Outcome of locking compression plates in humeral shaft nonunions

Abstract

Background:Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. We report a prospective followup study of the outcome of the use of LCP for humeral nonunion following failed internal fixation in which implants other than LCP had been used.Materials and Methods:Twenty four patients with nonunion of humeral shaft fractures following failed internal fixation were included in the study. The mean followup period was 3.4 years (range: 2.4 to 5.7 years) and the minimum followup period was 2 years. Mean age of the patients was 41.04 years (range: 24 to 57 years). All 24 patients underwent osteosynthesis using LCP and autologous bone grafting (cortico-cancellous iliac crest graft combined with or without fibular strut graft). Main outcome measurements included radiographic assessment of fracture union and pre and postoperative functional evaluation using the modified Constant and Murley scoring system.Results:23 out of 24 fractures united following osteosynthesis. Average time to union was 16 weeks (range: 10 to 28 weeks). Complications included delayed union (n = 2), transient radial nerve palsy (n = 2) and persistent nonunion (n = 1). Functional evaluation using the Constant and Murley score showed excellent results in 11, good in 10, fair in two and poor outcome in one patient.Conclusions:Locking compression plating and cancellous bone grafting is a reliable option for achieving union in humeral diaphyseal nonunion with failed previous internal fixation and results in good functional outcome in patients with higher physiological demands.

Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

“…22 In our study, all patients treated with LCP and bone grafting achieved 100% union. Our results were similar to Ring et al and Kumar et al 23,24 We would like to highlight the use of LCP in younger patients as it has good outcome and patients can achieve higher activity levels with heavier demand on upper extremity function. LCP is useful in all levels of humeral shaft nonunion.…”

LCP with autograft in the treatment of adult forearm aseptic nonunions

“…Stable fixation and early rehabilitation are essential in obtaining successful results. [23] In accordance with those of previous studies, [6,8,16,24,25] oligotrophic non-union was the prevailing finding. The majority of the present patients underwent surgery at another clinic and were referred upon development of non-union.…”

“…[33] In a study by Kumar et al, a union rate of 96% following LCP and autograft treatment was reported in patients with atrophic and hypertrophic nonunion of the humerus. [23] Saka et al also reported high rates of union and functional recovery using nails and autografts in cases of forearm non-union. [21] When coverage of the surrounding soft tissue was taken into account, it was presently preferred to harvest autografts from the iliac wing, as donor site morbidity was lower in this region.…”

Iatrogenic Radial Nerve Palsy After Humeral Shaft Nonunion Repair

“…A recently published series evaluating the use of locking plate fixation for HSNU initially treated nonoperatively identified 2 of 24 patients with a postoperative RNP (8%). 25 Abalo et al 26 29 Although these series report rates of occurrence substantially lower than in our reported series, we believe that the focus of our report was RNP; thus, we only included patients with documented neurovascular examinations. Therefore, we are of the opinion that our critical evaluation demonstrates a fairly accurate representation of the risk of iatrogenic RNP after the treatment of HSNU.…”