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Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion

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Abstract

Aim of the study

The aim of this study was to evaluate union rate and clinical outcome in patients with proximal humeral nonunions treated by open reduction and locking plate fixation without bone grafting.

Methods

From 2011 to 2016, nine patients were treated using open reduction and locking plate stabilization without bone grafting. They were examined both clinically and radiologically, with a mean follow-up period of 31 months. Outcome was evaluated using pain and range of motion (ROM) parameters. In addition, self-assessment by patients was registered on the Disability of the Arm, Shoulder and Hand score, Constant-Murley Score, Oxford Shoulder Score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. A CT scan of the shoulder was performed to analyze union.

Results

At checkup, all patients showed union in the CT scans, where the mean ROM in abduction was 139° (SD 50°), in adduction 39° (SD 8°), in forward flexion 136° (SD 40°), in extension 44° (SD 11°), in internal rotation 62° (SD 15°), and external rotation 54° (SD 31°). ROM improved significantly in all planes of motion, except for adduction, post-surgery (p < 0.05). Plate removal was necessary in three patients. No complications were reported.

Conclusion

Open reduction and locking plate fixation without bone grafting is a reasonable and safe option for treating proximal humerus nonunion. It leads to a high union rate, significant improvement in ROM, and in the majority of the cases to an “excellent” and “good” functional outcome without an increased risk of complications.

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Authors and Affiliations

  1. AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Stefan Quadlbauer, Georg J. Hofmann, Martin Leixnering, Rudolf Rosenauer, Thomas Hausner & Jürgen Reichetseder

  2. AUVA Research Center, Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, 1200, Vienna, Austria

    Stefan Quadlbauer, Rudolf Rosenauer & Thomas Hausner

  3. Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria

    Stefan Quadlbauer, Rudolf Rosenauer & Thomas Hausner

  4. Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria

    Thomas Hausner

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  1. Stefan Quadlbauer
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Correspondence to Stefan Quadlbauer.

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Institutional review board approval was obtained for this retrospective study (institutional review board number: 1_2017).

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The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Informed consent was obtained from all individual participants included in the study.

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Institutional review board approval was obtained from the ethical committee of the Austrian Workers’ Compensation Board for this study. Ethical committee number: 1_2017.

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Quadlbauer, S., Hofmann, G.J., Leixnering, M. et al. Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion. International Orthopaedics (SICOT) 42, 2199–2209 (2018). https://doi.org/10.1007/s00264-018-3820-3

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