Abstract
Introduction
A nonunion of the humeral shaft is not a rare condition and is a complication of both nonoperative and operative treatment of the fracture. Several fixation options were used in the nonunion treatment, including various plate techniques, intramedullary nails and external fixator. We applied our Selfdynamisable internal fixator for the treatment of humeral shaft nonunion after surgical failure and evaluated its clinical outcome.
Materials and methods
Six patients with persistent atrophic nonunion of the humeral shaft were treated with Selfdynamisable internal fixator. The inclusion criteria were mobile, unstable resistant nonunion of the humeral diaphysis which persisted after surgical treatment for nonunion. All patients were men with a mean age of 32 (27–39) years. The initial fracture treatment was external fixator in two patients and plaster cast for four patients. All cases failed to unite after primary treatment. Plate fixation was resorted for fracture union but failed. The revision surgery consisted of removal of hardware, freshening of bone ends and bone grafting, and internal fixation with a Selfdynamisable internal fixator.
Results
The average follow-up was 33 months. All the nonunions healed after indexed operation. The average time for union was 5.5 months (range 4–9 months). There was no loosening or breakage of the fixation device. The functional results, according to the scale of Constant and Murlay modified by Ring, were excellent in five and good in one patient. There were no complications of nerve injuries or infections related to the operation.
Conclusion
Selfdynamisable internal fixator with bone graft for the treatment of recalcitrant humeral shaft nonunion provided successful clinical outcome with minimal complications.
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References
Dujardin FH, Mazirt N, Tobenas AC, Duparc F, Thomine JM (2000) Failure of locked centro-medullary nailing in pseudarthrosis of the humeral diaphysis. Rev Chir Orthop Reparatrice Appar Mot 86(8):773–780
Gerber A, Marti R, Jupiter J (2003) Surgical management of diaphyseal humeral nonunion after intramedullary nailing: wave-plate fixation and autologous bone grafting without nail removal. J Shoulder Elbow Surg 12(4):309–313
Hornicek FJ, Zych GA, Hutson JJ, Malinin TI (2001) Salvage of humeral nonunions with onlay bone plate allograft augmentation. Clin Orthop 386:203–209
Ilyas I, Younge DA (2003) Locked intramedullary nailing for difficult nonunions of the humeral diaphysis. Int Orthop 27(5):278–281
Jupiter JB, von Deck M (1998) Ununited humeral diaphyses. J Shoulder Elbow Surg 7:644–653
Kocaoglu M, Eralp L, Tomak Y (2001) Treatment of humeral shaft non-unions by the Ilizarov method. Int Orthop 25:396–400
Lammens J, Bauduin G, Driesen R, Moens P, Stuyck J, Smet LD et al (1998) Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop 353:223–230
Martinez AA, Cuenca J, Herrera A (2004) Treatment of humeral shaft nonunions: nailing versus plating. Arch Orthop Trauma Surg 124(2):92–95
Mitkovic M (2001) New biological method of internal fixation of the femur. Facta Universitatis 8(1):50–53
Pacheco RJ, Saleh M (2004) The role of external fixation in trauma. Trauma 6:143–160
Patel VR, Menon DK, Pool RD, Simonis RB (2000) Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br 82(7):977–983
Perren SM (1991) The concept of biological plating using the limited contact-dynamic compression plate (LC-DCP): scientific background, design and application. Injury 22(Suppl):1–41
Pugh DMW, McKee MD (2003) Advances in the management of humeral nonunion. J Am Acad Orthop Surg 11:48–59
Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK (2000) Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg Br 82(6):867–871
Ring D, Kloen P, Kadzielski J, Helfet D, Jupiter JB (2004) Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop 425:50–54
Ring D, Perey BH, Jupiter JB (1999) The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients. J Bone Joint Surg Am 81:177–190
Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82:478–486
Uhthoff HK, Poitras P, Backman DS (2006) Internal plate fixation of fractures: short history and recent developments. J Orthop Sci 11(2):118–126
Van Houwelingen AP, McKee MD (2005) Treatment of osteopenic humeral shaft nonunion with compression plating, humeral cortical allograft struts, and bone grafting. J Orthop Trauma 19(1):36–42
Weber BG, Cech O (1976) Pseudarthrosis pathophysiology, biomechanics, therapy, results. Grune and Stratton, New York
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Micic, I., Mitkovic, M., Mladenovic, D. et al. Treatment of the humeral shaft nonunion after surgical failure using the Selfdynamisable internal fixator. Arch Orthop Trauma Surg 127, 713–718 (2007). https://doi.org/10.1007/s00402-007-0331-x
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DOI: https://doi.org/10.1007/s00402-007-0331-x