Treatment of Osteopenic Humeral Shaft Nonunion With Compression Plating, Humeral Cortical Allograft Struts, and Bone Grafting

Abstract

Surgical stabilization of humeral shaft nonunions can be difficult to achieve if severe osteopenia or loss of bone stock is present. We present a technique whereby a 4.5-mm standard dynamic compression plate is used in conjunction with a humeral cortical allograft strut and bone grafting to stabilize humeral shaft nonunions complicated by severe bone loss. Six patients with established nonunion of the humeral shaft underwent this technique. Union was achieved at an average of 3.4 months (range 2-6 months). Our method using onlay allograft struts can provide an effective alternative in the management of humeral shaft nonunion complicated by severe osteopenia of various etiologies.

Two-Plate Fixation for Humeral Shaft Nonunions

“…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.…”

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

“…But problems such as limited range of motion of the shoulder joint and screw displacement may arise following intramedullary nailing. In patients with a narrow medullary cavity, cavity expansion operations may commonly cause perforation of the cortical bones [6,9,24]. Lin et al [12] reported their experience with 41 humeral shaft nonunion cases managed with intramedullary nailing and autologous bone grafting, and success was achieved in 39 cases.…”

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

“…There are some examples using a similar technique in nonunions [15,21]. Hornicek et al [15] treated ten established humeral shaft non-unions with a similar surgical technique and achieved excellent results with a union rate of 100%.…”

“…When dealing with such complex fractures, the surgeon should provide the optimum mechanical stabilisation, biological stimulation of healing, and early joint motion to optimise function [18,21]. This issue is also important for the treatment of fractures in osteoporotic patients.…”

“…In an effort to provide improved screw fixation, cortical strut allografts can be used as a way of anchoring the screw to the opposite cortex, thus "sandwiching" the host shaft. The allograft struts provide stability to the fracture site, and they can incorporate [4] and ultimately increase the femoral or humeral bone stock [1,7,9,13,14,21]. Similar techniques have been described for periprosthetic fractures, hip revisions, or complex non-unions [5,11,12,14,19,22].…”