The use of a new locking 90° blade plate in the treatment of atrophic proximal humerus nonunions

Abstract

This level IV case series study prospectively evaluated patients with atrophic proximal humerus nonunions stabilised with a locking 90°blade plate. All patients were women with an average age of 69 years (range 56-78). Time from trauma to nonunion treatment averaged 23 months. Five patients had had previous surgical treatments. Two patients had a history of infection and one patient with active infection was reconstructed in two stages. Follow-up averaged 22 months (range 18-36); union was achieved in all seven cases after an average of 5.85 months. The DASH score at the last follow-up averaged 25 points and Constant score averaged 72.7 points. No patient required additional procedures. At the last follow-up all patients were free of infection, and there were no cases of avascular necrosis. The results with locked 90°blade plates in atrophic nonunions of the proximal humerus in adults were favourable in this series.

Infected nonunions of long bones of the upper extremity: staged reconstruction using polymethylmethacrylate and bone graft impregnated with antibiotics

“…Follow-up averaged 19 months (range 12-96). All nonunions healed after an average of 5.2 months after definitive surgery (range [4][5][6][7][8]. DASH score at last followup averaged 15 points (range 0-26).…”

“…Definitive stabilization in infected nonunions is demanding, particularly because it is generally associated to poor bone quality, bone loss from previous osteosynthesis and bony defects, which hinder the achievement of rigid internal fixation. The advent of new advances in osteosynthesis techniques and materials such as the use of bridge plating, locked plates or locked blade plates help increase the stability achieved in these lesions [8,15,16].…”

“…No patient referred allergies to antibiotics. In the three cases in which a rush nail was used to aid in achieving stability, it was prepared as described by Sancineto and Barla [13]; in the case affecting the humerus, the rush nail was completely covered with PMMA and placed intramedullary [8]; and in the two cases affecting the ulna, the nail was covered with PMMA only in the area corresponding to the bony defect while the proximal and distal segments of the nail placed intramedullary were not covered by PMMA due to the small diameter of the medullary canals. In the remaining cases, the PMMA was molded to fit the defect and placed as a solid interposition mass (Fig.…”

“…The combination of local and systemic antibiotic treatment seems to be better than either one of them alone [7]. Published reports using PMMA include infected nonunions affecting the lower extremities and case reports or small series of cases for infected nonunions affecting the long bones of the upper extremities [2,8,9]; while significant anatomic, functional and treatment differences exist between the long bones of the upper and lower extremities [10,11].…”

Nonunion of proximal humerus fractures

“…The vast majority of these were surgical neck nonunions (Galatz et al, 2004;Tauber et al, 2011;Allende and Allende, 2009). The vast majority of these were surgical neck nonunions (Galatz et al, 2004;Tauber et al, 2011;Allende and Allende, 2009).…”