Initial Surgical Treatment of Humeral Shaft Fracture Predicts Difficulty Healing when Humeral Shaft Nonunion Occurs

Konda, Sanjit R.; Davidovitch, Roy I.; Egol, Kenneth A.

doi:10.1007/s11420-015-9453-9

Cited by 17 publications

(12 citation statements)

References 7 publications

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“…As most patients showed varying degree of misalignment, implant broken and/or loosen, or pseudarthrosis, use of LCP xation could achieve a high degree of cortex-to-cortex stability with compression of the bone segments and correction of the deformities for those cases. Also, repeated prior surgeries might result in a poor biological environment for fracture repair in cases during this study, this is consistent with the founding of Konda et al [30], where humeral shaft nonunions following initial operative xation of the index fracture were more resistant to achieving union when compared to nonunions forming after initial non-operative treatment. And they recommended plate xation and bone graft for recalcitrant humeral shaft nonunion.…”

Section: Discussionsupporting

confidence: 90%

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

Feng¹,

Wang²,

Sun³

et al. 2020

Preprint

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Background: Despite the majority humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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Section: Discussionsupporting

confidence: 90%

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

Feng¹,

Wang²,

Sun³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Firstly, plate xation is the most widely used method for long bone xation due to economic constraints and surgeons' preference in China, and as most patients in this study showed varying degrees of misalignment or pseudarthrosis, the use of LCP xation could achieve a high degree of cortex-to-cortex stability with compression of the bone segments while correcting deformities. Secondly, repeated prior surgeries might result in a poor biological environment for fracture repair in cases in this study, a second plate xing vertically to the anterior of the bone graft for structural support could maintain intimate contact between the bone graft and both nonunion segments, maximizing osteoconductive, osteogenic and osteoinductive properties of autologous bone, this is consistent with the founding of Konda et al [30], where humeral shaft nonunions following initial operative xation of the index fracture were more resistant to achieving union when compared to nonunions forming after initial non-operative treatment. And they recommended plate xation and bone graft for recalcitrant humeral shaft nonunion.…”

Section: Discussionsupporting

confidence: 87%

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

Feng¹,

Wang²,

Sun³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Despite the majority of humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.

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“…One study reported a healing rate of 97% for anterior augmentation plating of aseptic humeral shaft nonunion [ 28 ], and a review of 36 studies found that plating with autologous bone grafting achieves a union rate of up to 98% in patients with humeral shaft nonunion [ 29 ]. Furthermore, plate fixation and bone grafting is recommended for recalcitrant humeral shaft nonunion following initial operative fixation of the index fracture [ 30 ]. In the present study, double plate fixation combined with autologous iliac crest structural bone grafting achieved excellent or good outcomes in patients with recalcitrant humeral shaft nonunion after prior failed surgeries.…”

Section: Discussionmentioning

confidence: 99%

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

Feng

Wang

Sun

et al. 2020

BMC Musculoskelet Disord

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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.

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Initial Surgical Treatment of Humeral Shaft Fracture Predicts Difficulty Healing when Humeral Shaft Nonunion Occurs

Cited by 17 publications

References 7 publications

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion

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

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

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