Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion

Abstract

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

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

“…Vascularized fibular graft increases the complexity and cost of osteosynthesis. 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.…”

“…Ten patients (56%) were treated by traditional bone setters, eight (44%) patients had some form of internal fixation, (nails=2, LCP=4, DCP=2). The mean duration of nonunion was 18.3 months (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. In patients treated by traditional bone setters seven had atrophic type, two had gap nonunion, one had pseudoarthrosis.…”

Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft

“…2), the high cost associated with the procedure, and a risk of infection. Although Vidyadhara et al [29] showed concern regarding slow revascularization of the dead graft by creeping substitution or graft resorption, we did not encounter such problems.…”

Anterior plating as a surgical alternative in the treatment of humeral shaft non-union

“…It is associated with a high union rate, low complication rate, and rapid return to function [1,3,[6][7][8][9]. For pseudoarthrosis specifically, plate osteosynthesis is the gold standard [10][11][12][13][14]. It is generally accepted that the best face of a long bone for plate placement is the tension face; theoretically, this is the posterior face of the humerus [10,15].…”