Reconstruction of aseptic humerus non-union with compression plating and cortico-cancellous bone grafting
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262029Keywords:
Humeral shaft non-union, Non-union, Aseptic non-union, Bone grafting, Locking compression plateAbstract
Background: Managing humeral shaft nonunion requires a comprehensive approach. Key factors include infection, prior surgeries, and severe bone loss. Treatment is challenging due to various surgical options, a lack of clear protocols, and limited evidence-based guidelines.
Methods: Forty-four adults with humeral shaft nonunion (not caused by infection) were treated over 8 years from January 2012 to December 2020. Seven cases were particularly stubborn. Cases were excluded if they involved open fractures, infections, breaks with big gaps, bone disease, or other upper limb injuries. Treatment included removing unhealthy bone and tissue, correcting bone shape, using the patient’s own bone to help healing, and fixing the bone with a strong plate. Outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score at baseline and at least 24 months later.
Results: Patients were followed for an average of 75 months. All patients healed. On average, healing took about 6 months (ranging from 4 to 12 months). Four patients (11.1%) had temporary nerve problems that fully recovered within 6 months. Two patients (5.5%) had mild wound infections. Arm function scores improved from an average of 76 before treatment to 7 at the end, showing excellent recovery.
Conclusions: Our study shows that open surgery with a locking plate, supplemented with additional bone when needed, is very effective for healing stubborn humeral shaft fractures. Careful steps, such as gentle tissue handling, maintaining a healthy blood supply, and fully removing the bad tissue, are key to success.
References
Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006;88(11):1469-73.
Peters RM, Claessen FM, Doornberg JN, Kolovich GP, Diercks RL, Van den Bekerom MP. Union rate after operative treatment of humeral shaft nonunion: a systematic review. Injury. 2015;46(12):2314-24.
Sarmiento A. Functional bracing of fractures of the shaft of the humerus. Orthop Trauma Dir. 2008;6(1):33.
King AR, Moran SL, Steinmann SP. Humeral nonunion. Hand Clin. 2007;23(4):449-63.
Singh AK, Arun GR, Narsaria N, Srivastava A. Treatment of nonunion of humerus diaphyseal fractures: a prospective study comparing interlocking nail and locking compression plate. Arch Orthop Trauma Surg. 2014;134(7):947-53.
Van Houwelingen AP, McKee MD. Treatment of osteopenic humeral shaft nonunion with compression plating, humeral cortical allograft struts, and bone grafting. J Orthop Trauma. 2005;19(1):36-42.
Hsu TL, Chiu FY, Chen CM, Chen TH. Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft. J Chin Med Assoc. 2005;68(2):73-6.
Sitati F, Kingori J. Outcome of management of humerus diaphysis nonunion. East Cent Afr J Surg. 2009;14(2):13-8.
Cadet ER, Yin B, Schulz B, Ahmad CS, Rosenwasser MP. Proximal humerus and humeral shaft nonunions. J Am Acad Orthop Surg. 2013;21(9):538-47.
Bernard de Dompsure R, Peter R, Hoffmeyer P. Uninfected nonunion of the humeral diaphysis: review of 21 patients treated with shingling, compression plate, and autologous bone graft. Orthop Traumatol Surg Res. 2010;96(2):139-46.
Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: the diamond concept. Injury. 2007;38(4):S3-6.
Babhulkar S, Babhulkar S, Vasudev A. Recalcitrant aseptic atrophic nonunion of the shaft of the humerus after failure of surgical treatment: management by excision of nonunion, bone grafting and stabilization by LCP in different modes. Injury. 2017;48(2):S33-43.
Dheenadhayalan J, Vembanan K, Devendra A, Perumal R, Nagashree V, Kumar AH, et al. Consistent protocol-based management of humerus shaft nonunion: an analysis of 100 cases. Indian J Orthop. 2023;57(4):552-64.
Ozdemir G, Bingol O, Inci F, Ceyhan E, Karahan N, Deveci A. Treatment of the refractory atrophic humeral nonunion with autogenous block iliac crest graft and spongioplasty: a retrospective study. Acta Chir Orthop Traumatol Cech. 2022;89(3):208-12.
Feng D, Wang X, Sun L, Cai X, Zhang K, Wang Z, et al. Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion. BMC Musculoskelet Disord. 2020;21(1):769.
Pollon T, Reina N, Delclaux S, Bonnevialle P, Mansat P, Bonnevialle N. Persistent nonunion of the humeral shaft treated by plating and autologous bone grafting. Int Orthop. 2017;41(2):367-73.
Rollo G, Prkić A, Pichierri P, Eygendaal D, Bisaccia M, Filipponi M, et al. Plate-and-bone-strut fixation of distal third humeral shaft aseptic nonunions: a consecutive case series. J Clin Orthop Trauma. 2019;10(1):S127-32.
Zalavras CG, Yasmeh S, Bougioukli S. Surgical management of humeral shaft nonunions: success of a consistent protocol over 17 years. Injury. 2021;52(12):3580-7.
Wiss DA, Garlich JM. Healing the index humeral shaft nonunion: risk factors for the development of a recalcitrant nonunion in 125 patients. J Bone Joint Surg Am. 2020;102(5):375-80.
Kontakis GM, Papadokostakis GM, Alpantaki K, Chlouverakis G, Hadjipavlou AG, Giannoudis PV. Intramedullary nailing for nonunion of the humeral diaphysis: a review. Injury. 2006;37(10):953-60.
Kusnezov N, Dunn JC, Stewart J, Mitchell JS, Pirela-Cruz M. Acute limb shortening for major near and complete upper extremity amputations with associated neurovascular injury: a review of the literature. Orthop Surg. 2015;7(4):306-16.
Lin J, Chiang H, Hou SM. Open exchange locked nailing in humeral nonunions after intramedullary nailing. Clin Orthop Relat Res. 2003;(411):260-8.
Crolla R, De Vries L, Clevers G. Locked intramedullary nailing of humeral fractures. Injury 1993;24(6):403.
Lin J, Hou SM, Hang YS, Chao EY. Treatment of humeral shaft fractures by retrograde locked nailing. Clin Orthop Relat Res. 1997;(342):147-55.
Konda SR, Davidovitch RI, Egol KA. Initial surgical treatment of humeral shaft fracture predicts difficulty healing when humeral shaft nonunion occurs. HSS J. 2016;12(1):13-7.
Mukhopadhaya J, Bhadani JS, Ranjan R, Kushwaha SR. Operative management of aseptic humeral shaft nonunion: a retrospective study from Eastern India. Indian J Orthop. 2024;58(12):1793-805.
Massin V, Laumonerie P, Bonnevialle N, Le Baron M, Ollivier M, Flecher X, et al. What treatment for humeral shaft nonunion? Case-series assessment of a strategy. Orthop Traumatol Surg Res. 2023;109(5):103532.
Koh J, Tornetta P, Walker B, Jones C, Sharma T, Sems S, et al. What is the real rate of radial nerve injury after humeral nonunion surgery?. J Orthop Trauma. 2020;34(8):441-6.
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