Anterior plating as a surgical alternative in the treatment of humeral shaft non-union

Abstract

This study included 15 patients with humeral shaft fractures who had no clinical, radiological or bone scan signs of healing after eight months. The patients were followed for a mean of 35.8 months. No patient was lost to follow-up. Anterior plating of humeral shaft nonunion via an anterior approach was performed using a straight plate and compression for well-vascularised non-unions and wave plating with a tricortical graft for poorly vascularised non-unions. All non-unions healed within 6-18 weeks (mean, nine weeks) without local complication. One patient had a mild decrease in elbow and shoulder range of motion. No neurovascular injury was observed. Anterior plating is a simple, safe and effective treatment for humeral shaft nonunion. As this approach avoids the need for radial nerve visualisation and extensive soft-tissue dissection, and the healing time is similar to that of other methods, we suggest this treatment as an alternative option.

Anteromedial Plating of Humerus—An Easier and Effective Approach

“…He reported high complication rate with intramedullary nail and suggested plating as primary treatment for humeral shaft fractures. In most instances dynamic compression plating is preferred [2] [6] [8]. The most commonly used approach are the posterior and anterolateral approaches [4] [7].…”

“…Attachments from major pectoralis deltoid, rotator cuff muscles influence the degree of displacement of fractures. Uncomplicated cases of shafts of humerus fractures are treated conservatively [2]. Plate osteosynthesis remains the gold standard of surgical treatment.…”

Vorteile der anteromedialen Plattenlage bei Osteosynthese der Frakturen im mittleren Drittel des Humerusschaftes

“…Th e causes of secondary radial nerve palsy include manipulation of the surgeons, impingement between fracture fragments, entrapment by fracture callus, and tissue scar formation. Primary radial nerve palsy and secondary radial nerve palsy are indications for surgical exploration [8][9][10][11].…”

“Comparative Study of Functional Outcome of Dynamic Compression Plating and Interlocking Nailing For Fracture Shaft of Humerus in Adults”

“…The second most common cause is fall on outstretched hand , which is an indirect injury especially in the geriatric group 1-4. Most fractures were conservatively treated except for those who had the indications. The surgical indications are: Unacceptable reduction of fractures, radial nerve palsy, associated vascular lesions, open fractures, polytrauma patients, floating elbow ,obese patients who may develop varus angulations [1][2][3][4][5] . Among surgical options , open reduction and fixation with plate and screw, is the gold standard, because of shorter time to union and lesser complications, when compared to intra medullary nailing.…”

“…Among surgical options , open reduction and fixation with plate and screw, is the gold standard, because of shorter time to union and lesser complications, when compared to intra medullary nailing. [1][2][3][4] The soft tissue violation is a major disadvantage of plating over nailing, thus less invasive measures like indirect reduction and percutaneous plate fixation has been developed. A simple, effective and safe treatment , is anterior plating for nonunion of humeral shaft fracture.…”