Biomechanical Strategies for Managing Atrophic and Oligotrophic Nonunions

Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity

“…Only two studies (a combined total of nine patients) 44,45 report union outcomes for atrophic humeral diaphyseal nonunions managed with plating but without BG. Historically, BG has been considered essential in atrophic nonunions to provide an appropriate healing environment [59][60][61][62][63] , with autologous BG preferred to biological or synthetic allografts due to its osteoinductive and osteoconductive properties and lack of immunogenicity 35,37,63,64 . However, others have suggested that debridement of the nonunion (exposing viable bone) is the most important step in stimulating callus formation 30 , and that correcting the mechanical environment should generate secondary union without the need for BG [65][66][67] .…”

“…Historically, BG has been considered essential in atrophic nonunions to provide an appropriate healing environment, [59][60][61][62][63] with autologous BG preferred to biological or synthetic allografts because of its osteoinductive and osteoconductive properties and lack of immunogenicity. 35,37,63,64 However, others have suggested that debridement of the nonunion (exposing viable bone) is the most important step in stimulating callus formation 30 and that correcting the mechanical environment should generate secondary union without the need for BG. [65][66][67] This is supported by immunohistochemical analysis demonstrating that bone morphogenic protein signaling components remain present and active in most nonunions.…”