Nine-year-long complex humeral nonunion salvaged by distraction osteogenesis technique: a case report and review of the literature

Abstract

Background Humeral nonunion with significant bone loss or shortening is uncommon and poses a complex clinical problem. We present a case of humeral nonunion with a large segmental bone defect treated with the distraction osteogenesis technique and remedy the radial nerve palsy produced during distraction osteogenesis by forearm tendon transfers. The reconstruction of upper limb function was achieved with satisfactory results. This case provides a referenceable alternative method for repairing large segmental bone defects due to complex nonunion of the upper extremity, as well as a remedy in the unfortunate event of radial nerve palsy, providing a reference and lessons learned for the treatment of similar cases and the management of possible complications. Case presentation A 31-year-old male patient experienced 9 years of hypertrophic nonunion due to an unreliable internal fixation. The radiographs showed the absence of bone bridging between the two fragments, loosening of the screws, and extensive osteolysis around the internal screws. The patient was treated with distraction osteogenesis. At the end of the distraction period, the patient unfortunately developed right radial nerve paresis, which was salvaged by forearm tendon transplantation, and finally reconstructed hand function and achieved bone union of the humerus. Conclusion Distraction osteogenesis, although not a panacea for all humeral nonunions with significant segmental bone loss, does offer a viable salvage procedure in this unusual and often complex clinical problem. When irreversible radial nerve palsy occurs during distraction, forearm tendon transfers can have a good clinical effect.

Ilizarov technique used for humeral lengthening in adults：a case report

“…Humeral lengthening should be considered for patients with a strong demand and limited participation in particular athletic activities during childhood, resulting in psychological hurdles, when experiencing a humeral shortening of 3-6cm . [8,9] Previous studies have reported that the humeral lengthening using Wagner external xator, plate internal xation and autogenous bone transplantation not only has limited lengthening, but also has many complications, leading to the surgical effect not ideal . [1] At present, Ilizarov technique remains the standard technique for the treatment of limb deformities and lengthening .…”

Long Bone Defect Filling with Bioactive Degradable 3D-Implant: Experimental Study

“…Ilizarov’s distraction osteogenesis method demonstrates effectiveness in treatment and reconstruction of large bone defects [ 3 , 4 , 5 ]. However, difficulties and complications associated with the use of the Ilizarov bone transport technique have been reported: high rate of pin-site infection, prolonged time of external frame fixation, joint contractures, risk of ischemic regeneration in compromised soft tissues around a large defect, and physical and psychological suffering of patients [ 4 , 5 , 49 , 50 ].…”

“…Unsatisfactory outcomes of orthopedic surgery for non-unions and bone defects are not rare [ 1 , 2 , 3 ]. The methods of transosseous osteosynthesis developed by G. Ilizarov based on low-invasive surgery, fixation stability, preservation of blood supply, and functional loading demonstrated its efficiency in the treatment of pseudarthrosis and bone defects [ 4 , 5 , 6 ].…”