A case report of recalcitrant non union humerus treated with on lay fibular bone grafting and locking compression plate

Authors

  • Vivekananda Bheemisetty Department of Orthopaedics, Osmania Medical College, Koti, Hyderabad, Telangana, India
  • Rentala Vamshi Department of Orthopaedics, Osmania Medical College, Koti, Hyderabad, Telangana, India
  • S. Sreenivasa Reddy Department of Orthopaedics, Osmania Medical College, Koti, Hyderabad, Telangana, India
  • Y. Thimma Reddy Department of Orthopaedics, Osmania Medical College, Koti, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20180690

Keywords:

Non union humerus, On lay fibular grafting, Locking compression plate

Abstract

Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. Fixation using a compression plate and a non-vascularised fibular graft achieves good outcome for infected non-union of the humerus despite prior multiple failed surgeries. We report a failed case of fracture shaft humerus which was operated three times, first with DCP and next two times with DCP and autologous cancellous bone graft from iliac crest. The patient is now treated with LCP and on lay fibular bone grafting.

Author Biography

Vivekananda Bheemisetty, Department of Orthopaedics, Osmania Medical College, Koti, Hyderabad, Telangana, India

Orthopaedics Senior resident

References

Ring D, Perey BH, Jupiter JB. The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients. J Bone Joint Surg Am. 1999;81:177–90.

Jupiter JB, Wyss H. Stable fixation of osteoporotic fractures and nonunions in the upper limb-life before the “locking plate” Acta Chir Orthop Traumatol Cech. 2010;77:361–4.

Ring D, Kloen P, Kadzielski J, Helfet D, Jupiter JB. Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res. 2004;425:50–4.

Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: Review of literature and our experience. J Trauma. 2008;65:482–6.

Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, et al. Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am. 2002;84:1315–22.

Otsuka NY, McKee MD, Liew A, Richards RR, Waddell JP, Powell JN, et al. The effect of comorbidity and duration of nonunion on outcome after surgical treatment for nonunion of the humerus. J Shoulder Elbow Surg. 1998;7:127–33.

Jupiter JB, Mullaji AB. Blade plate fixation of proximal humeral non-unions. Injury. 1994;25:301–3.

Kumar A, Sadiq SA. Non-union of the humeral shaft treated by internal fixation. Int Orthop. 2002;26:214–6.

Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK. Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg Br. 2000;82:867–71.

Barquet A, Fernandez A, Luvizio J, Masliah R. A combined therapeutic protocol for aseptic nonunion of the humeral shaft: a report of 25 cases. J Trauma. 1989:29:95–8.

Segonds JM, Alnot JY, Masmejean E. Aseptic non-union of humeral shaft fractures treated by plating and bone grafting [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2003;89:107–14.

MartinezAA, HerreraA, Cuenca J. Good results with unreamed nail and bone grafting for humeral nonunion: a retrospective study of 21 patients. Acta Orthop Scand. 2002;73:273–6.

Dendrinos GK, Kontos S, Lyritsis E. Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am. 1995;77:835–46.

Fattah HA, Halawa EE, Shafy TH. Non-union of the humeral shaft: a report on 25 cases. Injury. 1982;14:255–62.

Kocaoglu M, Cakmak M, Basturk S, Tuncay I. Ilizarov method in pseudoarthrosis of long tubular bones, treatment and clinical results. Acta Orthop Traumatol Turc. 1996;30:120–4.

Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part 1. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989;238:249–81.

Martinez AA, Herrera A, Perez JM, Cuenca J, Martínez J. Treatment of humeral shaft nonunion by external fixation: a valuable option. J Orthop Sci. 2001;6:238–41.

Vidyadhara S,Vamsi K, Rao SK, Gnanadoss JJ, Pandian S. Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion. Int Orthop. 2009;33:1009–14.

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Published

2018-02-23

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Section

Case Reports