Non-union of the humeral shaft treated by internal fixation

Abstract

We reviewed 40 cases with non-union of the humeral shaft. There were 31 men and nine women patients with an average age of 38.5 (35-65) years. Thirtyfour non-unions were of the atrophic type. Non-union was most often found at the transition of the middle third to the lower third of the humeral shaft. Six fractures were classified as open at the time of the initial injury. All patients were treated by open reduction and internal fixation with a dynamic compression plate (DCP). Cancellous bone graft was used in all atrophic non-unions. In one patient an additional fibular graft was used. The average follow-up was 13 (6-18) months. Final results were available for 34 patients. Thirty-one fractures (91%) healed in an average of 4.5 (3-9) months. Main complications were temporary radial nerve palsy in two patients and deep infection in one.Résumé Nous avons examiné 40 cas de non -consolidation de la diaphyse humérale. Il y avait 31 hommes et neuf femmes avec un âge moyen de 38.5 années (35-65 années). Trente-quatre non -consolidations étaient du type atrophique. Le défaut de consolidation était le plus souvent à la jonction 1/3 moyen-1/3 inférieur de la diaphyse humérale. Six fractures ont été classées comme ouvertes au temps de la blessure initiale. Tous les malades ont été traités par réduction ouverte et fixation interne avec une plaque à compression dynamique. Une greffe spongieuse a été utilisé dans tous les cas de non-consolidation atrophique. Chez un malades une greffe supplé-mentaire de péroné a été utilisée. La moyenne de suivi était 13 mois (6-18 mois). Les résultats définitifs étaient disponibles pour 34 malades. Trente-une fractures (91%) ont guéri dans une période moyenne de 4,5 mois (3-9 mois). Les principales complications étaient une paralysie temporaire du nerf radial pour deux malades et une infection profonde pour un patient.

Two-Plate Fixation for Humeral Shaft Nonunions

“…[9][10][11][12][13][14][15][16][17][18][19][20] The rates for intramedullary nailing range between 30 and 60% for the Seidel nail 1,5,6 and 100% for the unreamed humeral nail 2 or the Marchetti-Vicenzi nail. 3 There was no significant difference in the union rate and the time to union between plating and nailing, but transient radial nerve palsy was more common after plating.…”

“…22,23 Plate fixation requires a wide dissection that carries a high risk of damage to the radial nerve; such palsies are usually transient and their incidence is around 5%. 11,[13][14][15][16]18 Sufficient screw purchase for stable fixation may be difficult to obtain in patients with osteoporosis secondary to ageing, disuse or previous surgery. Methods to enhance fixation stability in cases of osteopenia include the use of a long plate, a blade plate, 2 plates, reinforcing screw fixation with polymethylmethacrylate, replacing the 4.5-mm cortical screws with 6.5-mm cancellous screws, adding an allograft strut on the medial surface of the humerus, and attaching washers and nuts to the plate and screws.…”

“…[9][10][11][12][13][14][15][16][17][18] Failure rates of intramedullary nailing using the Seidel nail were 30% to 60%, 1,5,6 but using the unreamed humeral nail 2 or the Marchetti-Vicenzi nail 3 the union rate was 100%. Ilizarov external fixation has yielded a union rate of 94%, 7,8 but requires long fixation time and risks pin-tract infection and patient discomfort because of the large size of the frame.…”

“…Ilizarov external fixation has yielded a union rate of 94%, 7,8 but requires long fixation time and risks pin-tract infection and patient discomfort because of the large size of the frame. Plate fixation with bone grafting achieves a union rate of >90%, [9][10][11][12][13][14][15][16][17][18][19][20] but requires a wide dissection which entails a high risk of damage to the radial nerve (around 5%). 11,[13][14][15][16]18 Poor bone quality or a deficient plate technique may lead to non-union.…”

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

“…To facilitate primary bone healing, one must ensure rigid fracture stabilisation through firm bone contact and compression of the bone ends. Sufficient mechanical stability is essential to reduce strain at the fracture site and allow biological repair [16]. In an effort to provide improved screw fixation, cortical strut allografts can be used as a way of anchoring the screw to the opposite cortex, thus "sandwiching" the host shaft.…”