Failure of reamed nailing in humeral non-union: an analysis of 26 patients

Allografting in Locked Nailing and Interfragmentary Wiring for Humeral Nonunions

“…Today, the use of allografts has become widespread and approximately one-third of the bone grafts used in North America are allografts [14,30]. Some authors have emphasized bone grafting for treatment of humeral nonunions [13,29,35], but published studies with direct comparison of the effectiveness of autografts with that of allografts are still lacking. This study was conducted to compare rates of healing and functional outcomes between allograft and autograft augmentation in the humeral nonunions treated by locked nailing and interfragmentary wiring.…”

“…Possible explanations for those high failure rates are that the size discrepancy between the locking screws and the nail holes may cause initial instability and lack of compression may cause residual fracture gap [19]. These problems may be worsened further by the physiologic distraction and torsional forces in the upper extremities and may lead to persistent nonunion [25,35]. To overcome these problems, we used interfragmentary wiring technique to eliminate the initial instability and residual fracture gap and to resist the physiologic distraction and torsional forces [19].…”

“…To overcome these problems, we used interfragmentary wiring technique to eliminate the initial instability and residual fracture gap and to resist the physiologic distraction and torsional forces [19]. Interfragmentary wiring also could provide more efficient compression than ordinary compressive locked nails [35]. The tight interdigitation between the nonunion fragments could further enhance the fixation stability and facilitate eventual nonunion healing and functional recovery.…”

“…Persistent nonunion rate after attempted surgical repair is reported to occur in 4% to 44% of cases [33]. Excessive soft tissue injury, unstable fixation, and persistent fracture gap are suggested as the common causes of treatment failure [15,35].…”

Treatment of Resistant and High-Risk Humeral Non-union Cases with rhBMP7

“…If the fracture was initially pinned, it may not be sufficient to simply ream the medullary canal and change out the fixation device. In some studies with fewer than 30 patients [10], [11], [12], the union rate was below 50% when the revision of the non-union was fixed with percutaneous nailing, without grafting. Although reaming seems to play a biological role, it cannot compensate for insufficient rotational stability.…”