Nonunion of the humerus after failure of surgical treatment

Abstract

We used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function.

Allografting in Locked Nailing and Interfragmentary Wiring for Humeral Nonunions

“…This result is consistent with previous reports that stable fixation and fracture compression are the main factors contributing to successful results [13,16] regardless of different kinds of bone grafts. High failure rates of locked nailing in the treatment of humeral nonunions have been reported [8,15,16,25,26]. 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].…”

“…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].…”

Reconstruction after Bone Healing Problems in Humeral Shaft Fractures

“…In numerous cases, the origin of bone healing disturbances is incorrect treatment or technical failure [9,10,13,18,23,24,[30][31][32][33][34][35][36][37]. A waiting period without any kind of treatment after the normal healing period makes no sense.…”

Connecting biology and mechanics in fracture healing: an integrated mathematical modeling framework for the study of nonunions

“…Classical treatment strategies for (hypertrophic) nonunions are aimed at restoring optimal mechanical circumstances to induce healing. Excess motion of the fracture fragments is reduced by the use of plates, external or intramedullary fixators (Patel et al 2000;Hsu et al 2005;Olson and Hahn 2006). Additionally, the application of appropriate dynamic stimulation of the fracture has been shown to enhance the healing process (Goodship et al 1998;Kenwright and Gardner 1998).…”