Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

Abstract

Background Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. Methods A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. Results The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. Conclusion Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Functional Outcomes of Patients Treated with Fibula Strut Graft and Double Plate in the Treatment of Recalcitrant Humerus Nonunions

“…We achieved full union in all our patients. Feng et al also reported a 100% union rate and better Constant-Murley scores with this method(12). They reported the mean union time as 6.4 ± 1.8 months, which is slightly longer than reported in our study, 5.1±0.63 months.…”

Infected humeral shaft nonunion treatment with the induced membrane technique and a novel fixation construct: a case report

“…20,21 Double plate fixation with autogenous ICBG is also recommended as a salvage procedure for humeral shaft nonunion after failed prior interventions. 22…”

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

“…Another advantage of this study was that the bone-forming channel technique ensured that the autogenous structural iliac bone extended over the osteogenesis deactivation zone and bridged the osteogenesis activation zones, maximizing the osteoinduction and osteoconduction effects of the bone graft, resulting in bone healing. Furthermore, this technology had been successfully used in previous studies, and achieved a satisfactory outcome with a bone union rate of 100% [ 10 – 13 ]. To the best of our knowledge, this is the first time this technique has been applied to treat recalcitrant nonunion.…”

“…The authors used a new bone graft technique termed the bone-forming channel technique, which spans the osteogenesis deactivation zone to bridge the osteogenesis activation zones [ 10 ]. Combined with this technology, this study adopted a new surgical strategy and achieved good results in clinical treatment [ 11 – 13 ]. In the present study, the authors retrospectively analyzed the patients with recalcitrant nonunion to whom this surgical method was applied, with the belief that this surgical strategy can have a good therapeutic effect on such patients, and to provide some data for clinical treatment.…”