-union","volume":"110","author":"Gagnon","year":"2024","journal-title":"Orthop. Traumatol. Surg. Res. OTSR"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00104-017-0547-4","article-title":"Pseudarthroses of the long bones","volume":"89","author":"Everding","year":"2018","journal-title":"Chirurg"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1302\/2058-5241.5.190037","article-title":"Nonunion\u2014Consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society","volume":"5","author":"Schmal","year":"2020","journal-title":"EFORT Open Rev."},{"key":"ref_7","first-page":"799","article-title":"Scaphoid fractures: Current diagnostic and treatment concepts","volume":"126","author":"Windolf","year":"2023","journal-title":"Unfallchirurgie"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Labmayr, V., Huber, E., Wenzel-Schwarz, F., Holweg, P., Ornig, M., Jakob, G., Palle, W., Borchert, G.H., and Pastl, K. (2024). Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw\u00ae). J. Pers. Med., 14.","DOI":"10.20944\/preprints202403.0142.v1"},{"key":"ref_9","first-page":"869","article-title":"Nonunions and Their Operative Treatment\u2014A DRG-Based Epidemiological Analysis for the Years 2007\u20132019 in Germany","volume":"119","author":"Reeh","year":"2022","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_10","first-page":"1442","article-title":"Plate fixation of ununited humeral shaft fractures: Effect of type of bone graft on healing","volume":"88","author":"Hierholzer","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.2106\/00004623-200411000-00013","article-title":"Ununited diaphyseal forearm fractures with segmental defects: Plate fixation and autogenous cancellous bone-grafting","volume":"86","author":"Ring","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s00590-023-03687-8","article-title":"Long-term clinical and radiological results after scaphoid non-union treatment: A retrospective study about 60 cases","volume":"34","author":"Delamarre","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_13","first-page":"207","article-title":"Allograft versus autograft in forearm aseptic non-union treatment","volume":"34","author":"Rollo","year":"2020","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.jhsa.2023.04.022","article-title":"Complications Following Volar Locking Plate Fixation of Distal Radius Fractures in Adults: A Systematic Review of Randomized Control Trials","volume":"48","author":"Nwosu","year":"2023","journal-title":"J. Hand Surg. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1007\/s00590-021-02915-3","article-title":"Some outcomes of patients treated operatively for distal humerus fractures are affected by hand dominance","volume":"31","author":"Shields","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.jhsa.2022.04.018","article-title":"Volar Locking Plate Compared with Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases","volume":"47","author":"Lundqvist","year":"2022","journal-title":"J. Hand Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s00402-019-03196-6","article-title":"Practicability of a locking plate for difficult pathologies of the scaphoid","volume":"139","author":"Mehling","year":"2019","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1142\/S2424835522500539","article-title":"Arthrodesis for Primary Osteoarthritis of Trapeziometacarpal Joint Using Multiple Kirschner Wires and Tension Band Wire in Female Patients Older than 40","volume":"27","author":"Hattori","year":"2022","journal-title":"J. Hand Surg. Asian Pac. Vol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/S0020-1383(99)00312-5","article-title":"The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden","volume":"31","author":"Nowak","year":"2000","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1186\/s13018-023-04232-3","article-title":"Risk factors and healthcare costs associated with long bone fracture non-union: A retrospective US claims database analysis","volume":"18","author":"Vanderkarr","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/s00113-019-0609-9","article-title":"Scaphoid pseudarthrosis: Complex reconstruction using vascularized bone grafts","volume":"122","author":"Kalb","year":"2019","journal-title":"Unfallchirurg"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jcot.2021.03.003","article-title":"A systematic review of mechanical stabilization by screw fixation without bone grafting in the management of stable scaphoid non-union","volume":"17","author":"Elgayar","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_23","first-page":"e235","article-title":"Scaphoid Nonunion: A Review of Surgical Strategies","volume":"45","author":"Ilyas","year":"2022","journal-title":"Orthopedics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.jhsa.2005.04.007","article-title":"Results of four-corner arthrodesis using dorsal circular plate fixation","volume":"30","author":"Kendall","year":"2005","journal-title":"J. Hand Surg. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103665","DOI":"10.1016\/j.otsr.2023.103665","article-title":"Treatment of scaphoid nonunion by arthroscopic cancellous bone grafting","volume":"109","author":"Burnier","year":"2023","journal-title":"Orthop. Traumatol. Surg. Res. OTSR"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s00113-020-00825-3","article-title":"Osteophyte-induced impingement reduces range of motion in humpback deformity of incorrectly healed scaphoid reconstruction","volume":"124","author":"Moog","year":"2021","journal-title":"Unfallchirurg"},{"key":"ref_27","first-page":"191","article-title":"Scaphoid pseudarthrosis without circulatory disorder: Management and standard procedure for primary treatment","volume":"122","author":"Frosch","year":"2019","journal-title":"Unfallchirurg"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/j.jhsa.2016.04.021","article-title":"Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions","volume":"41","author":"Dodds","year":"2016","journal-title":"J. Hand Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1530\/EOR-21-0102","article-title":"Arthrodesis of the proximal interphalangeal joint of the finger\u2014A systematic review","volume":"7","author":"Millrose","year":"2022","journal-title":"EFORT Open Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/17453674.2017.1321351","article-title":"The risk of non-union per fracture: Current myths and revised figures from a population of over 4 million adults","volume":"88","author":"Mills","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ekegren, C.L., Edwards, E.R., de Steiger, R., and Gabbe, B.J. (2018). Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15122845"},{"key":"ref_32","unstructured":"Basile, G., Avato, F.M., Passeri, A., Accetta, R., Amadei, F., Giorgetti, A., Castoldi, D., and Fozzato, S. (2022). Atrophic pseudarthrosis of humeral diaphyseal fractures: Medico-legal implications and methodological analysis of the evaluation. Acta Biomed., 93."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Brcic, I., Pastl, K., Plank, H., Igrec, J., Schanda, J.E., Pastl, E., and Werner, M. (2021). Incorporation of an Allogenic Cortical Bone Graft Following Arthrodesis of the First Metatarsophalangeal Joint in a Patient with Hallux Rigidus. Life, 11.","DOI":"10.3390\/life11060473"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/j.jhsa.2015.05.003","article-title":"Treatment of Scaphoid Nonunion: A Systematic Review of the Existing Evidence","volume":"40","author":"Pinder","year":"2015","journal-title":"J. Hand Surg. Am."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1302\/0301-620X.84B8.0841093","article-title":"Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: Choosing a new balance between stability and biology","volume":"84","author":"Perren","year":"2002","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1302\/0301-620X.89B5.19039","article-title":"Bone allografts: What they can offer and what they cannot","volume":"89","author":"Delloye","year":"2007","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1007\/s00402-021-03880-6","article-title":"The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: A case series","volume":"142","author":"Pastl","year":"2021","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_38","first-page":"54","article-title":"Osteosynthese mit Schraubentransplantat Shark Screw\u00ae aus humanem Knochen","volume":"4","author":"Walther","year":"2018","journal-title":"Jatros Unfallchir Sport."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s10195-023-00686-7","article-title":"Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study","volume":"24","author":"Sailer","year":"2023","journal-title":"J. Orthop. Traumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4557","DOI":"10.1007\/s00402-023-04785-2","article-title":"A human, allogeneic cortical bone screw for distal interphalangeal joint (DIP) arthrodesis: A retrospective cohort study with at least 10 months follow-up","volume":"143","author":"Krasny","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1302\/0301-620X.98B7.36061","article-title":"A unified theory of bone healing and nonunion: BHN theory","volume":"98-B","author":"Elliott","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_42","first-page":"659","article-title":"Long Bone Nonunion","volume":"153","author":"Schmidmaier","year":"2015","journal-title":"Z. Orthop. Unf."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.4045\/tidsskr.14.1256","article-title":"Examination and treatment of scaphoid fractures and pseudarthrosis","volume":"135","author":"Reigstad","year":"2015","journal-title":"Tidsskr. Nor. Legefore"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s00132-016-3337-7","article-title":"Scaphoid pseudarthrosis: Indications for avascular iliac crest or radius bone grafts","volume":"45","author":"Asmus","year":"2016","journal-title":"Orthopade"},{"key":"ref_45","first-page":"9204","article-title":"Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures","volume":"26","author":"Atilgan","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/a-0889-1013","article-title":"Definition, Risikofaktoren und Klassifikationsmodelle von Pseudarthrosen","volume":"35","author":"Braun","year":"2019","journal-title":"OP-Journal"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.jhsa.2012.02.048","article-title":"Distal interphalangeal joint arthrodesis for degenerative osteoarthritis with compression screw: Results in 102 digits","volume":"37","author":"Villani","year":"2012","journal-title":"J. Hand Surg. Am."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3419","DOI":"10.1007\/s00590-023-03558-2","article-title":"Operative treatment of distal radius fractures involving the volar rim-A systematic review of outcomes and complications","volume":"33","author":"Lari","year":"2023","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"103636","DOI":"10.1016\/j.otsr.2023.103636","article-title":"Functional and radiologic outcomes of non-displaced scaphoid waist fractures in adolescents approaching skeletal maturity: Comparison between conservative treatment and percutaneous screw fixation","volume":"110","author":"Andre","year":"2023","journal-title":"Orthop. Traumatol. Surg. Res. OTSR"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/1558944716658747","article-title":"The Scaphoid Staple: A Systematic Review","volume":"12","author":"Dunn","year":"2017","journal-title":"Hand"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Zenke, Y., Oshige, T., Menuki, K., Hirasawa, H., Yamanaka, Y., Tajima, T., Kosugi, K., and Sakai, A. (2020). Four-corner fusion method using a bioabsorbable plate for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists: A case series study. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03709-0"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e561","DOI":"10.5435\/JAAOS-D-23-00188","article-title":"The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing","volume":"31","author":"Waters","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1302\/2046-3758.118.BJR-2021-0238.R3","article-title":"The epidemiology and direct healthcare costs of aseptic nonunions in Germany\u2014A descriptive report","volume":"11","author":"Walter","year":"2022","journal-title":"Bone Jt. Res."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/9\/1421\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:06Z","timestamp":1760035386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/9\/1421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["life15091421"],"URL":"https:\/\/doi.org\/10.3390\/life15091421","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}