Open Reduction and Internal Fixation of Humeral Nonunions

Two-Plate Fixation for Humeral Shaft Nonunions

“…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. 11,15,17,19 Locking compression plates enable screws to lock directly into the plate and yielded a 92% union rate in elderly patients. 16 Both dynamic and locking compression plates attain comparable results, but locking compression plates may be more reliable in patients with poor bone stock.…”

“…16 Both dynamic and locking compression plates attain comparable results, but locking compression plates may be more reliable in patients with poor bone stock. 20 A 2-plate construct (a posterior limited-contact dynamic compression plate and a reconstruction plate) was significantly stiffer than a single limitedcontact dynamic compression plate construct, 17 but the stiffness of a locking plate versus a 2-plate construction was not compared. The complication and non-union rates were similar in fixations using 17 The torsional stability of a locked plate is 3 times greater than that of a conventional plate.…”

“…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.…”

“…11,[13][14][15][16]18 Poor bone quality or a deficient plate technique may lead to non-union. 15,20 A 2-plate construct is significantly stiffer than a single-plate construct, 17 and attains a similar healing rate. We retrospectively reviewed 22 patients who underwent 2-plate fixation for non-union of the humeral shaft.…”

Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion

“…The treatment of humeral shaft nonunion is often complex and technically demanding. The last decade has witnessed much technical improvement in various internal fixation devices and surgical approaches for the treatment of humeral shaft nonunion, including the application of cancellous bone grafting plus dynamic compression plate, intramedullary nails, external fixation frames and transplantation of vascularised bone graft [1,2,5,17,19].…”