Reconstruction after Bone Healing Problems in Humeral Shaft Fractures

Abstract

Background: Categorization and therapy of bone healing disturbances of diaphyseal humeral fractures vary in the literature. Patients and Methods: A consecutive series of 25 revisions for bone healing disturbances was reviewed retrospectively. Timing of revisions, characteristics of delayed healing and nonunions, various operative techniques, duration of bony consolidation, and 1-year functional results were recorded. Results: The indication for revision was delayed healing in 52% of cases and nonunion in 48%. One hypertrophic, 15 normotrophic, seven hypotrophic, and two lytic fracture sites were seen. For stabilization, the operative method used was closed in 28% of cases, open in 40%, and combined in 32%. The rate of bony consolidation amounted to 96%, and the average duration of bone healing was 5.7 months. One of the two septic complications observed healed after metal removal. The second patient died from a preexisting disease. Operative technical complications, iatrogenic radial nerve damage, and metal loosening were not detected. Timing of revision and an adequate operative method form the basis of successful treatment. Conclusion: With the protocol suggested, hospitalization time and financial costs to the patient, muscle and bone atrophy, and contractures of the elbow and shoulder can be lowered significantly. Furthermore, it allows to optimally correct complications of primary treatment and/or earlier revisions.